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UHHSCSAHS - CUYAHOGA INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
UHHSCSAHS - CUYAHOGA INC (EIN 34-1893452)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-10
IRS object ID
201113149349300246
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-11-10T11:44:01-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PLANTE & MORAN PLLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line165 EAST STATE ST STE 600AddressLine1
CityCOLUMBUSCity
StateOHState
ZIP Code43215ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN341893452EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1UHHSCSAHS - CUYAHOGA INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlUHHSNameControl
Phone4407402180Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line16935 TREELINE DRIVE NO JAddressLine1
CityBRECKSVILLECity
StateOHState
ZIP Code441413393ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameALLEN TRACYName
TitlePRESIDENTTitle
Phone4407402180Phone
Date Signed2011-11-07DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBERNIE OSTROWSKIName
Phone6148493000Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonALLEN TRACYNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line16935 TREELINE DRIVE NO JAddressLine1
CityBRECKSVILLECity
StateOHState
ZIP Code441413393ZIPCode
FieldValueIRS element (for citing)
Gross Receipts73147580GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1999YearFormation
State Legal DomicileOHStateLegalDomicile
Activity Or Mission DescriptionSEE SCHEDULE OUHHS/CSAHS-CUYAHOGA, INC (CUYAHOGA) IS AN ORGANIZATION JOINTLY OWNED BY THE SISTERS OF CHARITY HEALTH SYSTEM AND UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. (THE MEMBERS) OPERATED FOR THE EXCLUSIVE BENEFIT OF THE MEMBERS AND THEIR RELATED SUBSIDIARIES. BOTH MEMBERS ARE TAX-EXEMPT 501(C)3 CHARITABLE ORGANIZATIONS. CUYAHOGA PROVIDES ADMINISTRATIVE SUPPORT SERVICES FOR ORGANIZATIONS OPERATED BY THE MEMBERS. THE ADMINISTRATIVE SUPPORT SERVICES PROVIDED PRINCIPALLY INCLUDE: ACCOUNTING, PAYROLL, ACCOUNTS PAYABLE, PATIENT BILLING, REIMBURSEMENT, AND INFORMATION TECHNOLOGY SUPPORT. MEMBERS REIMBURSE CUYAHOGA FOR THE ADMINISTRATIVE SERVICES PROVIDED BASED UPON MUTUALLY AGREED UPON ALLOCATIONS.ActivityOrMissionDescription
Nbr Voting Members Governing Body4NbrVotingMembersGoverningBody
Nbr Independent Voting Members4NbrIndependentVotingMembers
Total Nbr Employees1680TotalNbrEmployees
Total Nbr Volunteers4TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year2947818ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year256337279ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year390396InvestmentIncomePriorYear
Investment Income Current Year1319InvestmentIncomeCurrentYear
Other Revenue Prior Year9533702OtherRevenuePriorYear
Other Revenue Current Year73146261OtherRevenueCurrentYear
Total Revenue Prior Year269209195TotalRevenuePriorYear
Total Revenue Current Year73147580TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year127655574SalariesEtcPriorYear
Salaries Etc Current Year66502725SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year132943356OtherExpensePriorYear
Other Expenses Current Year6096576OtherExpensesCurrentYear
Total Expenses Prior Year260598930TotalExpensesPriorYear
Total Expenses Current Year72599301TotalExpensesCurrentYear
Revenues Less Expenses Prior Year8610265RevenuesLessExpensesPriorYear
Revenues Less Expenses CY548279RevenuesLessExpensesCY
Total Assets BOY217044547TotalAssetsBOY
Total Assets EOY13270046TotalAssetsEOY
Total Liabilities BOY55524404TotalLiabilitiesBOY
Total Liabilities EOY9996411TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY161520143NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY3273635NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionUHHS/CSAHS-CUYAHOGA, INC (CUYAHOGA) IS AN ORGANIZATION JOINTLY OWNED BY THE SISTERS OF CHARITY HEALTH SYSTEM AND UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. (THE MEMBERS) OPERATED FOR THE EXCLUSIVE BENEFIT OF THE MEMBERS AND THEIR RELATED SUBSIDIARIES. BOTH MEMBERS ARE TAX-EXEMPT 501(C)3 CHARITABLE ORGANIZATIONS. CUYAHOGA PROVIDES ADMINISTRATIVE SUPPORT SERVICES FOR ORGANIZATIONS OPERATED BY THE MEMBERS. THE ADMINISTRATIVE SUPPORT SERVICES PROVIDED PRINCIPALLY INCLUDE: ACCOUNTING, PAYROLL, ACCOUNTS PAYABLE, PATIENT BILLING, REIMBURSEMENT, AND INFORMATION TECHNOLOGY SUPPORT. MEMBERS REIMBURSE CUYAHOGA FOR THE ADMINISTRATIVE SERVICES PROVIDED BASED UPON MUTUALLY AGREED UPON ALLOCATIONS. THIS MISSION STATEMENT IS PENDING FORMAL BOARD APPROVAL.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change1SignificantChange
Expense0Expense
Grants0Grants
Revenue0Revenue
DescriptionSEE PART III, LINE 1 MISSION STATEMENT.Description
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation1PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109610NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees1680NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members4NbrVotingGoverningBodyMembers
Number Independent Voting Members4NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledOHStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1MARY KOWTUNBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4407402181TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line16935 TREELINE DRIVEAddressLine1
CityBRECKSVILLECity
StateOHState
ZIP Code441413393ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (8 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
PATRICK MCMAHON
CHAIRPERSON, BOARD DIRECTOR2.00XX000
ALLEN TRACY
PRESIDENT & CEO, BOARD DIRECTOR2.00XX000
MELISSA ROGERS
TREASURER, BOARD DIRECTOR2.00XX000
PAUL TAIT
SECRETARY, BOARD DIRECTOR2.00XX000
JOHN RUSNACZYK
VICE-PRESIDENT CONTROLLER40.00178947026123X
ROBERT KALISZEWSKI
DIRECTOR OF REIMBURSEMENT/REVENUE40.0012109708072X
DANIEL EVANS
DIRECTOR OF TECHNICAL SERVICES40.0011910707348X
CHRISTINE SCHUTTE
DIRECTOR OF APPLICATIONS40.0010398204876X
FieldValueIRS element (for citing)
Total Reportable Comp From Org523133TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation46419TotalOtherCompensation
Number Individuals GT100 K4NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MEDICAL INFORMATION TECHNOLOGY
PO BOX 74569CHICAGOIL60696IT SUPPORT697696
SISTERS OF CHARITY HEALTH SYSTEM
2475 EAST 22ND STREETCLEVELANDOH44115MANAGEMENT SERVICES314110
VELOCITY TECHNOLOGY
850 3RD AVE 1003NEW YORKNY10022IT SUPPORT267396
HUMAN ARC
1457 EAST 40TH STREETCLEVELANDOH44103COLLECTION SERVICES242683
PLANTE & MORAN PLLC
27400 NORTHWESTERN HIGHWAYSOUTHFIELDMI48034AUDITING158500
FieldValueIRS element (for citing)
Number Of Contractors GT100 K9NumberOfContractorsGT100K

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1319TotalRevenueColumn
Exclusion$1,319ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
LEASED EMPLOYEE-SJMC56100061359901$61,359,901
MEMBER REVENUES56100010993726$10,993,726
BANKRUPTCY/LEHMAN PROC900099771997$771,997

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column20637TotalRevenueColumn
Exclusion$20,637ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue73146261TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column73147580TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$73,147,580ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total205070Total
Management And General205070ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total53092747Total
Management And General53092747ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total211559Total
Management And General211559ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total12703900Total
Management And General12703900ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total289449Total
Management And General289449ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total86944Total
Management And General86944ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total456106Total
Management And General456106ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total629541Total
Management And General629541ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total2077761Total
Management And General2077761ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total608527Total
Management And General608527ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total22738Total
Management And General22738ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total1965Total
Management And General1965ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total610054Total
Management And General610054ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total48206Total
Management And General48206ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneral
COLLECTION FEES12095681209568
BANK FEES317376317376
DUES/SUBSCRIPTIONS1797917979
MISCELLANEOUS OTHER EXP98119811

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total72599301Total
Program Services0ProgramServices
Management And General72599301ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY6766BOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY82068727BOY
EOY816525EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY874455BOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY18380608BOY
EOY1182429EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY5526286BOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1487148BOY
EOY694162EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis13068274LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec10271089LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY84132925BOY
EOY2797185EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY22982556BOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1585076BOY
EOY7779745EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY217044547BOY
EOY13270046EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY34918343BOY
EOY2216666EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY771996BOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY1317741BOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY18516324BOY
EOY7779745EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY55524404BOY
EOY9996411EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY146954706BOY
EOY3273635EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2346187BOY
EOY0EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY12219250BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY161520143BOY
EOY3273635EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY217044547BOY
EOY13270046EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses548279ReconcilationRevenueExpenses
Reconcilation Other Changes-158794787ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis204666OtherCostOrOtherBasis
Depreciation193088Depreciation
Book Value11578BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis12863608OtherCostOrOtherBasis
Depreciation10078001Depreciation
Book Value2785607BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2797185TotalOfBookValueLandBuildings

Other Assets OtherAssets

FieldValueIRS element (for citing)
DescriptionST JOHN MEDICAL CENTER - LEASING ARRANGEMENTDescription
Book Value7779745BookValue
FieldValueIRS element (for citing)
Total Book Value Other Assets7779745TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionST JOHN MED CTR - LEASING/BENEFITSDescription
Amount$7,779,745Amount
FieldValueIRS element (for citing)
Total Of Amounts7779745TotalOfAmounts
Total Revenue73147580TotalRevenue
Total Expenses72599301TotalExpenses
Excess Or Deficit For Year548279ExcessOrDeficitForYear
Other-$28,177OtherAmount
Total Adjustments-28177TotalAdjustments
Excess Or Deficit Per FS520102ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt73119259TotRevenueEtcAuditedFinclStmt
Other Revenues-28321OtherRevenues
Revenue Not Rptd F990-28321RevenueNotRptdF990
Revenue Subtotal73147580RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99073147580TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt72599157TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal72599157ExpensesSubtotal
Other Expenses Not Included144OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt144ExpensesNotRptdOnFinStmt
Total Expenses Per Form99072599301TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierExplanationExplanation
PART XI, LINE 8 - OTHER ADJUSTMENTS:CONTRACTUAL EXPENSE FOR CLOSED ENTITY, PROFESSIONAL MEDICAL EQUIPMENT -28,321. FRANCHISE EXPENSE FOR CLOSED ENTITY, PROFESSIONAL MEDICAL EQUIPMENT 144.
PART XII, LINE 2D - OTHER ADJUSTMENTS:CONTRACTUAL EXPENSE FOR CLOSED ENTITY, PROFESSIONAL MEDICAL EQUIPMENT -28,321.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:FRANCHISE EXPENSE FOR CLOSED ENTITY, PROFESSIONAL MEDICAL EQUIPMENT 144.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonJOHN RUSNACZYKNamePerson
Base Compensation Filing Org168947BaseCompensationFilingOrg
Comp Based On Related Orgs0CompBasedOnRelatedOrgs
Bonus Filing Org10000BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org15083DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org11040NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs0NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org205070TotalCompensationFilingOrg
Total Compensation Related Orgs0TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Schedule N IRS990ScheduleN

Disposition Table DispositionTable (2 entries)

Description Of AssetDescriptionOfAssetDate Of DistributionDateOfDistributionFMV Of AssetFMVOfAssetMethod Of FMV DeterminationMethodOfFMVDeterminationEINEINAddress Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeIRC SectionIRCSection
ST VINCENT CHARITY MED CTR
ENDING BALANCE SHEET FOR NET ASSETS DETERMINED AT 12/31/092010-01-0147326015ASSET APPRAISAL AND ASSUMPTION OF LIABILITIES3407147562351 EAST 22ND STREETCLEVELANDOH44115501(C)(3)
ST JOHN MEDICAL CENTER
ENDING BALANCE SHEET FOR NET ASSETS DETERMINED AT 12/31/092010-01-0145631275ASSET APPRAISAL AND ASSUMPTION OF LIABILITIES34126097829000 CENTER RIDGE RDWESTLAKEOH44145501(C)(3)
FieldValueIRS element (for citing)
Director Of Successor21DirectorOfSuccessor2
Employee Of Successor21EmployeeOfSuccessor2
Owner Of Successor20OwnerOfSuccessor2
Receive Compensation20ReceiveCompensation2

Form990 Schedule N Part III Form990ScheduleNPartIII

FieldValueIRS element (for citing)
ExplanationPART II, LINE 2E: THE FOLLOWING INDIVIDUALS LISTED IN FORM 990, PART VII AS A TRUSTEE, DIRECTOR, OR OFFICER BECAME AN OFFICER, TRUSTEE, OR LEASED EMPLOYEE OF ONE OF THE TRANSFEREE ORGANIZATIONS LISTED IN PART II LINE 1: PAUL TAIT, BOARD DIRECTOR AND SECRETARY OF THIS ORGANIZATION, IS ALSO AN OFFICER AND TRUSTEE OF ST. JOHN MEDICAL CENTER; PATRICK MCMAHON, BOARD DIRECTOR AND CHAIRPERSON OF THIS ORGANIZATION, IS ALSO AN OFFICER AND TRUSTEE OF ST. VINCENT CHARITY MEDICAL CENTER; AND ALLEN TRACY, BOARD DIRECTOR AND PRESIDENT/CEO OF THIS ORGANIZATION, IS AN OFFICER AND LEASED EMPLOYEE FROM UNIVERSITY HOSPITAL HEALTH SYSTEM TO ST. JOHN MEDICAL CENTER.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
CHANGES IN PROGRAM SERVICESFORM 990, PART III, LINE 3ON JANUARY 1, 2010 AT 12:01 A.M., UHHS/CSAHS-CUYAHOGA, INC (CUYAHOGA) TRANSFERRED HOSPITAL ASSETS AND OPERATIONS TO THE RELATED BUT SEPARATE LEGAL ENTITIES OF ST. VINCENT CHARITY MEDICAL CENTER (TAX ID 34-0714756) OWNED BY THE SISTERS OF CHARITY HEALTH SYSTEM AND ST. JOHN MEDICAL CENTER, (TAX ID 34-1260978) A JOINTLY OWNED HOSPITAL BETWEEN THE SISTERS OF CHARITY HEALTH SYSTEM AND UNIVERSITY HOSPITALS HEALTH SYSTEM. CUYAHOGA EXCLUSIVELY OPERATES AS A SUPPORTING ORGANIZATION PROVIDING ADMINISTRATIVE SUPPORT SERVICES TO THE SISTERS OF CHARITY HEALTH SYSTEM AND UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. (JOINTLY, THE MEMBERS) AND CERTAIN OF THEIR SUBSIDIARIES.
FORM 990, PART VI, SECTION A, LINE 6THE ORGANIZATION HAS TWO CORPORATE MEMBERS: SISTER OF CHARITY HEALTH SYSTEM AND UNIVERSITY HOSPITALS HEALTH SYSTEM.
FORM 990, PART VI, SECTION A, LINE 7ATHE ORGANIZATION'S MEMBER MAY ELECT MEMBERS OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION A, LINE 7BCERTAIN DECISIONS OF THE GOVERNING BODY, SUCH AS APPROVAL OF BUDGETS, CAPITAL EXPENDITURES AND ACQUISITION OF LAND, MUST BE APPROVED BY THE BOARD OF THE MEMBER ORGANIZATION.
FORM 990, PART VI, SECTION B, LINE 11AFTER THE 990 RETURN IS REVIEWED INTERNALLY; IT IS SUBMITTED FOR REVIEW TO OUR TAX AUDITOR. THEY REVIEW FOR COMPLETENESS AND COMMUNICATE ANY CONCERNS THAT THEY IDENTIFY WITHIN THE DOCUMENTS AND WORKSHEETS OF THE TAX RETURN. ITEMS IDENTIFIED ARE REVIEWED BY STAFF AND ANY NEEDED CORRECTIONS ARE MADE. THE RETURN IS THEN PROVIDED TO THE CFO FOR REVIEW AND APPROVAL. IT IS THEN SUBMITTED TO THE BOARD FOR REVIEW.
FORM 990, PART VI, SECTION B, LINE 12CTHE ORGANIZATION HAS IN PLACE A CONFLICT OF INTEREST POLICY AS WELL AS A NON-RETALIATION POLICY (WHISTLE-BLOWER) MANAGED THRU ST JOHN MEDICAL CENTER'S COMPLIANCE OFFICER. THE CONFLICT OF INTEREST FORMS ARE SENT OUT ANNUALLY TO ADMINISTRATION, AND OTHER LEADERSHIP EMPLOYEES AS WELL AS BOARD MEMBERS. THE FORMS ARE RETURNED TO ADMINISTRATION. ONCE RETURNED, THEY ARE REVIEWED BY THE COMPLIANCE OFFICER AND CEO TO DETERMINE IF ANYTHING WOULD BE DEEMED A POTENTIAL CONFLICT OF INTEREST. IF THERE IS A CONFLICT, THE CEO, COMPLIANCE OFFICER AND EMPLOYEE/INDIVIDUAL MEET TO DISCUSS. THE RESULTS OF THOSE MEETINGS ARE AN AGENDA ITEM AT THE ORGANIZATION'S ADMINISTRATIVE COMPLIANCE COMMITTEE MEETING AND IT IS FURTHER DISCUSSED THERE. ONCE A DECISION IS MADE REGARDING THE CONFLICT, FOLLOW-UP IS MADE BY THE COMPLIANCE OFFICER/CEO WITH THE EMPLOYEE, IF APPROPRIATE. THE ORGANIZATION ALSO DISCUSSES THE RESULTS OF THE CONFLICT OF INTERESTS AT THE AUDIT COMMITTEE AND COMPLIANCE COMMITTEE OF THE BOARD.
FORM 990, PART VI, SECTION B, LINE 15THE BOARD REVIEWS EACH EXECUTIVE POSITION AT THE CORPORATE LEVEL. EXECUTIVE POSITIONS INCLUDE CEO, OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. THE ORGANIZATION UTILIZES AN OUTSIDE CONSULTING FIRM TO COMPLETE MARKET ANALYSIS, WHICH OCCURS ANNUALLY IN JANUARY FOR EACH EXECUTIVE POSITION. THE RESULTS ARE SUBMITTED TO THE BOARD. THE BOARD REVIEWS THE RECOMMENDATIONS OF THE CEO AGAINST THE EXTERNAL DATA. THE BOARD THEN ACTS ON THAT RECOMMENDATION. THIS PROCESS WAS LAST COMPLETED IN 2011.
FORM 990, PART VI, SECTION C, LINE 18FORMS 990 AND 1023 ARE AVAILABLE TO PUBLIC UPON REQUEST AT THE FINANCIAL SERVICE CENTER LOCATION.
FORM 990, PART VI, SECTION C, LINE 19GOVERNING DOCUMENTS, THE FINANCIAL STATEMENTS, AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE TO PUBLIC UPON REQUEST AT THE FINANCIAL SERVICE CENTER LOCATIONS.
FORM 990, PART VII, SECTION A:A KEY EMPLOYEE WAS BEING PAID BY AN UNRELATED ORGANIZATION (SISTERS OF CHARITY HEALTH SYSTEM, SCHS - 50% MEMBER OF THIS ORGANIZATION). THAT EMPLOYEE WORKED AT THIS ORGANIZATION ONLY, AND COMPENSATION WAS TREATED AS IF PAID BY THIS ORGANIZATION.
CHANGES IN NET ASSETS OR FUND BALANCES:FORM 990, PART XI, LINE 5:ASSET TRANSFER TO ST VINCENT CHARITY MEDICAL CENTER -47,326,015. ASSET TRANSFER TO ST JOHN MEDICAL CENTER -45,631,275. PAID OUT CAPITAL TO HOLDING CO REPORTED ON 1120 -65,837,497. TOTAL TO FORM 990, PART XI, LINE 5: -158,794,787.

Schedule R IRS990ScheduleR

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1UHHSCSAHS-CUYAHOGA HOLDING COMPANY INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line16935 TREELINE DRIVEAddressLine1
CityBRECKSVILLECity
StateOHState
ZIP Code44141ZIPCode
FieldValueIRS element (for citing)
EIN341895400EIN
Primary ActivityHOLDING COPrimaryActivity
Legal Domicile StateOHLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1UHHSCSAHS CUYAHOGA INCBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
Share Of Total Income-28172ShareOfTotalIncome
Percentage Ownership1.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1UHHSCSAHS CUYAHOGA HOLDING COBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeCTransactionType
Amount Involved65837497AmountInvolved
Method Of Amt DeterminationACTUALMethodOfAmtDetermination