FORUM HEALTH: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- FORUM HEALTH (EIN 31-1560189)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-11-14
- IRS object ID
- 201113189349300826
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-11-14T08:21:33-06:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PACKER THOMAS | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6601 WESTFORD PLACE SUITE 101 | AddressLine1 |
| City | CANFIELD | City |
| State | OH | State |
| ZIP Code | 44406 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311560189 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FORUM HEALTH | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | FORU | NameControl |
| Phone | 3308419929 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1350 E MARKET STATTN ACCT DEPT | AddressLine1 |
| City | WARREN | City |
| State | OH | State |
| ZIP Code | 444836608 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DALTON T EDGECOMB | Name |
| Title | CHIEF RESTRUCTURING OFFICER | Title |
| Phone | 3308419929 | Phone |
| Date Signed | 2011-11-07 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KAREN S COHEN | Name |
| Phone | 3305339777 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | CHARLES W NEUMANN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8747 SQUIRES LANE NE | AddressLine1 |
| City | WARREN | City |
| State | OH | State |
| ZIP Code | 44484 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 18481447 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.FORUMHEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1997 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | FORUM HEALTH IS OPERATED EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTIONS OF, TO SUPPORT, OR TO CARRY OUT THE CHARITABLE PURPOSE OF TRUMBULL MEMORIAL HOSPITAL AND WESTERN RESERVE CARE SYSTEM. ON 3/16/09, FORUM HEALTH FILED FOR CHAPTER 11 BANKRUPTCY PROTECTION. ON 10/01/10, COMMUNITY HEALTH SYSTEMS, INC. ACQUIRED SUBSTANIALLY ALL OF THE ASSETS OF FORUM HEALTH. THE BANKRUPTCY ESTATE OF THIS ENTITY IS CURRENTLY IN THE PROCESS OF WINDING DOWN. | ActivityOrMissionDescription |
| Termination Or Contraction | X | TerminationOrContraction |
| Nbr Voting Members Governing Body | 16 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 14 | NbrIndependentVotingMembers |
| Total Nbr Employees | 176 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 24340119 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 16231941 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 0 | InvestmentIncomePriorYear |
| Investment Income Current Year | -1688991 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 3856 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2218949 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 24343975 | TotalRevenuePriorYear |
| Total Revenue Current Year | 16761899 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 10541834 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 7051317 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 13802141 | OtherExpensePriorYear |
| Other Expenses Current Year | 10233622 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 24343975 | TotalExpensesPriorYear |
| Total Expenses Current Year | 17284939 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 0 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -523040 | RevenuesLessExpensesCY |
| Total Assets BOY | 192258704 | TotalAssetsBOY |
| Total Assets EOY | 148557274 | TotalAssetsEOY |
| Total Liabilities BOY | 290942867 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 251169644 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -98684163 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -102612370 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | SEE SCHEDULE O, PART I, LINE 1. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 17284939 | Expense |
| Revenue | 16761395 | Revenue |
| Description | FORUM HEALTH SUPPORTS WESTERN RESERVE CARE SYSTEM (WRCS), TRUMBULL MEMORIAL HOSPITAL (TMH) AND THEIR AFFILIATES. IN ORDER TO SUPPORT THE ACTIONS OF WRCS & TMH, FORUM HEALTH HAS CONSOLIDATED THE ISSUANCE OF THE TAX EXEMPT BONDS FOR THE OBLIGATED GROUP AND HAS MANAGED THE EFFICIENT USE OF THE BOND PROCEEDS. | Description |
| Total Program Service Expense | 17284939 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 1 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 1 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 41 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 176 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 1 | ForeignFinancialAccount |
| Name Of Foreign Country | BD | NameOfForeignCountry |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 16 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 14 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LISA M MEDOVICH | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3308419929 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1350 E MARKET ST | AddressLine1 |
| City | WARREN | City |
| State | OH | State |
| ZIP Code | 44483 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (22 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| CHARLES W NEUMANN | ||||||||
| INTERIM CEO | 50.00 | X | X | 782966 | 0 | 0 | ||
| LISA M MEDOVICH | ||||||||
| SR VP & CFO | 50.00 | X | X | 156882 | 0 | 10868 | ||
| PHILLIP B DENNISON | ||||||||
| CHAIRMAN | 3.00 | X | 0 | 0 | 0 | |||
| DIANE SAUER | ||||||||
| VICE CHAIR | 3.00 | X | 0 | 0 | 0 | |||
| NANCY JASTATT-JUERGENS | ||||||||
| SECRETARY | 3.00 | X | 0 | 0 | 0 | |||
| DAVID COLE | ||||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | |||
| DAVID RITCHIE DPM | ||||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | |||
| JAMES M SUDIMACK MD | ||||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | |||
| JEFF HEINTZ ESQ | ||||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | |||
| KENNETH JONES MD | ||||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | |||
| LEE SNELSON DDS | ||||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | |||
| NAZIM JAFFER MD | ||||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | |||
| PETER DEVITO MD | ||||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | |||
| ROBERT HOY | ||||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | |||
| STEPHANIE SHAW | ||||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | |||
| THOMAS D HURA | ||||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | |||
| KRISTIN K HOWARD | ||||||||
| CH LEGAL OFF | 50.00 | X | 152021 | 0 | 3023 | |||
| ROBERT G WOLLEBEN | ||||||||
| COO-TMH | 50.00 | 230858 | 0 | 1833 | X | |||
| MICHAEL SEELMAN | ||||||||
| COO-WRCS | 50.00 | 162311 | 0 | 5927 | X | |||
| TIM E ROE | ||||||||
| CIO | 50.00 | 118141 | 0 | 0 | X | |||
| JEFF D REXROAD | ||||||||
| CORP DIR-PFS | 50.00 | 140846 | 0 | 942 | X | |||
| CHRISTINE E AUCREMANN | ||||||||
| VP-REVENUE CYCLE | 50.00 | 108345 | 0 | 10051 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1852370 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 32644 | TotalOtherCompensation |
| Number Individuals GT100 K | 8 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| HOULIHAN LOKEY | |||||
| 245 PARK AVENUE 20TH FLOOR | NEW YORK | NY | 10167 | CONSULTING | 6429417 |
| MCDONALD HOPKINS LLC | |||||
| 600 SUPERIOR AVE SUITE 2100 | CLEVELAND | OH | 44114 | LEGAL | 4246502 |
| JONES DAY | |||||
| PO BOX 165017 | COLUMBUS | OH | 43216 | LEGAL | 3373436 |
| HURON CONSULTING SERVICES LLC | |||||
| 550 WEST VAN BUREN ST SUITE 1700 | CHICAGO | IL | 60607 | CONSULTING | 3293523 |
| BRIDGE ASSOCIATES LLC | |||||
| 2701 N ROCKY POINT DR STE 183 | TAMPA | FL | 33607 | CONSULTING | 1416064 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 19 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | SUPPORT SERVICES | Description |
| Business Code | 621300 | BusinessCode |
| Total Revenue Column | 16231941 | TotalRevenueColumn |
| Related Or Exempt Function Income | 16231941 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 16231941 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 504 | TotalRevenueColumn |
| Exclusion | $504 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 1689495 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -1689495 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -1689495 | TotalRevenueColumn |
| Related Or Exempt Function Income | -1689495 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Of Goods Sold | 30053 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -30053 | TotalRevenueColumn |
| Related Or Exempt Function Income | -30053 | RelatedOrExemptFunctionIncome |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| GAIN FROM DEBT DISCHAR | 621300 | 2245676 | 2245676 |
| PURCHASE DISCOUNT | 621300 | 2372 | 2372 |
| OUTSIDE SERVICES | 621300 | 954 | 954 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 2249002 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 16761899 | TotalRevenueColumn |
| Related Or Exempt Function Income | 16761395 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $504 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1485038 | Total |
| Program Services | 1485038 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3808840 | Total |
| Program Services | 3808840 | ProgramServices |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 178579 | Total |
| Program Services | 178579 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1218358 | Total |
| Program Services | 1218358 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 360502 | Total |
| Program Services | 360502 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 143360 | Total |
| Program Services | 143360 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 822268 | Total |
| Program Services | 822268 | ProgramServices |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1923595 | Total |
| Program Services | 1923595 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 141105 | Total |
| Program Services | 141105 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11338 | Total |
| Program Services | 11338 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6350 | Total |
| Program Services | 6350 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1054 | Total |
| Program Services | 1054 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 603993 | Total |
| Program Services | 603993 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 129612 | Total |
| Program Services | 129612 | ProgramServices |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| PURCHASED SERVICES | 5000157 | 5000157 |
| RESTRUCTURING COST | 846499 | 846499 |
| MAINTENANCE AGREEMENTS | 413195 | 413195 |
| MEMBERSHIP DUES | 63082 | 63082 |
| EQUIPMENT REPAIRS-PART/ | 39088 | 39088 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 88926 | Total |
| Program Services | 88926 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17284939 | Total |
| Program Services | 17284939 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 13032431 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12335 | BOY |
| EOY | 42421 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13084002 | BOY |
| EOY | 10649721 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 52707 | BOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1371861 | BOY |
| EOY | 324908 | EOY |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2543686 | BOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 108307927 | BOY |
| EOY | 108307927 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 66886186 | BOY |
| EOY | 16199866 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 192258704 | BOY |
| EOY | 148557274 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9725325 | BOY |
| EOY | 1696531 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 132677000 | BOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 148540542 | BOY |
| EOY | 249473113 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 290942867 | BOY |
| EOY | 251169644 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -98684163 | BOY |
| EOY | -102612370 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -98684163 | BOY |
| EOY | -102612370 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 192258704 | BOY |
| EOY | 148557274 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -523040 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -3405167 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 0 | FSAudited |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type2 | X | SupportingOrg509a3Type2 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation (2 entries)
| EINEIN | Type Of OrganizationTypeOfOrganization | Listed In Governing DocListedInGoverningDoc | Supported Organization NotifiedSupportedOrganizationNotified | Organized In USOrganizedInUS | AmountAmount |
|---|---|---|---|---|---|
| WESTERN RESERVE CARE SYSTEM | |||||
| 341454933 | 3 | 1 | 1 | 1 | $0 |
| TRUMBULL MEMORIAL HOSPITAL | |||||
| 341461049 | 3 | 1 | 1 | 1 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 2 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 0 | SumOfAmounts |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | INVESTMENT IN SUBSIDIARIES | Description |
| Book Value | 108307927 | BookValue |
| Method Of Valuation | C | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Program Related | 108307927 | TotalOfBookValueProgramRelated |
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| DEBT SERVICE FUND INVESTMENTS | 483219 |
| PREPAID PENSION COSTS | 15154440 |
| WORKERS COMPENSATION STANDBY LOC | 361927 |
| INDEMNITY ACCOUNT | 200280 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 16199866 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| PENSION LIABILITY - SFAS 87 | $124,646,011 |
| DUE TO AFFILIATES | $124,742,509 |
| WORKERS COMP RESERVE | $84,593 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 249473113 | TotalOfAmounts |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CHARLES W NEUMANN | |||||||||||||
| 755000 | 0 | 0 | 0 | 27966 | 0 | 0 | 0 | 0 | 0 | 782966 | 0 | 0 | 0 |
| LISA M MEDOVICH | |||||||||||||
| 144162 | 0 | 0 | 0 | 12720 | 0 | 0 | 0 | 10868 | 0 | 167750 | 0 | 0 | 0 |
| KRISTIN K HOWARD | |||||||||||||
| 139421 | 0 | 0 | 0 | 12600 | 0 | 0 | 0 | 3023 | 0 | 155044 | 0 | 0 | 0 |
| ROBERT G WOLLEBEN | |||||||||||||
| 230858 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1833 | 0 | 232691 | 0 | 0 | 0 |
| MICHAEL SEELMAN | |||||||||||||
| 149388 | 0 | 0 | 0 | 12923 | 0 | 0 | 0 | 5927 | 0 | 168238 | 0 | 0 | 0 |
Schedule N IRS990ScheduleN
Disposition Table DispositionTable (5 entries)
| Description Of AssetDescriptionOfAsset | Date Of DistributionDateOfDistribution | FMV Of AssetFMVOfAsset | Method Of FMV DeterminationMethodOfFMVDetermination | EINEIN | Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | IRC SectionIRCSection |
|---|---|---|---|---|---|---|---|---|---|
| YOUNGSTOWN OHIO HOSPITAL CO | |||||||||
| INVENTORY | 2010-10-01 | 30053 | BOOK VALUE | 273074094 | 4000 MERIDIAN BLVD | FRANKLIN | TN | 37067 | LLC |
| YOUNGSTOWN OHIO HOSPITAL CO | |||||||||
| FIXED ASSETS | 2010-10-01 | 2207254 | BOOK VALUE | 273074094 | 4000 MERIDIAN BLVD | FRANKLIN | TN | 37067 | LLC |
| YOUNGSTOWN OHIO HOSPITAL CO | |||||||||
| OTHER ASSETS, PETTY CASH & PREPAIDS | 2010-10-01 | 822792 | BOOK VALUE | 273074094 | 4000 MERIDIAN BLVD | FRANKLIN | TN | 37067 | LLC |
| YOUNGSTOWN OHIO HOSPITAL CO | |||||||||
| TITLE CHARGES ON SALES | 2010-10-01 | 59210 | BOOK VALUE | 273074094 | 4000 MERIDIAN BLVD | FRANKLIN | TN | 37067 | LLC |
| YOUNGSTOWN OHIO HOSPITAL CO | |||||||||
| ASSUMPTION OF LIABILITIES | 2010-10-01 | -1399761 | BOOK VALUE | 273074094 | 4000 MERIDIAN BLVD | FRANKLIN | TN | 37067 | LLC |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor2 | 1 | DirectorOfSuccessor2 |
| Employee Of Successor2 | 1 | EmployeeOfSuccessor2 |
| Owner Of Successor2 | 0 | OwnerOfSuccessor2 |
| Receive Compensation2 | 0 | ReceiveCompensation2 |
Form990 Schedule N Part III Form990ScheduleNPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | PART II, LINE 2E: ON 3/16/09, FORUM HEALTH FILED FOR CHAPTER 11 BANKRUPTCY PROTECTION. ON 10/01/10, COMMUNITY HEALTH SYSTEMS, INC. ACQUIRED SUBSTANTIALLY ALL OF THE ASSETS OF FORUM HEALTH. THE BANKRUPTCY ESTATE OF THIS ENTITY IS CURRENTLY IN THE PROCESS OF WINDING DOWN. THE EXISTING OFFICERS AND DIRECTORS OF THE ORGANIZATION ARE CONTINUING TO SERVE DURING THE PENDENCY OF BANKRUPTCY PROCEEDINGS. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | CLASSES OF MEMBERS OR STOCKHOLDERS FORUM HEALTH'S SOLE MEMBER IS FORUM HEALTH HOLDING CO. (FHHC). FHHC IS AN OHIO NONPROFIT CORPORATION THAT WAS FORMED AS THE PARENT CORPORATION FOR THE AFFILIATION OF TRUMBULL MEMORIAL HOSPITAL (TMH) AND WESTERN RESERVE CARE SYSTEM (WRCS) INTO A SINGLE INTEGRATED HEALTH SYSTEM. FHHC AND FORUM HEALTH WERE EACH ESTABLISHED AND OPERATE EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTIONS OF, TO SUPPORT, OR TO CARRY OUT THE CHARITABLE PURPOSES OF TMH AND WRCS. FHHC APPOINTS THE BOARD OF TRUSTEES OF FORUM HEALTH. | |
| FORM 990, PART VI, SECTION A, LINE 7A | ELECTION OF MEMBERS AND THEIR RIGHTS PERIODICALLY, OR AS VACANCIES ARISE, FORUM HEALTH HOLDING CO., AS THE SOLE MEMBER OF FORUM HEALTH, HAS THE RIGHT TO APPOINT ONE OR MORE MEMBERS OF THE FORUM HEALTH BOARD OF TRUSTEES. | |
| FORM 990, PART VI, SECTION A, LINE 7B | DECISIONS SUBJECT TO APPROVAL OF MEMBERS SUBJECT TO MATTERS REQUIRING THE CONSENT OF FORUM HEALTH HOLDING CO. (FHHC), AS THE SOLE MEMBER OF FORUM HEALTH, AS SET FORTH BELOW OR UNDER OHIO LAW, THE FORUM HEALTH BOARD OF TRUSTEES HAS FULL AUTHORITY TO OVERSEE AND DIRECT THE OPERATIONS OF FORUM HEALTH. NOTWITHSTANDING THE FOREGOING TO THE CONTRARY, THE FOLLOWING ACTIONS REQUIRE THE APPROVAL OF FHHC: (1) A MERGER OR CONSOLIDATION OF FORUM HEALTH OR OF TRUMBULL MEMORIAL HOSPITAL OR WESTERN RESERVE CARE SYSTEM OR OF ANY HOLDING COMPANY FOR THOSE ENTITIES (EACH A "HOSPITAL PARTY") WITH OR INTO ANOTHER ENTITY IN WHICH FORUM HEALTH OR, AS THE CASE MAY BE, A HOSPITAL PARTY IS NOT A SURVIVING ENTITY; (2) A SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OR BUSINESS OPERATIONS OF FORUM HEALTH OR A HOSPITAL PARTY; (3) THE TRANSFER OF CONTROL OF FORUM HEALTH OR A HOSPITAL PARTY TO ANY OTHER PERSON OR ENTITY; (4) THE DISSOLUTION OR LIQUIDATION OF FORUM HEALTH OR A HOSPITAL PARTY; OR (5) AMENDMENT OF THE ARTICLES OF INCORPORATION OR CODE OF REGULATIONS OF FORUM HEALTH; AND (6) ELECTION OR REMOVAL OF MEMBERS OF THE FORUM HEALTH BOARD OF TRUSTEES. | |
| FORM 990, PART VI, SECTION B, LINE 11 | ORGANIZATION'S PROCESS TO REVIEW FORM 990 AT THE TIME OF THIS RETURN'S FILING, THE BOARD WAS NOT ACTIVE. ON 10/01/10, COMMUNITY HEALTH SYSTEMS, INC. ACQUIRED SUBSTANTIALLY ALL OF THE ASSETS OF FORUM HEALTH. THE BANKRUPTCY ESTATE OF THIS ENTITY IS CURRENTLY IN THE PROCESS OF WINDING DOWN. | |
| ENFORCEMENT OF CONFLICTS POLICY FORUM HEALTH MONITORS FOR ACTUAL AND PROPOSED CONFLICTS OF INTEREST THROUGH ITS CORPORATE COMPLIANCE DEPARTMENT THAT PROVIDES ANNUAL EMPLOYEE EDUCATION ON ITS CONFLICTS OF INTEREST POLICY AND REQUIRES ALL MANAGEMENT EMPLOYEES TO ANNUALLY COMPLETE CONFLICT OF INTEREST QUESTIONNAIRES. FORUM HEALTH HAS DEVELOPED THIS POLICY TO GUIDE THE TRUSTEES (DIRECTORS), OFFICERS, EMPLOYEES AND AFFILIATES ASSOCIATED AND AFFILIATED WITH THE FORUM HEALTH SYSTEM IN AVOIDING CONFLICTS OF INTEREST AND IN IDENTIFYING AND DISCLOSING ACTUAL OR POTENTIAL CONFLICTS OF INTEREST AND TO PROTECT FORUM HEALTH FROM ENTERING INTO ANY ARRANGEMENT THAT BENEFITS OR POTENTIALLY BENEFITS THE PRIVATE INTEREST(S) OF ANY OFFICER, TRUSTEE (DIRECTOR), OR OTHER PERSON AFFILIATED WITH OR IN A POSITION TO EXERT SUBSTANTIAL INFLUENCE OR CONTROL OVER THE AFFAIRS OF THE FORUM HEALTH SYSTEM OR ANY OF ITS CORPORATE ENTITIES. BELOW IS THE CORPORATE CONFLICT OF INTEREST POLICY FOLLOWED BY THE ORGANIZATION. OFFICERS, DIRECTORS OR TRUSTEES, EXECUTIVES, EMPLOYEES, AFFILIATES, AGENTS AND CONTRACTORS, AND INTERESTED PERSONS/INSIDERS OF FORUM HEALTH SYSTEM ENTITIES SHALL NOT ENGAGE IN ACTUAL, POTENTIAL, APPARENT OR INDIRECT CONFLICTS OF INTEREST AS DEFINED IN THIS POLICY. CONFLICTS OF INTEREST PERTAIN TO FINANCIAL OR NON-FINANCIAL INTERESTS. ANY PERSON OR ENTITY HAVING ANY SUCH CONFLICT OF INTEREST HAS A DUTY TO DISCLOSE IT TO THE ORGANIZATION PURSUANT TO THIS POLICY, AS FOLLOWS: TRUSTEES OR DIRECTORS OF ALL FORUM HEALTH ENTITIES WILL ANNUALLY DISCLOSE ANY CONFLICTS OF INTEREST FOR THE RECORD TO THE SYSTEM BOARD OF TRUSTEES AND PROMPTLY DISCLOSE ANY CONFLICTS OF INTEREST WHEN RECOGNIZED TO THE BOARD PURSUANT TO THE BOARD'S CONFLICT OF INTEREST PROTOCOLS. THE GENERAL COUNSEL/CORPORATE SECRETARY REVIEWS ALL CONFLICT DISCLOSURES BY MEMBERS OF THE BOARD OF TRUSTEES. MEMBERS OF THE EXECUTIVE, SENIOR LEADERSHIP, AND MANAGEMENT TEAMS PROMPTLY DISCLOSE ANY CONFLICT OF INTEREST TO THE CEO, CHIEF COMPLIANCE OFFICER, OR CHAIR OF THE BOARD OF TRUSTEES. PHYSICIANS, AGENTS AND CONTRACTORS SHALL DISCLOSE ANY FINANCIAL INTEREST, OWNERSHIP INTEREST OR OTHER BUSINESS RELATIONSHIP, DIRECT OR INDIRECT, WITH COMPANIES, AFFILIATES OR PROVIDERS OF PRODUCTS OR SERVICES USED AT FORUM HEALTH, AND/OR FOR PATIENTS SEEN AT A FORUM FACILITY, RELATED TO GRADUATE MEDICAL EDUCATION (TEACHING, PRESENTATIONS OR RESEARCH) AND RELATED TO OR FOR USE IN RESEARCH CONDUCTED AT A FORUM FACILITY AND/OR REVIEWED THROUGH A FORUM IRB. EMPLOYEES DISCLOSE ANY CONFLICTS OF INTEREST TO THEIR SUPERVISORS PROMPTLY WHEN RECOGNIZED. SUPERVISORS CONSULT APPROPRIATE EXECUTIVE OR SENIOR MANAGEMENT AND THE CHIEF COMPLIANCE OFFICER REGARDING ANY CONFLICTS OF INTEREST DISCLOSURES. ADMINISTRATORS AND EMPLOYEES IN A POSITION TO INFLUENCE, AND IN AREAS WHERE CONFLICTS OF INTEREST ARE LIKELY TO ARISE (E.G., PHARMACY, BUSINESS OFFICE, FINANCE, PHYSICIAN CONTRACTING, LEASING, PURCHASING, PURCHASED SERVICES, FACILITIES MANAGEMENT, RESEARCH, AND THE LIKE) DISCLOSE ANY CONFLICTS OF INTEREST TO THE CEO, LEGAL SERVICES AND THE CORPORATE COMPLIANCE OFFICER OR OTHER DESIGNEE AS NOTED AND THROUGH ANNUAL DISCLOSURE PROTOCOLS. DISCLOSED CONFLICTS OF INTEREST: WITHIN THE DISCRETION OF MANAGEMENT, AND SUBJECT TO THE REQUIREMENT OF THE BOARD OF TRUSTEES CONFLICT OF INTEREST POLICY, WHEN A CONFLICT OF INTEREST IS DISCLOSED IN ADVANCE, THE ORGANIZATION TAKES ACTION TO ASSURE THE CONFLICTED PERSON OR ENTITY IS REMOVED FROM THE CONFLICT SITUATION (E.G., RECUSAL FROM VOTING ON THE ISSUE, REMOVAL FROM DECISION MAKING RESPONSIBILITY OVER THE ISSUE, ETC.) OR TO ASSURE DECISION MAKERS ARE AWARE OF THE CONFLICT SO THEY CAN TAKE INTO ACCOUNT THE POSSIBLE COMPETING INTERESTS WHEN MAKING DECISIONS. UNDISCLOSED CONFLICT OF INTEREST: AN UNDISCLOSED CONFLICT OF INTEREST REQUIRES DISCIPLINARY MEASURES CONSISTENT WITH THE DISCIPLINARY POLICY AND PROCEDURE OF FORUM HEALTH AND AS RECOMMENDED BY HUMAN RESOURCES, IN CONSULTATION WITH AND UPON THE APPROVAL BY THE CHIEF EXECUTIVE OFFICER AND/OR BOARD OF TRUSTEES. DISCIPLINE FOR UNDISCLOSED CONFLICTS OF INTEREST MAY BE SEVERE, UP TO AND INCLUDING TERMINATION OF EMPLOYMENT. | FORM 990, PART VI, SECTION B, LINE 12C | |
| COMPENSATION PROCESS FOR TOP OFFICIALS THE FORUM HEALTH BOARD OF TRUSTEES HAS ESTABLISHED A COMPENSATION COMMITTEE FOR THE PURPOSE OF REVIEWING AND APPROVING, ON BEHALF OF THE BOARD OF TRUSTEES, MANAGEMENT RECOMMENDATIONS REGARDING ALL FORMS OF COMPENSATION TO BE PROVIDED TO EACH EXECUTIVE OFFICER AND DIRECTOR OF THE ORGANIZATION. THE COMMITTEE SHALL CONSIST OF A MINIMUM OF THREE MEMBERS OF THE BOARD OF TRUSTEES, ALL OF WHOM SHALL BE "INDEPENDENT" UNDER THE STANDARDS SET FORTH IN THE ORGANIZATION'S CORPORATE GOVERNANCE PRINCIPLES, AS WELL AS UNDER ANY ADDITIONAL OR SUPPLEMENTAL INDEPENDENCE STANDARDS APPLICABLE TO COMPENSATION COMMITTEES ESTABLISHED UNDER ANY APPLICABLE LAW, RULE OR REGULATION. THE COMMITTEE REVIEWS WITH THE ORGANIZATION'S EXECUTIVE MANAGEMENT AND APPROVES ALL FORMS OF COMPENSATION TO BE PROVIDED TO EACH EXECUTIVE OFFICER AND NON-EMPLOYEE DIRECTOR. THE COMMITTEE ALSO REVIEWS WITH THE ORGANIZATION'S EXECUTIVE MANAGEMENT AND APPROVES RECOMMENDATIONS WITH REGARD TO AGGREGATE SALARY AND BONUS BUDGET GUIDELINES FOR ALL OF THE ORGANIZATION'S EMPLOYEES WHO MEET REVIEW CRITERIA. THE COMMITTEE MONITORS SUMMARY DATA ON THE ORGANIZATION'S POPULATION (E.G., TOTAL COMPENSATION COSTS, COMPENSATION BENCHMARK DATA, EMPLOYEE DIVERSITY, TURNOVER LEVELS, ETC.). THE COMMITTEE HAS THE POWER AND AUTHORITY TO RETAIN SUCH COMPENSATION CONSULTANTS, OUTSIDE COUNSEL AND OTHER ADVISORS AS THE COMMITTEE MAY DEEM APPROPRIATE. THE COMMITTEE HOLDS REGULAR MEETINGS AND MAINTAINS WRITTEN MINUTES OF EACH MEETING. | FORM 990, PART VI, SECTION B, LINE 15 | |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. | FORM 990, PART VI, SECTION C, LINE 19 | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | CHANGE IN NET ASSETS -3,405,167. TOTAL TO FORM 990, PART XI, LINE 5: -3,405,167. | FORM 990, PART XI, LINE 5: |
| FINANCIAL ACCOUNTS IN FOREIGN COUNTRIES BERMUDA | FORM 990, PART V, LINE 4B |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (14 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| FORUM HEALTH HOLDING CO | |||||||||||
| 1350 E MARKET ST | WARREN | OH | 44483 | 311560187 | SUPP SRVCS | OH | 501C3 | 11B | N/A | 0 | |
| TRUMBULL MEMORIAL HOSPITAL | |||||||||||
| 1350 E MARKET ST | WARREN | OH | 44483 | 341461049 | HOSPITAL | OH | 501C3 | 3 | N/A | 0 | |
| WESTERN RESERVE CARE SYSTEM | |||||||||||
| 1350 E MARKET ST | WARREN | OH | 44483 | 341454933 | HOSPITAL | OH | 501C3 | 3 | N/A | 0 | |
| TRUMBULL MEMORIAL HOSPITAL FOUNDATION | |||||||||||
| 1350 E MARKET ST | WARREN | OH | 44483 | 341195190 | FOUNDATION | OH | 501C3 | 11A | 0 | TRUMBULL MEMORIAL HOSPITAL | |
| WESTERN RESERVE HEALTH FOUNDATION | |||||||||||
| 1350 E MARKET ST | WARREN | OH | 44483 | 341461047 | FOUNDATION | OH | 501C3 | 11A | 0 | WESTERN RESERVE CARE SYSTEM | |
| FORUM HEALTH FOUNDATION | |||||||||||
| 1350 E MARKET ST | WARREN | OH | 44483 | 202711674 | FOUNDATION | OH | 501C3 | 11B | N/A | 0 | |
| FORUM HEALTH SERVICES CO | |||||||||||
| 1350 E MARKET ST | WARREN | OH | 44483 | 341461044 | MEDICAL | OH | 501C3 | 11B | N/A | 0 | |
| FORUM HEALTH REHABILITATIVE SERVICE | |||||||||||
| 1350 E MARKET ST | WARREN | OH | 44483 | 311581767 | REHAB | OH | 501C3 | 3 | 0 | FORUM HEALTH | |
| FORUM HEALTH ENTERPRISES CO | |||||||||||
| 1350 E MARKET ST | WARREN | OH | 44483 | 341368151 | PHYS SRVCS | OH | 501C3 | 3 | 0 | FORUM HEALTH | |
| BEEGHLY OAKS | |||||||||||
| 1350 E MARKET ST | WARREN | OH | 44483 | 311196072 | INACTIVE | OH | 501C3 | 9 | 0 | FORUM HEALTH | |
| DACAS NURSING SYSTEMS INC | |||||||||||
| 1350 E MARKET ST | WARREN | OH | 44483 | 341456983 | INACTIVE | OH | 501C3 | 9 | 0 | FORUM HEALTH | |
| DACAS NURSING SUPPORT SYSTEMS INC | |||||||||||
| 1350 E MARKET ST | WARREN | OH | 44483 | 341482591 | INACTIVE | OH | 501C3 | 9 | 0 | FORUM HEALTH | |
| FORUM HEALTH PHARMACY SERVICES CO | |||||||||||
| 1350 E MARKET ST | WARREN | OH | 44483 | 341754092 | INACTIVE | OH | 501C3 | 9 | 0 | FORUM HEALTH | |
| VISITING NURSE ASSOCIATION AND HOSPICE | |||||||||||
| 1350 E MARKET ST | WARREN | OH | 44483 | 340714388 | INACTIVE | OH | 501C3 | 9 | 0 | FORUM HEALTH | |
Form990 Schedule R Part IV Form990ScheduleRPartIV (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity |
|---|---|---|---|---|---|---|---|---|
| FORUM HEALTH VENTURES CO | ||||||||
| 1350 E MARKET ST | WARREN | OH | 44483 | 341489491 | SUPP SRVCS | OH | FORUM HEALTH | C |
| FORUM HEALTH OUTREACH LABORATORIES | ||||||||
| 1350 E MARKET ST | WARREN | OH | 44483 | 341437294 | LAB | OH | FORUM HEALTH | C |
| FORUM HEALTH DIAGNOSTICS CO | ||||||||
| 1350 E MARKET ST | WARREN | OH | 44483 | 341773672 | IMAGING | OH | FORUM HEALTH | C |
| PRIDECARE INC | ||||||||
| 1350 E MARKET ST | WARREN | OH | 44483 | 341490425 | INACTIVE | OH | FORUM HEALTH | C |
| COMPREHENSIVE PSYCHIATRY SPECIALIST | ||||||||
| 1350 E MARKET ST | WARREN | OH | 44483 | 341697739 | INACTIVE | OH | FORUM HEALTH | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (13 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| TRUMBULL MEMORIAL HOSPITAL | ||
| Q | 1053145 | FMV |
| WESTERN RESERVE CARE SYSTEM | ||
| Q | 2312688 | FMV |
| FORUM HEALTH REHABILITATIVE SERVICES | ||
| Q | 39333 | FMV |
| TRUMBULL MEMORIAL HOSPITAL | ||
| K | 7998875 | FMV |
| WESTERN RESERVE CARE SYSTEM | ||
| K | 6972508 | FMV |
| FORUM HEALTH SERVICES CO | ||
| K | 86995 | FMV |
| FORUM HEALTH REHABILITATIVE SERVICES | ||
| K | 564425 | FMV |
| TRUMBULL MEMORIAL HOSPITAL FOUNDATION | ||
| K | 14913 | FMV |
| WESTERN RESERVE HEALTH FOUNDATION | ||
| K | 6678 | FMV |
| FORUM HEALTH ENTERPRISES CO | ||
| K | 241963 | FMV |
| FORUM HEALTH VENTURES CO | ||
| K | 131685 | FMV |
| FORUM HEALTH OUTREACH LABORATORIES | ||
| K | 115979 | FMV |
| FORUM HEALTH DIAGNOSTICS CO | ||
| K | 56971 | FMV |