Coshocton County Memorial Hospital: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- Coshocton County Memorial Hospital (EIN 31-4387577)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-10-17
- IRS object ID
- 201122919349300212
- 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
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-10-17T12:33:57-05:00 | 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 | BLUE & CO LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8800 LYRA DRIVE SUITE 450 | AddressLine1 |
| City | COLUMBUS | City |
| State | OH | State |
| ZIP Code | 43240 | 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 | 314387577 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COSHOCTON COUNTY MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | COSH | NameControl |
| Phone | 7406234144 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1460 ORANGE STREET | AddressLine1 |
| City | COSHOCTON | City |
| State | OH | State |
| ZIP Code | 43812 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ROBERT MILLER | Name |
| Title | CFO | Title |
| Phone | 7406234144 | Phone |
| Date Signed | 2011-10-07 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | STEPHEN A SHERIDAN | Name |
| Phone | 6148852583 | 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 | ROBERT MILLER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1460 ORANGE STREET | AddressLine1 |
| City | COSHOCTON | City |
| State | OH | State |
| ZIP Code | 43812 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 64657753 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CCMH.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1946 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | COSHOCTON COUNTY MEMORIAL HOSPITAL OPERATES IN A MANNER CONSISTENT WITH THE REQUIREMENTS OF REVENUE RULING 69-545, THROUGH ITS PROVISION OF HEALTH CARE SERVICES TO THE COMMUNITY, REGARDLESS OF ABILITY TO PAY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 647 | TotalNbrEmployees |
| Total Nbr Volunteers | 141 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 143028 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 64093722 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 61545649 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 170020 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1755772 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 922290 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1330797 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 65329060 | TotalRevenuePriorYear |
| Total Revenue Current Year | 64632218 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 5000 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 5000 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 31131048 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 30103511 | 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 | 32837423 | OtherExpensePriorYear |
| Other Expenses Current Year | 31615925 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 63973471 | TotalExpensesPriorYear |
| Total Expenses Current Year | 61724436 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1355589 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2907782 | RevenuesLessExpensesCY |
| Total Assets BOY | 46412459 | TotalAssetsBOY |
| Total Assets EOY | 45755141 | TotalAssetsEOY |
| Total Liabilities BOY | 19717168 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 18359235 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 26695291 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 27395906 | NetAssetsOrFundBalancesEOY |
| Mission Description | COSHOCTON COUNTY MEMORIAL HOSPITAL OPERATES IN A MANNER CONSISTENT WITH THE REQUIREMENTS OF REVENUE RULING 69-545, THROUGH ITS PROVISION OF HEALTH CARE SERVICES TO THE COMMUNITY, REGARDLESS OF ABILITY TO PAY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 51435563 | Expense |
| Revenue | 63795487 | Revenue |
| Description | PHARMACYEMERGENCY DEPARTMENTLABORATORY | Description |
| Total Program Service Expense | 51435563 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Donor Advised Funds | 1 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | 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 | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 0 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 1 | 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 | 1 | 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 | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | 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 | 38 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 647 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | 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 | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 1 | LocalChapters |
| Policies Reference Chapters | 1 | PoliciesReferenceChapters |
| Form990 Provided To Governing Body | 1 | 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 |
| States Where Copy Of Return Is Filed | OH | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BENJAMIN ADAMS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7406234010 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 19892 STATE ROUTE 16 | AddressLine1 |
| City | COSHOCTON | City |
| State | OH | State |
| ZIP Code | 43812 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (16 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| MARCIA WALTERS | |||||||
| SECRETARY/TREASURER | 2.00 | X | 0 | 0 | 0 | ||
| JAMES BROWN | |||||||
| CHAIRPERSON | 3.00 | X | 0 | 0 | 0 | ||
| DIANE JONES | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| JASON BRADFORD | |||||||
| VICE CHAIRPERSON | 2.00 | X | 0 | 0 | 0 | ||
| DRJEROLD MEYER | |||||||
| MEMBER | 37.50 | X | 137511 | 0 | 34378 | ||
| GREGORY NOWAK | |||||||
| CEO | 37.50 | X | 244059 | 0 | 61015 | X | |
| ROBERT MILLER | |||||||
| CFO | 37.50 | X | 124071 | 0 | 31018 | X | |
| TODD BROWN | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| MAX CROWN | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| KAREN SIMPSON | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| SHARON POLAND | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| DRROBERT GWINN | |||||||
| PHYSICIAN | 37.50 | 192111 | 0 | 48028 | X | ||
| DRDOUGLAS VIROSTKO | |||||||
| PHYSICIAN | 37.50 | 162510 | 0 | 40628 | X | ||
| DR TERRY OVERHOLSER | |||||||
| PHYSICIAN | 37.50 | 188118 | 0 | 47030 | X | ||
| DR CHRISTOPHER COULSON | |||||||
| PHYSICIAN | 37.50 | 183700 | 0 | 45925 | X | ||
| DR DOUGLAS HAMILTON | |||||||
| PHYSICIAN | 37.50 | 164814 | 0 | 41204 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1396894 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 349226 | TotalOtherCompensation |
| Number Individuals GT100 K | 15 | 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 |
|---|---|---|---|---|---|
| PREMIER HEALTHCARE SERVICES | |||||
| PO BOX 631606 | CINCINNATI | OH | 45263 | ER PHYSICIAN SERVICES | 2200758 |
| ARAMARK | |||||
| 2500 WARRENVILLE ROAD | DOWNERS GROVE | IL | 60515 | HOUSEKEEPING SERVICES | 939237 |
| JACOBS VANAMAN AGENCY INC | |||||
| PO BOX 370 | COSHOCTON | OH | 43812 | INSURANCE SERVICES | 695697 |
| COSHOCTON ANESTHESIA ASSOC | |||||
| PO BOX 850 | COSHOCTON | OH | 43812 | ANESTHESIA SERVICES | 669611 |
| QUADRAMED | |||||
| PO BOX 1915 | MERRIFIELD | VA | 22116 | SOFTWARE SERVICES | 425742 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PROGRAM SERVICE REVENU | Description |
| Business Code | 623990 | BusinessCode |
| Total Revenue Column | 61545649 | TotalRevenueColumn |
| Related Or Exempt Function Income | 61545649 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 61545649 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 413772 | TotalRevenueColumn |
| Exclusion | $413,772 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 1342000 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 1342000 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1342000 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1342000 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 55625 | GrossIncomeFundraisingEvents |
| Fundraising Direct Expenses | 25535 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 30090 | TotalRevenueColumn |
| Exclusion | $30,090 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| MISCELLANEOUS | 900099 | 632773 | 632773 | |
| CAFETERIA REVENUE | 900099 | 304890 | $304,890 | |
| BOND PROCEEDS | 900099 | 143826 | 143826 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 219218 | TotalRevenueColumn |
| Related Or Exempt Function Income | 131239 | RelatedOrExemptFunctionIncome |
| Exclusion | $87,979 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1300707 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 64632218 | TotalRevenueColumn |
| Related Or Exempt Function Income | 63795487 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $836,731 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5000 | Total |
| Program Services | 5000 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1396893 | Total |
| Management And General | 1396893 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19382451 | Total |
| Program Services | 16475083 | ProgramServices |
| Management And General | 2907368 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 687231 | Total |
| Program Services | 591019 | ProgramServices |
| Management And General | 96212 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6958157 | Total |
| Program Services | 5914433 | ProgramServices |
| Management And General | 1043724 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1678779 | Total |
| Program Services | 1426962 | ProgramServices |
| Management And General | 251817 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 45002 | Total |
| Management And General | 45002 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4640477 | Total |
| Program Services | 3990810 | ProgramServices |
| Management And General | 649667 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 117263 | Total |
| Program Services | 100846 | ProgramServices |
| Management And General | 16417 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 490340 | Total |
| Program Services | 421692 | ProgramServices |
| Management And General | 68648 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1868913 | Total |
| Program Services | 1607265 | ProgramServices |
| Management And General | 261648 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 95087 | Total |
| Program Services | 81775 | ProgramServices |
| Management And General | 13312 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 301283 | Total |
| Program Services | 256091 | ProgramServices |
| Management And General | 45192 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3175897 | Total |
| Program Services | 2731271 | ProgramServices |
| Management And General | 444626 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 695313 | Total |
| Program Services | 591016 | ProgramServices |
| Management And General | 104297 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| SUPPLIES | 7277203 | 6185623 | 1091580 |
| BAD DEBTS | 4254337 | 3658730 | 595607 |
| MEDICAL PROFESSIONAL FE | 4135789 | 3556779 | 579010 |
| MISCELLANEOUS | 2344583 | 1992896 | 351687 |
| REPAIRS AND MAINTENANCE | 2174438 | 1848272 | 326166 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 61724436 | Total |
| Program Services | 51435563 | ProgramServices |
| Management And General | 10288873 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1332969 | BOY |
| EOY | 1119262 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10211893 | BOY |
| EOY | 8960900 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 257262 | BOY |
| EOY | 289416 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 521669 | BOY |
| EOY | 1255551 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 73270373 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 48068466 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25960360 | BOY |
| EOY | 25201907 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6369581 | BOY |
| EOY | 4233266 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1758725 | BOY |
| EOY | 4694839 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 46412459 | BOY |
| EOY | 45755141 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7435775 | BOY |
| EOY | 8081712 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8180000 | BOY |
| EOY | 8270254 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3381393 | BOY |
| EOY | 2007269 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 720000 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19717168 | BOY |
| EOY | 18359235 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26034845 | BOY |
| EOY | 26668607 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 585446 | BOY |
| EOY | 652299 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 75000 | BOY |
| EOY | 75000 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26695291 | BOY |
| EOY | 27395906 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 46412459 | BOY |
| EOY | 45755141 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2907782 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -2207167 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $1,266 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 1266 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF OTHER LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1I: | ReturnReference |
| Explanation | A PERCENTAGE OF OHA DUES IS USED FOR LOBBYING PURPOSES. | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number DA Fs Held | 6 | NumberDAFsHeld |
| Donor Advised Contributions | 47300 | DonorAdvisedContributions |
| Grants Paid From Donor Funds | 144 | GrantsPaidFromDonorFunds |
| Aggregate DAF Value | 696142 | AggregateDAFValue |
| Disclosed Orgs Legal Control | 1 | DisclosedOrgsLegalControl |
| Disclosed For Charitable Purposes | 1 | DisclosedForCharitablePurposes |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 961957 | OtherCostOrOtherBasis |
| Book Value | 961957 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 38710097 | OtherCostOrOtherBasis |
| Book Value | 38710097 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Depreciation | 48068466 | Depreciation |
| Book Value | -48068466 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 33507414 | OtherCostOrOtherBasis |
| Book Value | 33507414 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 90905 | OtherCostOrOtherBasis |
| Book Value | 90905 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 25201907 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (2 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| CORPORATE BONDS | 878840 | F |
| MARKETABLE EQUITY SECURITIES | 3354426 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 4233266 | TotalOfBookValueSecurities |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| ESTIMATED THIRD PARTY SETTLEMENTS | 3862234 |
| OTHER ASSETS | 832605 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 4694839 | TotalBookValueOtherAssets |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | CCMH GOLF OUTING | NameOfEvent1 |
| Gross Receipts Event1 | 55625 | GrossReceiptsEvent1 |
| Gross Revenue Event1 | 55625 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 17450 | CashPrizesEvent1 |
| Non Cash Prizes Event1 | 3722 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 2685 | RentFacilityCostsEvent1 |
| Entertainment Event1 | 1353 | EntertainmentEvent1 |
| Other Direct Expenses Event1 | 325 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 55625 | GrossReceiptsTotal |
| Gross Revenue Total Events | 55625 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 17450 | CashPrizesTotalEvents |
| Non Cash Prizes Total Events | 3722 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 2685 | RentFacilityCostsTotalEvents |
| Entertainment Total Events | 1353 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 325 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 25535 | DirectExpenseSummaryEvents |
| Net Income Summary | 30090 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 150.000000000000 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 1 | UnableToProvideCare |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4998085 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 4998085 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08100 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9309857 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1634572 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 7675285 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.12430 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 14307942 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1634572 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 12673370 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.20530 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 72866 | PersonsServed |
| Total Community Benefit Expense | 810210 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 59995 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 750215 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01220 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10530 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 10530 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 72866 | PersonsServed |
| Total Community Benefit Expense | 820740 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 59995 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 760745 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01240 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 72866 | PersonsServed |
| Total Community Benefit Expense | 15128682 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1694567 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 13434115 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.21770 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,914,452 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 12495774 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 14203098 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -1707324 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV (2 entries)
| Description Ent Primary ActivityDescriptionEntPrimaryActivity | Organization Profit Or OwnershipOrganizationProfitOrOwnership |
|---|---|
| 1 EAST OHIO HOSPITAL ALLIANCE | |
| PURCHASING VENTURE | 0.33330 |
| 2 COSHOCTON COUNTY MEMORIAL HOSPITAL AND GENESIS SLEEP LAB LLC | |
| OPERATION OF A SLEEP LAB DEPARTMENT | 0.60000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COSHOCTON COUNTY MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1460 ORANGE STREET | AddressLine1 |
| City | COSHOCTON | City |
| State | OH | State |
| ZIP Code | 43812 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | EXTEND CARE | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COSHOCTON COUNTY MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)
| ExplanationExplanation |
|---|
| PART II: WE HOLD SEVERAL HEALTH CARE SUPPORT GROUPS AND HAVE MULTIPLE HEALTH FAIRS THROUGHOUT THE COMMUNITY OVER THE YEAR. |
| PART III, LINE 4: THE ASSOCIATION PROVIDES SERVICES TO PATIENTS WHO RESIDE PRIMARILY IN THE LOCAL GEOGRAPHIC REGION. PATIENT ACCOUNTS RECEIVABLE AND PATIENT SERVICE REVENUES ARE RECORDED WHEN PATIENT SERVICES ARE PERFORMED AND ARE REPORTED BASED ON GROSS CHARGES, NET OF CERTAIN DEDUCTIONS FROM THOSE CHARGES. DEDUCTIONS ARE BASED ON THE DIFFERENCE BETWEEN CHARGES AT ESTABLISHED RATES AND AMOUNTS ESTIMATED BY MANAGEMENT TO BE REIMBURSABLE UNDER APPLICABLE LAWS, REGULATIONS AND PROGRAM INSTRUCTIONS. REIMBURSABLE AMOUNTS ARE GENERALLY LESS THAN THE ESTABLISHED GROSS CHARGES. FINAL DETERMINATION OF AMOUNTS EARNED FOR PATIENTS IS SUBJECT TO AUDIT BY THE GOVERNMENTAL AGENCIES. SUBSEQUENT ADJUSTMENTS, IF ANY, ARISING FROM SUCH REVIEWS ARE RECORDED IN THE YEAR THEY BECOME KNOWN. THE ASSOCIATION ESTIMATES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON AN EVALUATION OF HISTORICAL LOSSES, CURRENT ECONOMIC CONDITIONS, AND OTHER FACTORS UNIQUE TO THEIR OPERATIONS. |
| PART III, LINE 8: ANY SHORT FALL WOULD BE A COMMUNITY BENEFIT BECAUSE THE SHORT FALL REFLECTS THE $ AMOUNT OF UNCOMPENSATED CARE PROVIDED THAT WE CAN NOT GET REIMBURSED FOR. WE HAVE NO ABILITY TO PASS THIS DOLLAR AMOUNT ONWARD FOR COLLECTION. THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED [AUGUST 31, 2010] REPORT: HOSPITAL STATEMENT OF REIMBURSABLE COST. |
| PART III, LINE 9B: THE COLLECTION DOES NOT DIFFER FOR THOSE INDIVIDUALS, IT REMAINS THE SAME. IF THERE IS NO PAYMENT IN 120 DAYS IT GOES TO COLLECTION AS A BAD DEBT. IF THEY ARE MAKING PAYMENTS IN ACCORDANCE WITH OUR GUIDELINES IT REMAINS ACTIVE A/R AT CCMH. IF THE PAYMENTS FALL SHORT OF PP THEN IT WILL GO TO COLLECTIONS. |
| PART VI, LINE 2: WE HAVE NOT DONE A NEEDS ASSESSMENT AT THIS TIME. |
| PART VI, LINE 3: YES, WE HAVE A LADY FROM MEDASSIST TO ASSIST PATIENTS ON THIS MATTER. |
| PART VI, LINE 4: THE SERVICE AREA COVERS COSHOCTON COUNTY AND SOME OF TUSCARAWAS COUNTY. COSHOCTON'S POPULATION IS AROUND 37,000 PEOPLE WITH A TOTAL SERVICE AREA OF 50,000. |
| PART VI, LINE 6: WE PURCHASED A LARGE PCP IN THE COMMUNITY AND MOVED THIS CLINIC TO A HOSPITAL BASED CLINIC. |
| PART VI, LINE 7: N/A |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 0 | RecordsMaintained |
| No Grant More Than5000 | X | NoGrantMoreThan5000 |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | TUITION PAYMENTS ARE MADE FOR EMPLOYEES OR POTENTIAL EMPLOYEES WITH AGREEMENT TO REPAY WITH SERVICE | TypeOfGrant |
| Number Of Recipients | 20 | NumberOfRecipients |
| Amount Of Cash Grant | 12957 | AmountOfCashGrant |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Class Or Charter Travel | X | FirstClassOrCharterTravel |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| 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 (8 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DRJEROLD MEYER | |||||||||||||
| 137511 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 34378 | 0 | 171889 | 0 | 0 | 0 |
| GREGORY NOWAK | |||||||||||||
| 244059 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 61015 | 0 | 305074 | 0 | 0 | 0 |
| ROBERT MILLER | |||||||||||||
| 124071 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 31018 | 0 | 155089 | 0 | 0 | 0 |
| DRROBERT GWINN | |||||||||||||
| 192111 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 48028 | 0 | 240139 | 0 | 0 | 0 |
| DRDOUGLAS VIROSTKO | |||||||||||||
| 162510 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 40628 | 0 | 203138 | 0 | 0 | 0 |
| DR TERRY OVERHOLSER | |||||||||||||
| 188118 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 47030 | 0 | 235148 | 0 | 0 | 0 |
| DR CHRISTOPHER COULSON | |||||||||||||
| 183700 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 45925 | 0 | 229625 | 0 | 0 | 0 |
| DR DOUGLAS HAMILTON | |||||||||||||
| 164814 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 41204 | 0 | 206018 | 0 | 0 | 0 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues | Amount Of TransactionAmountOfTransaction |
|---|---|---|---|
| TODD BROWN | |||
| BANKING OFFICIAL AT THE BANK THE HOSPITAL USES | N/A | 0 | |
| DR JERALD MEYER | |||
| HOSPITALIST | HOSPITALIST COVERAGE | 0 | 30500 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | REVIEW OF FORM 990 IS DONE BY THE CFO. | |
| THE POLICIES ARE VIEWED ANNUALLY BY THE BOARD. EACH BOARD MEMBER SIGNS A CONFLICT OF INTEREST POLICY AND CONFIDENTIALITY POLICY AS WELL AS PARTICIPATING IN CONFLICT MANAGEMENT EDUCATION. THE EXECUTIVE SECRETARY OBTAINS ALL SIGNED COPIES BY THE BOARD MEMBERS. ANY CONFLICTS THAT ARISE DURING THE YEAR ARE DIRECTED TO THE BOARD CHAIRPERSON. | FORM 990, PART VI, SECTION B, LINE 12C | |
| THE CEO'S COMPENSATION IS DETERMINED BY A WRITE UP FROM MANAGEMENT PERFORMANCE INTERNATIONAL (MPI). THE OTHER COMPENSATION IS DETERMINED BY SALARY SURVEYS BY MPI AND DATA FROM THE OHIO HOSPITAL ASSOCIATION (OHA). THE HUMAN RESOURCE DIRECTOR AND CEO REVIEW THOSE DETERMINATIONS. | FORM 990, PART VI, SECTION B, LINE 15 | |
| IF AN INDIVIDUAL REQUESTS TO SEE THIS INFORMATION HE/SHE WILL CONTACT THE ADMINISTRATION OFFICE. IT IS THEN APPROVED BY THE CEO OR CFO AND THE INFORMATION REQUESTED MUST BE REVIEWED ON THE HOSPITAL PREMISES. | FORM 990, PART VI, SECTION C, LINE 19 | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED GAINS ON INVESTMENTS: 108,943. CONTRIBUTIONS TO SUBSIDIARIES -2,382,963. CHANGE IN TEMPORARILY RESTRICTED NET ASSETS 66,853. TOTAL TO FORM 990, PART XI, LINE 5: -2,207,167. | FORM 990, PART XI, LINE 5: |
| NO CHANGE FROM PRIOR YEAR. | FORM 990, PART XI, LINE 2C |
Schedule R IRS990ScheduleR
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CCMH GENESIS SLEEP LAB LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1460 ORANGE STREET | AddressLine1 |
| City | COSHOCTON | City |
| State | OH | State |
| ZIP Code | 43812 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 113682744 | EIN |
| Primary Activity | SLEEP DISORDERS | PrimaryActivity |
| Legal Domicile State | OH | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COSHOCTON COUNTY MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Share Of Total Income | 52879 | ShareOfTotalIncome |
| Share Of EOY Assets | 27815 | ShareOfEOYAssets |
| Disproportionate Allocations | 0 | DisproportionateAllocations |
| General Or Managing Partner | 0 | GeneralOrManagingPartner |
| Percentage Ownership | 0.60000 | PercentageOwnership |
| 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 | 1 | 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 | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType |
|---|
| CCMH GENESIS SLEEP LAB |
| I |
| CCMH GENESIS SLEEP LAB |
| K |