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OHIOHEALTH CORPORATION: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
OHIOHEALTH CORPORATION (EIN 34-4429514)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-14
IRS object ID
201123189349305677
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-11-14T15:07:05-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BLUE & CO LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line18800 LYRA DRIVE SUITE 450AddressLine1
CityCOLUMBUSCity
StateOHState
ZIP Code43240ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN344429514EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1VAN WERT COUNTY HOSPITAL ASSOCIATIONBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlVANWNameControl
Phone4192388609Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11250 SOUTH WASHINGTON STREETAddressLine1
CityVAN WERTCity
StateOHState
ZIP Code45891ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMICHAEL T HOLLIDAYName
TitleVICE PRESIDENTTitle
Phone4192388609Phone
Date Signed2011-11-14DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameNANCY KIRCHNERName
Phone6148852583Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMICHAEL T HOLLIDAYNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11250 SOUTH WASHINGTON STREETAddressLine1
CityVAN WERTCity
StateOHState
ZIP Code45891ZIPCode
FieldValueIRS element (for citing)
Gross Receipts53325759GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.VANWERTHOSPITAL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1905YearFormation
State Legal DomicileOHStateLegalDomicile
Activity Or Mission DescriptionPROVIDE A CONTINUUM OF HEALTH CARE SERVICES IN INPATIENT AND AMBULATORY SETTINGS AND MAINTAIN OR EXTEND ALL NECESSARY ELEMENTS OF CARE TO ADDRESS THE NEEDS OF EVERY PATIENT IN A COMPASSIONATE MANNER.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees468TotalNbrEmployees
Total Nbr Volunteers242TotalNbrVolunteers
Total Gross UBI242697TotalGrossUBI
Net Unrelated Business Txbl Income2200NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year313784ContributionsGrantsPriorYear
Contributions Grants Current Year1068464ContributionsGrantsCurrentYear
Program Service Revenue Prior Year47707763ProgramServiceRevenuePriorYear
Program Service Revenue CY48131111ProgramServiceRevenueCY
Investment Income Prior Year-430220InvestmentIncomePriorYear
Investment Income Current Year2473578InvestmentIncomeCurrentYear
Other Revenue Prior Year1439145OtherRevenuePriorYear
Other Revenue Current Year1486982OtherRevenueCurrentYear
Total Revenue Prior Year49030472TotalRevenuePriorYear
Total Revenue Current Year53160135TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year19695523SalariesEtcPriorYear
Salaries Etc Current Year22135169SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year133939TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY4109TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year4109TotalFundrsngExpCurrentYear
Other Expense Prior Year25177783OtherExpensePriorYear
Other Expenses Current Year26343417OtherExpensesCurrentYear
Total Expenses Prior Year45007245TotalExpensesPriorYear
Total Expenses Current Year48482695TotalExpensesCurrentYear
Revenues Less Expenses Prior Year4023227RevenuesLessExpensesPriorYear
Revenues Less Expenses CY4677440RevenuesLessExpensesCY
Total Assets BOY68883484TotalAssetsBOY
Total Assets EOY73725020TotalAssetsEOY
Total Liabilities BOY16818183TotalLiabilitiesBOY
Total Liabilities EOY14805096TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY52065301NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY58919924NetAssetsOrFundBalancesEOY
Mission DescriptionPROVIDE A CONTINUUM OF HEALTH CARE SERVICES IN INPATIENT AND AMBULATORY SETTING AND MAINTAIN OR EXTEND ALL NECESSARY ELEMENTS OF CARE TO ADDRESS THE NEEDS OF EVERY PATIENT IN A COMPASSIONATE MANNER.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense36875375Expense
Revenue48624179Revenue
DescriptionPROVIDE INPATIENT PATIENT CARE SERVICES, OUTPATIENT CARE SERVICES, AND EMERGENCY CARE SERVICES.Description
Total Program Service Expense36875375TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached0FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity1DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096468NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees468NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledOHStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonMICHAEL HOLLIDAYNamePerson
Telephone Number4192388609TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11250 SOUTH WASHINGTON STREETAddressLine1
CityVAN WERTCity
StateOHState
ZIP Code45891ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
MARK J MINICK
PRESIDENT AND CEO40.00XXX772753015677
ANDY CZAJKOWSKI
TRUSTEE2.00X000
GEORGE M BROOKS
TRUSTEE2.00X000
ERIC JELINGER MD
TRUSTEE2.00X000
JON BAGLEY
VICE-CHAIRMAN2.00X000X
BILL LUDWIG
TRUSTEE2.00X000
JON A RHOADES
CO-CHAIRMAN2.00X000
JOEL D KNERR MD
CO-CHAIRMAN2.00X000X
BARB KOHNEN
SECRETARY2.00X000X
GARY ADAMS
TRUSTEE2.00X000
AARON MECHLING
TRUSTEE2.00X000
JOCELYN WRAY MD
TRUSTEE2.00X000
MICHAEL HOLLIDAY
VP FISCAL & ADMIN SERVICES40.00XX184393011270
CRAIG HANSON MD
PHYSICIAN40.00XX343342010585
THOMAS CONTE MD
PHYSICIAN40.00XX427848012492
MUHAMMED AL-FAWAKHIRI MD
PHYSICIAN40.00X174920010208
SHANEETA JOHNSON MD
PHYSICIAN40.00XX29611102686
SCOTT JARVIS MD
PHYSICIAN40.00XX26290408335
DOUGLAS MOORE MD
PHYSICIAN40.00XX24159607343
THOMAS LAUTZENHEISER MD
PHYSICIAN40.00X16487109029
FieldValueIRS element (for citing)
Total Reportable Comp From Org2868738TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation87625TotalOtherCompensation
Number Individuals GT100 K9NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
WEIGAND CONSTRUCTION
7808 HONEYWELL DRIVEFORT WAYNEIN46825CONSTRUCTION & CONSTRUCTION MANAGEMENT2993854
THERAPY SOLUTIONS
120 W MAIN STREETVAN WERTOH45891PHYSICAL THERAPY SERVICES1249360
CLINICAL COLLEAGUES
613 TATEM AVECOLLINGSWOODNJ08108ANESTHESIA PROFESSIONAL SERVICES1023219
MORRISON MANAGEMENT SPECIALISTS
39395 W 12 MILE RED SUITE 101FARMINGTON HILLSMI48331FOOD SERVICE MANAGMENT570294
SIEMENS MEDICAL SOLUTIONS USA
51 VALLEY STREAM PARKWAYMALVERNPA19355INFORMATION SYSTEMS545555
FieldValueIRS element (for citing)
Number Of Contractors GT100 K18NumberOfContractorsGT100K
Government Grants775098GovernmentGrants
All Other Contributions293366AllOtherContributions
Total Contributions1068464TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNET PATIENT SERVICE REDescription
Business Code900099BusinessCode
Total Revenue Column48131111TotalRevenueColumn
Related Or Exempt Function Income48131111RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue48131111TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column219207TotalRevenueColumn
Exclusion$219,207ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real979106Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real979106Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column979106TotalRevenueColumn
Unrelated Business Revenue242697UnrelatedBusinessRevenue
Exclusion$736,409ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities2397826Securities
Other9436Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other152891Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities2397826Securities
Other-143455Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column2254371TotalRevenueColumn
Exclusion$2,254,371ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events27541GrossIncomeFundraisingEvents
Fundraising Direct Expenses12733FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column14808TotalRevenueColumn
Exclusion$14,808ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
CAFETERIA/CATERING900099272230272230
WELLNESS INCOME900099139406139406
MISCELLANEOUS INCOME9000998143281432
FieldValueIRS element (for citing)
Total Other Revenue493068TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column53160135TotalRevenueColumn
Related Or Exempt Function Income48624179RelatedOrExemptFunctionIncome
Unrelated Business Revenue242697UnrelatedBusinessRevenue
Exclusion$3,224,795ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total2822363Total
Program Services2822363ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total12738604Total
Program Services9426567ProgramServices
Management And General3312037ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total448885Total
Program Services332175ProgramServices
Management And General116710ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total5130089Total
Program Services3796266ProgramServices
Management And General1333823ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total995228Total
Program Services736469ProgramServices
Management And General258759ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total481052Total
Management And General481052ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total95258Total
Program Services14289ProgramServices
Management And General80969ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total606339Total
Management And General606339ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total4109Total
Fundraising4109Fundraising

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total7244055Total
Program Services7244055ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total339808Total
Program Services299031ProgramServices
Management And General40777ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total545555Total
Program Services354611ProgramServices
Management And General190944ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1976596Total
Program Services1620809ProgramServices
Management And General355787ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total93336Total
Program Services28001ProgramServices
Management And General65335ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total417434Total
Program Services354819ProgramServices
Management And General62615ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2351719Total
Program Services1740272ProgramServices
Management And General611447ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total428581Total
Program Services317150ProgramServices
Management And General111431ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL & OTHER SUPPLIE604721744749411572276
BAD DEBT EXPENSE29551672955167
MISCELLANEOUS23279302327930
NUTRITIONAL SERVICES28838521340574980
BIO-MED ENGINEERING144985144985

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total48482695Total
Program Services36875375ProgramServices
Management And General11603211ManagementAndGeneral
Fundraising4109Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1556478BOY
EOY783812EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY443413BOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY6143864BOY
EOY5601265EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY671307BOY
EOY712411EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY946537BOY
EOY512376EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis56397718LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec35505901LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY17319355BOY
EOY20891817EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY39329284BOY
EOY38735005EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2473246BOY
EOY6488334EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY68883484BOY
EOY73725020EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY4161134BOY
EOY4224168EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY9400693BOY
EOY7597814EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY2841673BOY
EOY2113615EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY414683BOY
EOY869499EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY16818183BOY
EOY14805096EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY47307208BOY
EOY54475361EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1474078BOY
EOY1131000EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY3284015BOY
EOY3313563EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY52065301BOY
EOY58919924EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY68883484BOY
EOY73725020EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses4677440ReconcilationRevenueExpenses
Reconcilation Other Changes2177183ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$3,892OtherActivitiesAmount
Total Lobbying Expenditures IIB3892TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF OTHER LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1I:ReturnReference
ExplanationPORTION OF DUES PAID TO THE OHIO HOSPITAL ASSOCIATION IS USED FOR POLITICAL PURPOSES.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance6496893BeginningOfYearBalance
Contributions29533Contributions
Investment Earnings Or Losses612733InvestmentEarningsOrLosses
Other Expenditures-217775OtherExpenditures
Administrative Expenses-27348AdministrativeExpenses
End Of Year Balance7384282EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance5715171BeginningOfYearBalance
Contributions2535Contributions
Investment Earnings Or Losses1004939InvestmentEarningsOrLosses
Other Expenditures-202203OtherExpenditures
Administrative Expenses-23549AdministrativeExpenses
End Of Year Balance6496893EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance5998772BeginningOfYearBalance
Contributions63420Contributions
Investment Earnings Or Losses-1216525InvestmentEarningsOrLosses
Other Expenditures-207220OtherExpenditures
Administrative Expenses-27917AdministrativeExpenses
End Of Year Balance4610531EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.52500BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.47500PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.00000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis27966499OtherCostOrOtherBasis
Depreciation35505901Depreciation
Book Value-7539402BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis735249OtherCostOrOtherBasis
Book Value735249BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis27362686OtherCostOrOtherBasis
Book Value27362686BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis333284OtherCostOrOtherBasis
Book Value333284BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings20891817TotalOfBookValueLandBuildings

Other Assets OtherAssets (5 entries)

DescriptionDescriptionBook ValueBookValue
DEBT ISSUANCE COST, NET56350
INVESTMENT IN JOINT VENTURE617511
OTHER ASSETS1044640
UNCONDITIONAL PROMISES TO GIVE872933
ASSETS WHOSE USE IS LIMITED3896900
FieldValueIRS element (for citing)
Total Book Value Other Assets6488334TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
THIRD PARTY SETTLEMENTS$454,639
INTEREST RATE SWAP$154,739
ESTIMATED LIABILITY CLAIMS$51,000
PENSION LIABILITY$209,121
FieldValueIRS element (for citing)
Total Of Amounts869499TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:Identifier
Return ReferencePART V, LINE 4:ReturnReference
ExplanationTHE INVESTMENT INCOME GENERATED BY THE ENDOWMENT FUNDS DISTRIBUTED TO THE HOSPITAL IS ABLE TO BE USED FOR GENERAL OPERATING AND CAPITAL EQUIPMENT NEEDS.Explanation

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1VAN WERT COMMUNITY HOSPITAL GOLF OUNameOfEvent1
Gross Receipts Event127541GrossReceiptsEvent1
Gross Revenue Event127541GrossRevenueEvent1
Non Cash Prizes Event1608NonCashPrizesEvent1
Food And Beverage Event14482FoodAndBeverageEvent1
Other Direct Expenses Event17643OtherDirectExpensesEvent1
Gross Receipts Total27541GrossReceiptsTotal
Gross Revenue Total Events27541GrossRevenueTotalEvents
Non Cash Prizes Total Events608NonCashPrizesTotalEvents
Food And Beverage Total Events4482FoodAndBeverageTotalEvents
Other Direct Expenses Total Events7643OtherDirectExpensesTotalEvents
Direct Expense Summary Events12733DirectExpenseSummaryEvents
Net Income Summary14808NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Number Of Activities Or Programs1121NumberOfActivitiesOrPrograms
Total Community Benefit Expense205069TotalCommunityBenefitExpense
Net Community Benefit Expense205069NetCommunityBenefitExpense
Percent Of Total Expense0.00420PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Number Of Activities Or Programs14700NumberOfActivitiesOrPrograms
Total Community Benefit Expense6058114TotalCommunityBenefitExpense
Direct Offsetting Revenue2770195DirectOffsettingRevenue
Net Community Benefit Expense3287919NetCommunityBenefitExpense
Percent Of Total Expense0.06780PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Number Of Activities Or Programs1034NumberOfActivitiesOrPrograms
Total Community Benefit Expense446205TotalCommunityBenefitExpense
Direct Offsetting Revenue273073DirectOffsettingRevenue
Net Community Benefit Expense173132NetCommunityBenefitExpense
Percent Of Total Expense0.00360PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Number Of Activities Or Programs16855NumberOfActivitiesOrPrograms
Total Community Benefit Expense6709388TotalCommunityBenefitExpense
Direct Offsetting Revenue3043268DirectOffsettingRevenue
Net Community Benefit Expense3666120NetCommunityBenefitExpense
Percent Of Total Expense0.07560PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs3545NumberOfActivitiesOrPrograms
Total Community Benefit Expense126159TotalCommunityBenefitExpense
Direct Offsetting Revenue1170DirectOffsettingRevenue
Net Community Benefit Expense124989NetCommunityBenefitExpense
Percent Of Total Expense0.00260PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs395NumberOfActivitiesOrPrograms
Total Community Benefit Expense12580TotalCommunityBenefitExpense
Net Community Benefit Expense12580NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs6911NumberOfActivitiesOrPrograms
Total Community Benefit Expense1005497TotalCommunityBenefitExpense
Direct Offsetting Revenue825752DirectOffsettingRevenue
Net Community Benefit Expense179745NetCommunityBenefitExpense
Percent Of Total Expense0.00370PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs157NumberOfActivitiesOrPrograms
Total Community Benefit Expense34407TotalCommunityBenefitExpense
Net Community Benefit Expense34407NetCommunityBenefitExpense
Percent Of Total Expense0.00070PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs11008NumberOfActivitiesOrPrograms
Total Community Benefit Expense1178643TotalCommunityBenefitExpense
Direct Offsetting Revenue826922DirectOffsettingRevenue
Net Community Benefit Expense351721NetCommunityBenefitExpense
Percent Of Total Expense0.00730PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs27863NumberOfActivitiesOrPrograms
Total Community Benefit Expense7888031TotalCommunityBenefitExpense
Direct Offsetting Revenue3870190DirectOffsettingRevenue
Net Community Benefit Expense4017841NetCommunityBenefitExpense
Percent Of Total Expense0.08290PercentOfTotalExpense

Other Other

FieldValueIRS element (for citing)
Number Of Activities Or Programs57NumberOfActivitiesOrPrograms
Total Community Building Expense67583TotalCommunityBuildingExpense
Net Community Building Expense67583NetCommunityBuildingExpense
Percent Of Total Expense0.00140PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs57NumberOfActivitiesOrPrograms
Total Community Building Expense67583TotalCommunityBuildingExpense
Net Community Building Expense67583NetCommunityBuildingExpense
Percent Of Total Expense0.00140PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$1,477,315BadDebtExpenseAmount
Amount Attributable To29546AmountAttributableTo
Amount Reimbursed By Medicare14420347AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare16578400CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-2158053MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV (5 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivityOrganization Profit Or OwnershipOrganizationProfitOrOwnershipPhysicans Profit Or OwnershipPhysicansProfitOrOwnership
1 VAN WERT MEDICAL SERVICES
MEDICAL PROFESSIONAL SERVICES1.00000
2 SARAH JANE LIVING CENTER
LONG TERM ALZHEIMER'S CARE0.50000
3 HOME HEALTH CARE SOLUTIONS
HOME HEALTHCARE SERVICES0.50000
4 THERAPY SOLUTIONS
PHYSICAL THERAPY SOLUTIONS0.50000
5 COMMUNITY CARE SYSTEMS
MANAGED CARE CONTRACTING0.500000.50000
FieldValueIRS element (for citing)
Number Of Hospital Facilities4NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (4 entries)

Facility NumberFacilityNumberAddress Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalEr24 HoursEr24HoursOtherOther
VAN WERT COUNTY HOSPITAL
11250 WASHINGTON STREETVAN WERTOH45891XXXDISPROPORTIONATED SHARE HOSPITAL
VAN WERT HEALTH CENTER
2140 FOX ROADVAN WERTOH45891OUTPATIENT DIAGNOSIS
SARAH JANE LIVING CENTER
3328 W 2ND STDELPHOSOH45833LONG TERM ALZHEIMERS CARE
VANCREST OF CONVOY
4510 TULLY DRCONVOYOH45832LONG TERM NURSING CARE

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1THE VAN WERT COUNTY HOSPITAL ASSOCIATIONBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)

ExplanationExplanation
PART I, LINE 3C: THE ORGANIZATION USED THE FPG TO DETERMINE ELIGIBILITY FOR FREE AND DISCOUNTED CARE.
PART I, LINE 7: THE ORGANIZATION REPORTS BAD DEBTS AS AN OPERATING EXPENSE. THE COSTING METHODOLOGY USED IN REPORTING BAD DEBT DATA IS A COST TO CHARGE RATIO METHODOLOGY. THE ORGANIZATION DOES NOT CLAIM BAD DEBT EXPENSE AS A COMMUNITY BENEFIT.
PART II: THE HOSPITAL ENGAGES IN A NUMBER OF HEALTH COALITION INITIATIVES TO IMPROVE HEALTH STATUS OF OUR POPULATION. THE HOSPITAL PROVIDED A STARTUP GRANT & ONGOING SUPPORT FOR THE FAMILY HEALTH CARE OF NORTHWEST OHIO, A FQHC CURRENTLY WITH LOOK-ALIKE STATUS. FAMILY HEALTH CARE OF NORTHWEST OHIO IS CURRENTLY SERVING RESIDENTS OF VAN WERT, PAULDING & MERCER COUNTIES. THROUGH THE HOSPITAL'S HELP OF PROVIDING PRIMARY CARE PHYSICIANS AND FUNDING, THIS CLINIC SERVES AS A SAFETY NET PROVIDER TO CITIZENS THAT CURRENTLY HAD NO PRIMARY CARE PHYSICIAN OR ACCESS TO PRIMARY CARE SERVICES. IN 2009, THE HOSPITAL UNDERTOOK AN EXPANSION OF OUR EMERGENCY SERVICES DEPARTMENT, BECAUSE OF INCREASING VISITS DUE TO ECONOMIC, BEHAVIORAL, AND AGING POPULATION THE HOSPITAL EXPERIENCED INCREASING VOLUMES. IN PARTNERSHIP WITH OUR COMMUNITY THROUGH A CAPITAL RAISING CAMPAIGN CONSTRUCTION IS UNDERWAY. THIS STATE-OF THE-ART FACILITY WILL BETTER SERVE OUR POPULATION WITH EXPANDED TREATMENT AREAS (12,000 SQ. FT.) AND NEW TECHNOLOGY. THIS EXPANSION HAS ALSO PROVIDED ENHANCED OUR DISASTER RESPONSE CAPABILITIES. THE SIZE OF THE PROJECT ALSO INCLUDES MANY ECONOMIC BENEFITS FOR OUR COMMUNITY BEYOND THE CONSTRUCTION PHASE. THE HOSPITAL ALSO PARTICIPATES IN INITIATIVES WITH OTHER PROVIDERS AND AFFILIATES IN PROVISION OF SERVICES AND/OR DONATIONS. THE PROVISIONS OF LOW COST HEALTH SCREENING SERVICES IN COLLABORATION WITH OTHER ORGANIZATIONS HELP US IDENTIFY CONDITIONS ON A PROACTIVE BASIS TO BETTER IMPROVE OUR CITIZEN'S HEALTH OR MANAGEMENT OF CHRONIC DISEASES. THE CO-ORDINATION OF CARE THROUGH OUR HOME HEALTH REHABILITATIVE AND LONG TERM CARE PROVIDERS SERVE TO BETTER MEET THE NEEDS OF OUR PATIENTS AND POPULATION. OUR REGIONAL LABORATORY INITIATIVE HAS SHORTENED TURNAROUND TIME FOR TESTS AND HAS LOWERED COST TO OUR PATIENTS. THE HOSPITAL ALSO PARTICIPATES IN ECONOMIC DEVELOPMENT EFFORTS THROUGH ITS MEMBERSHIP IN THE CHAMBER OF COMMERCE AND OTHER ORGANIZATIONS.
PART III, LINE 4: THE ORGANIZATION REPORTS BAD DEBTS AS AN OPERATING EXPENSE. THE COSTING METHODOLOGY USED IN REPORTING BAD DEBT DATA IS A COST TO CHARGE RATIO METHODOLOGY. THE ORGANIZATION DOES NOT CLIAM BAD DEBT EXPENSE AS A COMMUNITY BENEFIT.
PART III, LINE 8: THE ORGANIZATION DOES NOT CONSIDER THE MEDICARE SHORTFALL AS A COMMUNITY BENEFIT.
PART III, LINE 9B: FOLLOWING THE GUIDELINES AND PROCESSES AS INDICATED IN QUESTION 3, PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE, THE ORGANIZATION APPROPRIATELY IDENTIFIES ACCOUNTS AS TO THE TYPE OF ASSISTANCE QUALIFIED FOR. THE AMOUNTS ELIGIBLE FOR ASSISTANCE ARE WRITTEN OFF TO THE APPROPRIATE PROGRAM AND COLLECTION ACTIVITY CEASES IN REGARD TO THOSE AMOUNTS. THE GOAL OF THE ORGANIZATION'S POLICIES IS TO INDENTIY ACCOUNTS ELIGIBLE FOR ASSISTANCE AND BRING THE ACCOUNT TO AN APPROPRIATE CONCLUSION AS EARLY IN THE BILLING CYCLE AS POSSIBLE.
PART VI, LINE 2: THE ORGANIZATION USES A VARIETY OF METHODS TO ASSESS HEALTH CARE NEEDS. DATA PROVIDED BY THE STATE OF OHIO IS USED TO DETERMINE EPIDEMIOLOGIES RELATED TO CHRONIC CONDITIONS AND CANCER REGISTRIES PROVIDING PREVALENCE. INTERNAL DATA IS ALSO USED AS WELL AS INPUT FROM OTHER PROVIDERS. THE HOSPITAL ALSO USES PATIENT ORIGIN DATA PROVIDED BY THE OHIO HOSPITAL ASSOCIATION TO DETERMINE CURRENT TREATMENT PATTERNS AND DIAGNOSIS FOR CURRENT RESIDENTS BEING TREATED IN VAN WERT COUNTY HOSPITAL AND OTHER SURROUNDING PROVIDERS. THE HOSPITAL ALSO SPONSORS A NUMBER OF HEALTH FAIRS/ASSESSMENTS TO BOTH ADULT AND PEDIATRIC POPULATIONS OF VAN WERT THAT IS ALSO EXAMINED FOR FREQUENCY AND NEEDS. A NUMBER OF STAFF AS WELL AS BOARD OF TRUSTEES MEMBERS ALSO SERVED ON COMMUNITY HEALTH PROVIDER BOARDS AND PROVIDE INPUT TO THE PLANNING PROCESS.THE HOSPITAL IS ALSO SUBSCRIBED TO A NUMBER OF BENCHMARKING ORGANIZATIONS THAT PROVIDE BEST OF INDUSTRY APPLICATIONS TO ASSESS METHODOLOGIES FOR TREATING OUR RESIDENTS.
PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE BEGINS AT THE PATIENT ACCESS TO CARE AREAS. INFORMATIONAL SIGNAGE IS POSTED IN ALL PATIENT ACCESS AREAS IDENTIFYING FINANCIAL ASSISTANCE PROGRAMS AND INSTRUCTIONS OF HOW TO SEEK OUT THESE PROGRAMS. SIMILAR INFORMATION IS ALSO FOUND IN PATIENT INFORMATIONAL BROCHURES PROVIDED TO PATIENTS PRIOR TO THE RENDERING OF CARE BASED UPON THE TYPE OF CARE BEING PROVIDED. ALSO, AVAILABLE AT ALL PATIENT ACCESS POINTS ARE THE PATIENT FINANCIAL ASSISTANCE BROCHURE.PATIENT REGISTRATION STAFF AT ALL PATIENT ACCESS POINTS ARE TRAINED IN THE PATIENT FINANCIAL ASSISTANCE PROGRAMS AVAILABLE AT THE HOSPITAL. THEY BECOME A VALUABLE RESOURCE TO PATIENTS DIRECTING THEM TO THE PROGRAMS THEY MAY QUALIFY FOR AND THE PROCESS WITH WHICH TO SEEK THE APPROPRIATE ASSISTANCE.THE HOSPITAL UTILIZES THE HOSPITAL WEBSITE AS AN ON-LINE AND TECHNOLOGICALLY CURRENT SOURCE OF FINANCIAL ASSISTANCE INFORMATION FOR PATIENTS THAT PREFER FINDING EDUCATIONAL INFORMATION IN THIS FORMAT. FINANCIAL ASSISTANCE PROGRAMS, POLICIES, ELIGIBILITY CRITERIA, AND ON-LINE APPLICATIONS FOR THE VARIOUS PROGRAMS ARE AVAILABLE.PATIENT BILLING STATEMENTS PROVIDE ANOTHER AVENUE FOR EDUCATING PATIENTS AS TO FINANCIAL ASSISTANCE PROGRAMS AVAILABLE AND HOW TO CONTACT THE HOSPITAL TO DETERMINE ELIGIBILITY. THIS INFORMATION IS LOCATED ON THE BACK OF EACH BILLING STATEMENT RECEIVED BY THE PATIENT.THE EXISTENCE OF A FINANCIAL COUNSELOR IN THE PATIENT ACCOUNTING FUNCTION IS ANOTHER MECHANISM UTILIZED IN EDUCATING PATIENTS REGARDING FINANCIAL ASSISTANCE AVAILABLE FOR HOSPITAL SERVICES. ALL UNINSURED OR SELF-PAY POTENTIAL ACCOUNTS ARE IDENTIFIED TO THE FINANCIAL COUNSELOR UPON PATIENT REGISTRATION. PATIENTS MAY BE CONTACTED UPON COMPLETION OF SERVICES. ALL PATIENTS THAT WERE NOT CONTACTED UPON COMPLETION OF SERVICES RECEIVE A FINANCIAL ASSISTANCE APPLICATION THROUGH THE MAIL THAT INCLUDES INFORMATION REGARDING ALL FINANCIAL ASSISTANCE PROGRAMS. THE COUNSELOR PROVIDES FOLLOW-UP AND ASSISTANCE TO IDENTIFY THE PATIENT WITH THE APPROPRIATE FINANCIAL ASSISTANCE PROGRAM.
PART VI, LINE 4: VAN WERT COUNTY HOSPITAL IS LOCATED IN THE RURAL COUNTY OF VAN WERT, OHIO THAT BOARDERS THE INDIANA STATE LINE ALONG ALLEN COUNTY INDIANA. OUR PRIMARY SERVICE AREA COMPRISES VAN WERT AND SOME PORTIONS OF PAULDING, PUTNAM AND MERCER COUNTIES. OHIO NUMERICALLY THIS BREAKS DOWN TO APPROXIMATELY 50,000 RESIDENTS IN OUR PRIMARY MARKET AREA. THE HOSPITAL IS LOCATED WITHIN THE CITY OF VAN WERT, WHICH POSSESSES A POPULATION OF 10,700. OUR POPULATION IS PREDOMINANTLY WHITE (97.1%) WITH HISPANIC (1.9%) A MIX OF MINORITIES COMPRISE THE REMAINDER. VAN WERT IS RURAL IN NATURE WITH EMPLOYMENT NOT ONLY IN AGRICULTURAL SERVICES BUT ALSO IN THE MANUFACTURING AND SERVICE SECTOR. OUR COUNTY HAS SEEN INCREASED UNEMPLOYMENT DUE TO THE LOSS OF MANUFACTURING JOBS RELATED TO THE AUTO SECTOR. THE UNEMPLOYMENT RATE IN 2009 WAS IN EXCESS OF 13%. THIS SITUATION HAS ALSO INCREASED THE NUMBER OF CITIZENS COVERED UNDER THE MEDICAID PROGRAM AND QUALIFYING FOR THE HOSPITAL'S CHARITY CARE PROGRAM AS WELL AS INCREASING BAD DEBT (IN 2000 4.2% OF THE POPULATION WAS BELOW FPG). LIKE MANY MIDWEST COMMUNITIES THE REGION IS EXPERIENCING AGING POPULATIONS OF 18.3% OVER 65 AND 27.2% 45-64 ACCORDING TO THE 2000 CENSUS. THE HOSPITAL ALSO HAS FACILITIES IN THE COMMUNITIES OF CONVOY AND DELPHOS PROVIDING LONG TERM CARE TO THESE GROUPS. BEHAVIORAL RISK FACTORS INCLUDE (2002 OHIO BEHAVIORAL RISK SURVEY) SMOKING (19.3%), ALCOHOL ABUSE (14%) AND OBESITY AT (34.1%) THESE BEHAVIORAL RISK FACTORS INFLUENCE THE INCIDENCE OF CHRONIC DISEASES WE TREAT.
PART VI, LINE 6: THE VAN WERT COUNTY HOSPITAL ASSOCIATION BOARD OF TRUSTEES IS COMPRISED OF VOLUNTEERS FROM OUR COMMUNITY. THE MAJORITY OF THESE MEMBERS LIVE AND WORK WITHIN THE COMMUNITY AND ARE INVOLVED WITH OTHER NON-PROFIT AGENCIES. SENIOR LEADERSHIP ALSO LIVES IN THE PRIMARY SERVICE AREA. THIS "SPIRIT" OF COMMUNITY BASED HEALTHCARE RESIDES IN OUR BOARD OF TRUSTEES AND IS FURTHER EVIDENCED BY OUR OPEN MEDICAL STAFF. THE ACCOMMODATION OF SPECIALTY SERVICES NOT CURRENTLY PRESENT IN OUR AREA BEING PROVIDED THROUGH A SPECIALTY CLINIC OF THE HOSPITAL WHICH INCLUDE NEUROLOGY, NEUROSURGERY, IMMUNOLOGY, AND ENT SERVICES. THE HOSPITAL ASSOCIATED PERSONNEL ALSO SIT ON OTHER COMMUNITY BASED GOVERNANCE BOARDS (UNITED WAY, AMERICAN RED CROSS, CHAMBER OF COMMERCE, WRIGHT STATE UNIVERSITY REGIONAL CAMPUS, PUBLIC ACCESS TELEVISION, AMERICAN CANCER SOCIETY & VAN WERT ECONOMIC DEVELOPMENT TO NAME A FEW). THROUGH PHYSICIAN RECRUITMENT WE HAVE BROUGHT IN A NUMBER OF NEW SPECIALTIES INCLUDING BARIATRIC AND ADDITIONAL LAPAROSCOPIC SURGICAL PROCEDURES. WE ALSO PROVIDE A LOAN FORGIVENESS PROGRAM FOR RESIDENTS INTERESTED IN BECOMING PHYSICIANS AND RETURNING TO OUR AREA. OUR WELLNESS CENTER PROVIDES HEALTH, EDUCATION, AND SOCIAL PROGRAMS FOR TARGETED POPULATIONS. WE HAVE JOINED A REGIONAL STROKE NETWORK AS WELL AS PARTICIPATING IN A NUMBER OF PATIENT AND EDUCATIONAL SUPPORT GROUPS (BETTER BREATHERS, STROKE SUPPORT GROUP, BETTER PARENTING). THE HOSPITAL ALSO PARTICIPATES IN HEALTH PROFESSIONS EDUCATIONAL PROGRAMS. A NUMBER OF OUR PHYSICIANS PROVIDE TRAINING FOR SENIOR MEDICAL STUDENTS THROUGH THE LIMA AREA HEALTH EDUCATION COMMITTEE. A NUMBER OF NURSING EDUCATIONAL PROGRAM USE OUR HOSPITAL TO DO THEIR CLINICAL ROTATIONS. THE HOSPITAL ON AVERAGE SPENDS IN EXCESS OF 1 MILLION DOLLARS IN NEW DIAGNOSTIC TECHNOLOGIES AND OTHER HEALTH RELATED EQUIPMENT TO BETTER DIAGNOSE AND TREAT OUR CLIENTS.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
MARK J MINICK
4081700215727014885607350083270788430000
MICHAEL HOLLIDAY
1454180003897504362069080195663000
CRAIG HANSON MD
14337800019996403688068970353927000
THOMAS CONTE MD
3844700004337807350051420440340000
MUHAMMED AL-FAWAKHIRI MD
1317330004318703374068340185128000
SHANEETA JOHNSON MD
2703330002577800026860298797000
SCOTT JARVIS MD
182483000804210735009850271239000
DOUGLAS MOORE MD
2259450001565100073430248939000
THOMAS LAUTZENHEISER MD
16417100070005076039530173900000

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1COUNTY OF VAN WERT OHIOBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN346401507IssuerEIN
Date Issued1920-10-29DateIssued
Issue Price10755255IssuePrice
Description Of PurposeFINANCE ACQUISITION, CONSTRUCTION, & EQUIPPING OF HOSPITAL FACILITIESDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Current Refunding0CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made0FinalAllocationMade
Adequate Books And Recds Maintaind0AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Post Issuance Compliance Procdrs0PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)

RelationshipRelationshipDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
GEORGE BROOKS
BOARD MEMBER & NORTHWEST OH PRESIDENT OF FIRST FINANCIAL BANKFIRST FINANCIAL BANK HOLDS A PORTION OF HOSPITAL INVESTMENTS AND HOSPITAL LONG TERM DEBT.0
ERIC JELINGER MD
BOARD MEMBER & PRINCIPAL WITH PRINCIPAL WEST OHIO X-RAYWEST OHIO X-RAY CONTRACTS FOR INDEPENDENT PROVISION OF HOSPITAL RADIOLOGY SERVICES0
JON BAGLEY
BOARD MEMBER & PRINCIPAL WITH VANCREST LTDVANCREST LTD IS A JOINT VENTURE PARTNER WITHT THE HOSPITAL INVOLVING NURSING HOME FACILITIES, HOME CARE, AND THERAPY SERVICES0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION B, LINE 11THE AUDIT COMMITTEE REVIEWS AND APPROVES THE 990. IT IS THEN PRESENTED TO THE FULL BOARD DURING A REGULARLY SCHEDULED BOARD MEETING.
A CONFLICT OF INTEREST QUESTIONNARE IS COMPLETED ON AN ANNUAL BASIS AND REVIEWED BY THE EXECUTIVE COMMITTEE. ANY ISSUES THAT ARISE ARE ADDRESSED WITH THE INDIVIDUAL AT THAT POINT. ANY ISSUES THAT ARISE THROUGHOUT THE YEAR ARE DEALT WITH AS NECESSARY.FORM 990, PART VI, SECTION B, LINE 12C
THE COMPENSATION COMMITTEE CONTRACTS WITH AN OUTSIDE, INDEPENDENT FIRM TO PROVIDE A COMPENSATION STUDY AND EVALUATION. THIS STUDY IS USED TO MAKE COMPENSATION DECISIONS.FORM 990, PART VI, SECTION B, LINE 15
THERE IS AN ANNUAL REPORT PREPARED THAT INCLUDES A STATEMENT OF OPERATIONS.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 2,188,264. CHANGE IN RESTRICTED NET ASSETSFORM 990, PART XI, LINE 5:
THE PROCESS HAS NOT CHANGED FROM THE PREVIOUS YEAR.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1VAN WERT MEDICAL SERVICESBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1140 FOX RDAddressLine1
CityVAN WERTCity
StateOHState
ZIP Code45891ZIPCode
FieldValueIRS element (for citing)
EIN202812541EIN
Primary ActivitiesMEDICAL PROFESSIONAL SERVICESPrimaryActivities
Legal Domicile StateOHLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1VAN WERT COUNTY HOSPITAL ASSOCIATIONBusinessNameLine1

Form990 Schedule R Part III Form990ScheduleRPartIII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStatePredominant Income TypePredominantIncomeTypeDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartner
SARAH JANE LIVING CENTER
1250 S WASHINGTON STVAN WERTOH45891311684009LONG TERM ALZHEIMERS CAREOHALZHEIMERS CARE00
HOME HEALTH CARE SOLUTIONS
1250 S WASHINGTON STVAN WERTOH45891200330544HOME HEALTH CARE SERVICESOHHOME CARE00
THERAPY SOLUTIONS
1250 S WASHINGTON STVAN WERTOH45891201417403PHYSICAL THERAPY SERVICESOHTHERAPY CARE00

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY CARE SYSTEMS INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11250 S WASHINGTON STAddressLine1
CityVAN WERTCity
StateOHState
ZIP Code45891ZIPCode
FieldValueIRS element (for citing)
EIN341783212EIN
Primary ActivityHEALTHCARE MANAGEMENT SERVICESPrimaryActivity
Legal Domicile StateOHLegalDomicileState
Type Of EntityCTypeOfEntity
Percentage Ownership0.50000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg