FURP.ORG / PUBLIC DATA EXPLORER

AVITA HEALTH FOUNDATION: Form 990, tax year 2023

View the entire original 990 at ProPublica ↗

Organization
AVITA HEALTH FOUNDATION (EIN 20-0934451)
Tax period
2023-07-01 to 2024-06-30
Filed
2025-05-15
IRS object ID
202521359349304952
Schema version
2023v6.0
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)
Return2025-05-15T09:53:46-05:00ReturnTs
Tax Period End2024-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN331498605PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1PLANTE & MORAN PLLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1250 S HIGH ST SUITE 100AddressLine1Txt
CityCOLUMBUSCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43215ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2023-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN200934451EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1AVITA HEALTH FOUNDATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlAVITBusinessNameControlTxt
Phone4194684841PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1269 PORTLAND WAY SOUTHAddressLine1Txt
CityGALIONCityNm
State AbbreviationOHStateAbbreviationCd
ZIP44833ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonD ERIC DRAIMEPersonNm
Person TitleCFOPersonTitleTxt
Phone4194684841PhoneNum
Signature2025-05-13SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd
FieldValueIRS element (for citing)
IRS Responsible Prty Info CurrYes (1)IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonAMY CIMINELLOPreparerPersonNm
PTINP00796388PTIN
Phone6148493000PhoneNum
Preparation2025-03-26PreparationDt
FieldValueIRS element (for citing)
Tax2023TaxYr
Build TS2025-03-06 01:10:19ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJERRY MORASKOPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1269 PORTLAND WAY SOUTHAddressLine1Txt
CityGALIONCityNm
State AbbreviationOHStateAbbreviationCd
ZIP44833ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$1,337,187GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressHTTPS://AVITAHEALTH.ORG/FOUNDATION/WebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2004FormationYr
Legal Domicile StateOHLegalDomicileStateCd
Activity Or MissionINSPIRE PHILANTHROPY AND PROVIDE FINANCIAL SUPPORT TO GALION COMMUNITY HOSPITAL AND AVITA HEALTH SYSTEM IN WAYS THAT HAVE A POSITIVE IMPACT ON PATIENTS, EMPLOYEES, AND THE COMMUNITY.ActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent11VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers11TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$1,067,540PYContributionsGrantsAmt
CY Contributions Grants$1,149,323CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$38,527PYInvestmentIncomeAmt
CY Investment Income$46,923CYInvestmentIncomeAmt
PY Other Revenue-$132,030PYOtherRevenueAmt
CY Other Revenue-$46,804CYOtherRevenueAmt
PY Total Revenue$974,037PYTotalRevenueAmt
CY Total Revenue$1,149,442CYTotalRevenueAmt
PY Grants And Similar Paid$466,070PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$432,234CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$249,351CYTotalFundraisingExpenseAmt
PY Other Expenses$286,856PYOtherExpensesAmt
CY Other Expenses$273,752CYOtherExpensesAmt
PY Total Expenses$752,926PYTotalExpensesAmt
CY Total Expenses$705,986CYTotalExpensesAmt
PY Revenues Less Expenses$221,111PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$443,456CYRevenuesLessExpensesAmt
Total Assets BOY$3,242,643TotalAssetsBOYAmt
Total Assets EOY$3,892,159TotalAssetsEOYAmt
Total Liabilities BOY$3,377TotalLiabilitiesBOYAmt
Total Liabilities EOY$9,627TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$3,239,266NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$3,882,532NetAssetsOrFundBalancesEOYAmt
MissionTO INSPIRE PHILANTHROPY AND TO PROVIDE FINANCIAL SUPPORT TO GALION AND BUCYRUS COMMUNITY HOSPITALS IN ORDER TO ENHANCE HEALTHCARE SERVICES AND TO IMPROVE THE WELL BEING OF THE RESIDENTS OF OUR COMMUNITIES.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$432,234ExpenseAmt
Grant$432,234GrantAmt
Revenue$0RevenueAmt
DescSUPPORT AVITA HEALTH SYSTEM, GALION, BUCYRUS, AND ONTARIO HOSPITALS AND SUBSIDIARY ORGANIZATIONS THAT PROMOTE HEALTH CARE IN CRAWFORD COUNTY, OHIO AND SURROUNDING COUNTIES.Desc
Total Program Service Expenses$432,234TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising ActivitiesYes (1)FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To IndividualsYes (1)GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo ContributionsYes (1)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (1)QuidProQuoContriDisclInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member11IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of Committees0MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1D ERIC DRAIMEBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone4194680501PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1269 PORTLAND WAY SOUTHAddressLine1Txt
CityGALIONCityNm
State AbbreviationOHStateAbbreviationCd
ZIP44833ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
JERRY MORASKO
PRESIDENT0.2040.60Yes (X)Yes (X)$0$775,227$19,187
D ERIC DRAIME
CFO0.2040.60Yes (X)Yes (X)$0$405,852$3,050
MYLES CREED
SECRETARY/TREASURER/VP OF MEDICAL STAFF0.2039.80Yes (X)Yes (X)$0$229,576$5,867
MATT HORN
VICE CHAIR0.200.00Yes (X)Yes (X)$0$0$0
RANDY MCDONALD
CHAIR0.200.00Yes (X)Yes (X)$0$0$0
DR ERIC HAUS
DIRECTOR0.2040.60Yes (X)$0$475,748$9,565
LARRY MORRISON
DIRECTOR0.200.00Yes (X)$0$0$0
MARYLYN STRANG
DIRECTOR0.200.00Yes (X)$0$0$0
BOYD EPPERSON
HONORARY DIRECTOR0.200.00Yes (X)$0$0$0
DAWN RATLIFF
DIRECTOR0.200.00Yes (X)$0$0$0
NICHOLAS GESOURAS
DIRECTOR0.200.00Yes (X)$0$0$0
ERIC GEYER
HONORARY DIRECTOR0.200.00Yes (X)$0$0$0
RICHARD HARER
DIRECTOR0.200.00Yes (X)$0$0$0
TROY SAPP
DIRECTOR0.200.00Yes (X)$0$0$0
CALEB ULMER
DIRECTOR0.200.00Yes (X)$0$0$0
DR GWENDOLINE FANG
DIRECTOR0.2040.60Yes (X)$0$376,384$9,958
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$2,262,787TotReportableCompRltdOrgAmt
Total Other Compensation$47,627TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Fundraising$466,728FundraisingAmt
Related Organizations$391,298RelatedOrganizationsAmt
Government Grants$23,710GovernmentGrantsAmt
All Other Contributions$267,587AllOtherContributionsAmt
Total Contributions$1,149,323TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$46,923TotalRevenueColumnAmt
Exclusion$46,923ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$140,941FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$466,728ContriRptFundraisingEventAmt
Fundraising Direct Expenses$187,745FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column-$46,804TotalRevenueColumnAmt
Exclusion-$46,804ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,149,442TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$119ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$407,734TotalAmt
Program Services$407,734ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$24,500TotalAmt
Program Services$24,500ProgramServicesAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$189,769TotalAmt
Fundraising$189,769FundraisingAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$9,860TotalAmt
Management And General$9,860ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$49,067TotalAmt
Fundraising$49,067FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$22,908TotalAmt
Management And General$14,541ManagementAndGeneralAmt
Fundraising$8,367FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$2,148TotalAmt
Fundraising$2,148FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$705,986TotalAmt
Program Services$432,234ProgramServicesAmt
Management And General$24,401ManagementAndGeneralAmt
Fundraising$249,351FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,915,187BOYAmt
EOY$2,357,463EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$9,935BOYAmt
EOY$9,585EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,317,521BOYAmt
EOY$1,525,111EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$3,242,643BOYAmt
EOY$3,892,159EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$3,377BOYAmt
EOY$9,627EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$3,377BOYAmt
EOY$9,627EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,622,971BOYAmt
EOY$1,987,250EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,616,295BOYAmt
EOY$1,895,282EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$3,239,266BOYAmt
EOY$3,882,532EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$3,242,643BOYAmt
EOY$3,892,159EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$443,456ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$199,810NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit RequiredYes (1)FederalGrantAuditRequiredInd
Federal Grant Audit Performed0FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$722,337CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,237,953CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,253,985CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,067,540CurrentTaxYearMinus1YearAmt
Current Tax Year$1,149,323CurrentTaxYearAmt
Total$5,431,138TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$722,337CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,237,953CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,253,985CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,067,540CurrentTaxYearMinus1YearAmt
Current Tax Year$1,149,323CurrentTaxYearAmt
Total$5,431,138TotalAmt
FieldValueIRS element (for citing)
Substantial Contributors Tot$840,776SubstantialContributorsTotAmt
Public Support Total170$4,590,362PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$859CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$28,390CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$33,447CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$38,527CurrentTaxYearMinus1YearAmt
Current Tax Year$46,923CurrentTaxYearAmt
Total$148,146TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$57,320CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$13,823CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$50,396CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$180,728CurrentTaxYearMinus1YearAmt
Current Tax Year$140,941CurrentTaxYearAmt
Total$443,208TotalAmt
FieldValueIRS element (for citing)
Total Support$6,022,492TotalSupportAmt
Public Support CY1700.76220PublicSupportCY170Pct
Public Support PY1700.72400PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Book Value Land Buildings$0TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp

FieldValueIRS element (for citing)
DescHELD FOR FUTURE INVESTMENTSDesc
Book Value$1,525,111BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Other Assets$1,525,111TotalBookValueOtherAssetsAmt

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1COMPREHENSIVE CAMPAIGNEvent1Nm
Gross Receipts Event1$116,625GrossReceiptsEvent1Amt
Charitable Contri Event1$116,625CharitableContriEvent1Amt
Event2CORNERSTONEEvent2Nm
Gross Receipts Event2$180,640GrossReceiptsEvent2Amt
Charitable Contri Event2$180,640CharitableContriEvent2Amt
Other Events Total1OtherEventsTotalCnt
Gross Receipts Other Events$310,404GrossReceiptsOtherEventsAmt
Charitable Contri Other Events$169,463CharitableContriOtherEventsAmt
Gross Revenue Other Events$140,941GrossRevenueOtherEventsAmt
Oth Direct Expnss Other Events$187,745OthDirectExpnssOtherEventsAmt
Gross Receipts Total$607,669GrossReceiptsTotalAmt
Charitable Contributions Tot$466,728CharitableContributionsTotAmt
Gross Revenue Total Events$140,941GrossRevenueTotalEventsAmt
Oth Direct Expnss Total Events$187,745OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$187,745DirectExpenseSummaryEventsAmt
Net Income Summary-$46,804NetIncomeSummaryAmt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1GALION COMMUNITY HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1269 PORTLAND WAY SOUTHAddressLine1Txt
CityGALIONCityNm
State AbbreviationOHStateAbbreviationCd
ZIP448332399ZIPCd
FieldValueIRS element (for citing)
Recipient EIN344451872RecipientEIN
IRC Section501(C)(3)IRCSectionDesc
Cash Grant$407,734CashGrantAmt
Non Cash Assistance$0NonCashAssistanceAmt
Purpose Of GrantSUPPORT THE HOSPITAL'S TAX EXEMPT PURPOSEPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)

Grant TypeGrantTypeTxtRecipientRecipientCntCash GrantCashGrantAmt
AVITA EMPLOYEE CRISIS12$12,000
SCHOLARSHIP23$12,500

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 2:GRANTS ARE USED TO SUPPORT THE TAX-EXEMPT PURPOSE OF RELATED ENTITIES. THESE ARE MONITORED INTERNALLY.
SCHEDULE I, PART III:GALION COMMUNITY HOSPITAL EMPLOYEES ARE ELIGIBLE FOR REIMBURSEMENT. APPLICATIONS ARE APPROVED BY HUMAN RESOURCES. TUITION INVOICES AND GRADES ARE MONITORED BY THE CONTROLLER TO MAKE SURE THE STUDENT MEETS CERTAIN CRITERIA TO RECEIVE THE FUNDS.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
JERRY MORASKO
PRESIDENT$0$706,318$0$68,909$0$0$0$0$0$19,187$0$794,414$0$0
DR ERIC HAUS
DIRECTOR$0$320,005$0$155,743$0$0$0$0$0$9,565$0$485,313$0$0
D ERIC DRAIME
CFO$0$353,139$0$52,713$0$0$0$0$0$3,050$0$408,902$0$0
DR GWENDOLINE FANG
DIRECTOR$0$355,367$0$21,017$0$0$0$0$0$9,958$0$386,342$0$0
MYLES CREED
SECRETARY/TREASURER/VP OF MEDICAL ST$0$200,237$0$29,339$0$0$0$0$0$5,867$0$235,443$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 3:FormAndLineReferenceDesc
ExplanationAVITA HEALTH FOUNDATION RELIED ON A RELATED ORGANIZATION THAT USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD -COMPENSATION COMMITTEEExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6THE SOLE MEMBER OF THE CORPORATION SHALL, AT ALL TIMES, BE GALION COMMUNITY HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7AMEMBERS OR DIRECTORS SHALL HAVE THE APPROVAL OF THE BOARD OF DIRECTORS OF GALION COMMUNITY HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7BTHE MEMBER HAS THE RIGHT TO APPROVE OR RATIFY DECISIONS OF THE ORGANIZATION'S GOVERNING BODY, SUCH AS APPROVAL OF THE GOVERNING BODY'S ELECTION OR REMOVAL OF MEMBERS.
FORM 990, PART VI, SECTION A, LINE 8BTHE ORGANIZATION DOES NOT HAVE SUB-COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11BTHE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS AND SENT TO THE EXECUTIVE COMMITTEE OF GALION COMMUNITY HOSPITAL'S BOARD FOR THEIR REVIEW PRIOR TO FILING. THE BOARD EXECUTIVE COMMITTEE APPROVES THE FORM 990 FOLLOWING REVIEW, AS AUTHORIZED BY THE FULL GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 12CGALION COMMUNITY HOSPITAL HAS A CONFLICT OF INTEREST POLICY THAT COVERS ALL BOARD OF DIRECTORS AND OFFICERS OF THE CORPORATION. CONFLICT OF INTEREST SURVEYS ARE REVIEWED BY BOARD CHAIRMAN AND THE CEO TO ENSURE COMPLIANCE. VARIOUS RESTRICTIONS ARE IMPOSED ON INDIVIDUALS WITH POTENTIAL CONFLICTS OF INTEREST (I.E. INABILITY TO VOTE) UNTIL DECISION HAS BEEN MADE ON POTENTIAL CONFLICT. AVITA HEALTH FOUNDATION HAS ADOPTED THIS POLICY.
FORM 990, PART VI, SECTION C, LINE 19NO DOCUMENTS ARE AVAILABLE TO THE PUBLIC, OTHER THAN THE FINANCIAL STATEMENTS WHICH ARE ATTACHED TO GALION COMMUNITY HOSPITAL'S FORM 990.
FORM 990, PART XI, LINE 2CTHE ORGANIZATION HAS A FINANCE COMMITTEE WHICH OVERSEES THE AUDIT OF THE FINANCIAL STATEMENTS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
FORM 990, PART XII, LINE 3B:SINGLE AUDIT IS IN PROCESS AND WILL BE COMPLETED ON A CONSOLIDATED BASIS.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
GALION COMMUNITY HOSPITAL
269 PORTLAND WAY SOUTHGALIONOH44833344451872HOSPITAL SERVICESOH501(C)(3)LINE 3AVITA HEALTH SYSTEMYes (1)
COMMUNITY HEALTH ASSOCIATES INC
955 BUCYRUS ROADGALIONOH44833341784017PHYSICIAN OFFICEOH501(C)(3)LINE 12A, IGALION COMMUNITY HOSPITALYes (1)
NORTH CENTRAL OHIO FAMILY CARE CENTER INC
269 PORTLAND WAY SOUTHGALIONOH44833341807906PHYSICIAN OFFICEOH501(C)(3)LINE 12A, IGALION COMMUNITY HOSPITALYes (1)
AVITA HEALTH SYSTEM
269 PORTLAND WAY SOUTHGALIONOH44833274385692HEALTHCAREOH501(C)(3)LINE 12B, II0N/A
CRAWFORD COUNTY SHARED HEALTH SERVICES INC
1220 NORTH MARKET STREETGALIONOH44833341484014HOME HEALTH & HOSPICEOH501(C)(3)LINE 11GALION COMMUNITY HOSPITALYes (1)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdDisproportionate AllocationsDisproportionateAllocationsIndGeneral Or Managing PartnerGeneralOrManagingPartnerInd
GALION COMMUNITY PAIN MANAGEMENT LLC
269 PORTLAND WAY SOUTHGALIONOH44833300602607HOSPITAL SUPPORTOHN/A00
GALION COMMUNITY VASCULAR SERVICES LLC
269 PORTLAND WAY SOUTHGALIONOH44833611613817HOSPITAL SUPPORTOHN/A00
AMERICAN SURGICAL SPINE SERVICES
629 N SANDUSKY AVEBUCYRUSOH44820371786727HOSPITAL SUPPORTOHN/A00
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other OrgYes (1)TransferFromOtherOrgInd