ASHTABULA COUNTY MEDICAL CENTER: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- ASHTABULA COUNTY MEDICAL CENTER (EIN 34-0726081)
- Tax period
- 2022-01-01 to 2022-12-31
- Filed
- 2023-11-15
- IRS object ID
- 202343199349302644
- Schema version
- 2022v5.0
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-11-15T08:23:10-06:00 | ReturnTs |
| Tax Period End | 2022-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 388 SOUTH MAIN STREET SUITE 420 | AddressLine1Txt |
| City | AKRON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44311 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 340726081 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASHTABULA COUNTY MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ASHT | BusinessNameControlTxt |
| Phone | 4409972262 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2420 LAKE AVENUE | AddressLine1Txt |
| City | ASHTABULA | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44004 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHAEL HABOWSKI | PersonNm |
| Person Title | PRESIDENT & CEO | PersonTitleTxt |
| Phone | 4409972262 | PhoneNum |
| Signature | 2023-11-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | MICHAEL | PersonFirstNm |
| Person Last | HABOWSKI | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | 0 | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | LISA HILLING | PreparerPersonNm |
| PTIN | P01624111 | PTIN |
| Phone | 3303760100 | PhoneNum |
| Preparation | 2023-11-13 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MICHAEL HABOWSKI | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2420 LAKE AVENUE | AddressLine1Txt |
| City | ASHTABULA | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44004 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $291,947,852 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 6026 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.ACMCHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1902 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | FULL-SERVICE ACUTE CARE HOSPITAL. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 1160 | TotalEmployeeCnt |
| Total Volunteers | 22 | TotalVolunteersCnt |
| Total Gross UBI | $143,409 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $4,938,666 | PYContributionsGrantsAmt |
| CY Contributions Grants | $8,183,656 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $164,118,347 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $166,339,593 | CYProgramServiceRevenueAmt |
| PY Investment Income | $4,416,803 | PYInvestmentIncomeAmt |
| CY Investment Income | $3,811,641 | CYInvestmentIncomeAmt |
| PY Other Revenue | $582,420 | PYOtherRevenueAmt |
| CY Other Revenue | $660,360 | CYOtherRevenueAmt |
| PY Total Revenue | $174,056,236 | PYTotalRevenueAmt |
| CY Total Revenue | $178,995,250 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $83,699,826 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $84,334,011 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $85,089,634 | PYOtherExpensesAmt |
| CY Other Expenses | $84,863,602 | CYOtherExpensesAmt |
| PY Total Expenses | $168,789,460 | PYTotalExpensesAmt |
| CY Total Expenses | $169,197,613 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,266,776 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $9,797,637 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $214,087,858 | TotalAssetsBOYAmt |
| Total Assets EOY | $274,103,659 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $76,503,362 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $133,081,867 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $137,584,496 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $141,021,792 | NetAssetsOrFundBalancesEOYAmt |
| Mission | ASHTABULA COUNTY MEDICAL CENTER PROVIDES QUALITY HEALTHCARE TO POSITIVELY IMPACT THE HEALTH OF OUR COMMUNITY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $123,857,421 | ExpenseAmt |
| Revenue | $166,339,593 | RevenueAmt |
| Desc | ASHTABULA COUNTY MEDICAL CENTER (ACMC) IS A PRIVATE, NOT-FOR-PROFIT, COMMUNITY-ORIENTED MEDICAL CENTER THAT PROVIDES THE BEST POSSIBLE MEDICAL CARE THROUGH ALL PHASES OF LIFE TO THOSE SEEKING HELP. IN 2022 WE MET OUR MISSION OF MEETING OUR COMMUNITY'S HEALTH CARE NEEDS AS EVIDENCED BY APPROXIMATELY 28,374 EMERGENCY DEPARTMENT VISITS, 4,382 INPATIENT DISCHARGES, 8,677 SURGICAL PROCEDURES (INCLUDING ENDOSCOPY), 0 BIRTHS, 69,705 RADIOLOGY PROCEDURES, AND 271,085 OUTPATIENT PROVIDER ENCOUNTERS. | Desc |
| Total Program Service Expenses | $123,857,421 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | Yes (1) | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 103 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 1160 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MICHAEL HABOWSKI PRESIDENT & CEO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4409972262 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2420 LAKE AVENUE | AddressLine1Txt |
| City | ASHTABULA | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44004 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| NANCY KISTER | ||||||||
| CHAIRPERSON | 0.30 | 0.30 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| CRAIG SERNIK | ||||||||
| VICE CHAIRPERSON | 0.30 | 0.30 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ROGER CORLETT | ||||||||
| SECRETARY/TREASURER | 0.30 | 0.30 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MICHAEL HABOWSKI | ||||||||
| PRESIDENT/CEO | 40.00 | 0.30 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| PEG CARLO | ||||||||
| BOARD MEMBER | 0.30 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| BILL DINGLEDINE | ||||||||
| BOARD MEMBER | 0.30 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| JOE GIANGOLA | ||||||||
| BOARD MEMBER | 0.30 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| REV VERNON PALO | ||||||||
| BOARD MEMBER | 0.30 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| MARLENE SARTINI | ||||||||
| BOARD MEMBER | 0.30 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| DAVID PONTIUS | ||||||||
| BOARD MEMBER | 0.30 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| JIM TIMONERE | ||||||||
| BOARD MEMBER | 0.30 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| RICHARD PARKER MD | ||||||||
| BOARD MEMBER/CCF REPRESENT | 0.30 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| KELLY HANCOCK | ||||||||
| BOARD MEMBER/CCF REPRESENT | 0.30 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| JASON HERGENROEDER | ||||||||
| BOARD MEMBER/CCF REPRESENT | 0.30 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| ALEXANDER TAICH MD | ||||||||
| CHIEF OF STAFF | 60.00 | 0.30 | Yes (X) | $1,370,829 | $0 | $53,005 | ||
| EVANGELOS J BIBIDAKIS | ||||||||
| VICE CHIEF OF STAFF | 60.00 | 0.30 | Yes (X) | $581,541 | $0 | $50,068 | ||
| DON KEPNER | ||||||||
| VP FINANCE/CFO (LEFT 6/3/2 | 40.00 | 0.60 | Yes (X) | $0 | $0 | $0 | ||
| JACQUELYN DIFIORE | ||||||||
| CNO (LEFT 1/31/22) | 40.00 | 0.60 | Yes (X) | $0 | $0 | $0 | ||
| AMANDA CLARK | ||||||||
| CNO (STARTING 5/1/22) | 40.00 | 0.60 | Yes (X) | $0 | $0 | $0 | ||
| NATHANIEL S FRANLEY MD | ||||||||
| PHYSICIAN | 60.00 | 0.00 | $776,780 | $0 | $34,839 | Yes (X) | ||
| JOHN LEE | ||||||||
| PHYSICIAN | 60.00 | 0.00 | $820,363 | $0 | $12,412 | Yes (X) | ||
| SHINOJ PATTALI JAYAVALSAN MD | ||||||||
| PHYSICIAN | 60.00 | 0.00 | $1,075,994 | $0 | $43,431 | Yes (X) | ||
| PAZHANIAANDI TIROUNILACANDIN MD | ||||||||
| PHYSICIAN | 60.00 | 0.00 | $734,778 | $0 | $49,944 | Yes (X) | ||
| SATHISH V ADIGOPULA | ||||||||
| PHYSICIAN | 60.00 | 0.00 | $732,188 | $0 | $51,905 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $6,092,473 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $295,604 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 103 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| AMERISOURCEBERGEN | |||||
| 25199 NETWORK PLACE | CHICAGO | IL | 60673 | MEDICAL | $19,527,988 |
| CLEVELAND CLINIC FOUNDATION | |||||
| PO BOX 931760 | CLEVELAND | OH | 44193 | ADMINISTRATIVE AND CLINICAL SERVICES | $9,614,017 |
| INDEPENDENCE CONSTRUCTION LLC | |||||
| 6400 E SCHAAF ROAD | INDEPENDENCE | OH | 44131 | CONSTRUCTION | $8,191,467 |
| BOSTWICK DESIGN PARTNERSHIP | |||||
| 2729 PROSPECT AVE | CLEVELAND | OH | 44115 | ARCHITECT AND DESIGN | $4,264,662 |
| CGS ADMINISTRATORS | |||||
| 26 CENTURY BLVD STE ST610 | NASHVILLE | TN | 37214 | ADMINISTRATIVE AND BUSINESS SERVICES | $3,890,599 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 108 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $7,712,621 | GovernmentGrantsAmt |
| All Other Contributions | $471,035 | AllOtherContributionsAmt |
| Total Contributions | $8,183,656 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 624100 | $155,236,132 | $155,236,132 |
| MISC OPERATING REVENUE | 624100 | $10,438,260 | $10,438,260 |
| REBATES AND REFUNDS | 624100 | $665,201 | $665,201 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $166,339,593 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,434,478 | TotalRevenueColumnAmt |
| Exclusion | $3,434,478 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $516,951 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $516,951 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $516,951 | TotalRevenueColumnAmt |
| Exclusion | $516,951 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $113,314,285 | SecuritiesAmt |
| Other | $15,480 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $112,952,602 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $361,683 | SecuritiesAmt |
| Other | $15,480 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $377,163 | TotalRevenueColumnAmt |
| Exclusion | $377,163 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PREMIER FITNESS | Desc |
| Business | 713940 | BusinessCd |
| Total Revenue Column | $143,409 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $143,409 | UnrelatedBusinessRevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $143,409 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $178,995,250 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $166,339,593 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $143,409 | UnrelatedBusinessRevenueAmt |
| Exclusion | $4,328,592 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,233,930 | TotalAmt |
| Management And General | $3,233,930 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,064,308 | TotalAmt |
| Program Services | $50,472,940 | ProgramServicesAmt |
| Management And General | $11,591,368 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,364,407 | TotalAmt |
| Management And General | $3,364,407 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,494,557 | TotalAmt |
| Program Services | $11,524,070 | ProgramServicesAmt |
| Management And General | -$29,513 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,176,809 | TotalAmt |
| Program Services | $4,176,809 | ProgramServicesAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $195 | TotalAmt |
| Management And General | $195 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $503,021 | TotalAmt |
| Management And General | $503,021 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $84,396 | TotalAmt |
| Management And General | $84,396 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,877 | TotalAmt |
| Management And General | $52,877 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,035,938 | TotalAmt |
| Program Services | $16,752,745 | ProgramServicesAmt |
| Management And General | $5,283,193 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $218,869 | TotalAmt |
| Program Services | $1,401 | ProgramServicesAmt |
| Management And General | $217,468 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $178,185 | TotalAmt |
| Program Services | $120,049 | ProgramServicesAmt |
| Management And General | $58,136 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,073,128 | TotalAmt |
| Program Services | $22,756 | ProgramServicesAmt |
| Management And General | $2,050,372 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,861 | TotalAmt |
| Program Services | $29,616 | ProgramServicesAmt |
| Management And General | $16,245 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$71,044 | TotalAmt |
| Program Services | -$71,044 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,261,118 | TotalAmt |
| Program Services | $3,293,675 | ProgramServicesAmt |
| Management And General | $967,443 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $855,092 | TotalAmt |
| Program Services | $200,001 | ProgramServicesAmt |
| Management And General | $655,091 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $34,491,030 | $33,496,342 | $994,688 |
| BAD DEBT EXPENSE | $9,366,382 | $133,482 | $9,232,900 |
| EQUIPMENT REPAIRS AND M | $4,950,397 | $2,432,578 | $2,517,819 |
| LICENSES AND PERMITS | $4,114,671 | $106,129 | $4,008,542 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,703,486 | TotalAmt |
| Program Services | $1,165,872 | ProgramServicesAmt |
| Management And General | $537,614 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $169,197,613 | TotalAmt |
| Program Services | $123,857,421 | ProgramServicesAmt |
| Management And General | $45,340,192 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,487,736 | BOYAmt |
| EOY | $12,228,545 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,991,210 | BOYAmt |
| EOY | $75,356,243 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,526,431 | BOYAmt |
| EOY | $19,748,514 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,924,681 | BOYAmt |
| EOY | $2,086,091 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,650,901 | BOYAmt |
| EOY | $3,858,931 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $122,818,930 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $80,297,749 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,585,831 | BOYAmt |
| EOY | $42,521,181 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $116,252,937 | BOYAmt |
| EOY | $104,320,168 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,102,006 | BOYAmt |
| EOY | $3,542,452 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,566,125 | BOYAmt |
| EOY | $10,441,534 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $214,087,858 | BOYAmt |
| EOY | $274,103,659 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,885,861 | BOYAmt |
| EOY | $23,354,523 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $73,895,938 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $903,270 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,617,501 | BOYAmt |
| EOY | $34,928,136 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $76,503,362 | BOYAmt |
| EOY | $133,081,867 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $137,570,194 | BOYAmt |
| EOY | $141,007,490 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,302 | BOYAmt |
| EOY | $14,302 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $137,584,496 | BOYAmt |
| EOY | $141,021,792 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $214,087,858 | BOYAmt |
| EOY | $274,103,659 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $9,797,637 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$15,552,851 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $9,192,510 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $11,597 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $11,597 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | TOTAL DUES OF $44,963 WERE PAID TO THE OHIO HOSPITAL ASSOCIATION BY ACMC, OF WHICH 5.5% WERE RELATED TO LOBBYING ACTIVITIES. TOTAL DUES OF $33,433 WERE PAID TO THE AMERICAN HOSPITAL ASSOCIATION BY ACMC, OF WHICH 27.29% WERE RELATED TO LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,905,338 | OtherCostOrOtherBasisAmt |
| Book Value | $2,905,338 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $42,243,818 | OtherCostOrOtherBasisAmt |
| Depreciation | $28,435,197 | DepreciationAmt |
| Book Value | $13,808,621 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,494,637 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,580,747 | DepreciationAmt |
| Book Value | $913,890 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $57,623,116 | OtherCostOrOtherBasisAmt |
| Depreciation | $48,281,805 | DepreciationAmt |
| Book Value | $9,341,311 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,552,021 | OtherCostOrOtherBasisAmt |
| Book Value | $15,552,021 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $42,521,181 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| DEFERRED COMPENSATION | $3,116,468 |
| INVESTMENT FROM CLEVELAND CLINIC FOUNDATION | $15,000,000 |
| THIRD-PARTY PAYABLES | $3,854,172 |
| SELF-INSURANCE | $12,957,496 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $34,928,136 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | ASHTABULA COUNTY MEDICAL CENTER IS A NONPROFIT CORPORATIONS AND IS RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE. WHEN TAX RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD BE ULTIMATELY SUSTAINED. IN ACCORDANCE WITH THE INCOME TAXES TOPIC OF THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASS) ACCOUNTING STANDARDS CODIFICATION, THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS TAKEN ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY OF BEING REALIZED UPON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| Most Hospitals Policy | Yes (X) | MostHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $982,760 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $982,760 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00580 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $24,638,770 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $19,851,921 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,786,849 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02830 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $185,762 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $678,807 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $25,807,292 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $20,530,728 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,769,609 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03410 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,911,605 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $10,911,605 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06450 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $24,243 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $24,243 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $108,862 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $108,862 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,044,710 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $11,044,710 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06520 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $36,852,002 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $20,530,728 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $16,814,319 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09930 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $9,366,382 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $32,058,294 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $32,151,050 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$92,756 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASHTABULA COUNTY MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2420 LAKE AVENUE | AddressLine1Txt |
| City | ASTHABULA | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44004 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.ACMCHEALTH.ORG | WebsiteAddressTxt |
| State License | 360125 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASHTABULA COUNTY MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.ACMCHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 20 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.ACMCHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.ACMCHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-SERVICES/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.ACMCHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-SERVICES/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.ACMCHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-SERVICES/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| ASHTABULA COUNTY MEDICAL CENTER | PART V, SECTION B, LINE 5: THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT RELIED ON MULTIPLE DATA SOURCES AND COMMUNITY INPUT GATHERED BETWEEN JANUARY AND AUGUST 2019. INPUT FROM 6 PERSONS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY, AS WELL AS A FOCUS GROUP OF KEY CONSTITUENTS, WAS TAKEN INTO ACCOUNT THROUGH KEY INFORMANT INTERVIEWS. INTERVIEWS INCLUDED INDIVIDUALS WITH SPECIAL KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH, LOCAL PUBLIC HEALTH DEPARTMENTS, AGENCIES WITH CURRENT DATA OR INFORMATION ABOUT THE HEALTH AND SOCIAL NEEDS OF THE COMMUNITY, REPRESENTATIVES OF SOCIAL SERVICE ORGANIZATIONS, AND LEADERS, REPRESENTATIVES AND MEMBER OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. SEE PAGE 9 OF THE 2019 CHNA FOR A LIST OF PARTICIPATING ORGANIZATIONS AND AGENCIES. THE HOSPITAL COLLABORATED WITH HEALTH ASHTABULA COUNTY TO CONDUCT AND PRODUCE AN UPDATED CHNA IN LATE-2022 WITH THE IMPLEMENTATION STRATEGY TO BEGIN IN 2023. |
| ASHTABULA COUNTY MEDICAL CENTER | PART V, SECTION B, LINE 11: BECAUSE CALENDAR YEAR 2022 FALLS INTO THE FINAL YEAR OF THE IMPLEMENTATION STRATEGY FOR THE 2019 CHNA, THE ACTIVITIES TO ADDRESS SIGNIFICANT HEALTH NEEDS REMAIN THE SAME AS REPORTED FOR 2021. ASHTABULA COUNTY MEDICAL CENTER HAS A 117-YEAR HISTORY OF PROVIDING SIGNIFICANT AMOUNTS OF COMMUNITY BENEFIT TO THE COMMUNITIES IT SERVES. ACMC WILL CONTINUE THIS COMMITMENT BY ALLOCATING APPROPRIATE HUMAN AND FINANCIAL RESOURCES TO MEET THOSE NEEDS THROUGH THE IMPLEMENTATION OF THE FOLLOWING STRATEGY:IMPROVE ACCESS TO COMPREHENSIVE PRIMARY CARE- OPEN ORWELL FAMILY HEALTH CENTER TO ADDRESS HEALTHCARE PROFESSIONAL SHORTAGE AREA IN SOUTHERN ASHTABULA COUNTY- CREATE PRIMARY CARE TEAM MODEL CONCEPT TO REDUCE WAIT TIME FOR NEW PATIENT APPOINTMENT- CONNECT EXPRESS CARE (WALK-IN CLINIC FOR MINOR ILLNESS/INJURY) TO A PRIMARY CARE PROVIDER- CONNECT EMPLOYEES OF WORKPLACE WELLNESS CLIENTS TO A PRIMARY CARE PROVIDER- CONNECT COMMUNITY MEMBERS AT OUTREACH EVENTS TO A PRIMARY CARE PROVIDER- CONTINUE TO RECRUIT FOR FAMILY MEDICINE, INTERNAL MEDICINE, AND PEDIATRICSIMPROVE ACCESS TO SPECIALTY CARE- CONTINUE TO RECRUIT SPECIALTY PHYSICIANS TO ENSURE ASHTABULA COUNTY RESIDENTS DO NOT HAVE TO LEAVE THE COUNTY FOR SPECIALTY CARE- CONTINUE TO COLLABORATE WITH CLEVELAND CLINIC TO PROVIDE SPECIALISTS AND SPECIALTY CLINICS FOR SERVICES NOT AVAILABLE IN THE COMMUNITYPREVENT HEART DISEASE- IMPLEMENT PRE-HYPERTENSION AND HYPERTENSION PATIENT EDUCATION- PROVIDE FREE HYPERTENSION SCREENINGS AT ACMC EXPRESS CARE LOCATIONS- PROVIDE FREE HYPERTENSION SCREENINGS AT COMMUNITY OUTREACH EVENTS- CONTINUE FREE EXERCISE PRESCRIPTION PROGRAM AT ACMC-OWNED FITNESS CENTERREDUCE THE PREVALENCE OF DIABETES- CONTINUE TO OFFER INPATIENT AND OUTPATIENT DIABETES EDUCATION- INCREASE NUMBER OF PROVIDERS PRESCRIBING EXERCISE- EXPLORE IMPLEMENTATION OF A PRE-DIABETES RISK ASSESSMENT AT PRIMARY CARE APPOINTMENTSREDUCE OBESITY- COLLABORATE WITH THE INTERVENTION AND PREVENTION OF ONGOING DISEASES (IPOD) COMMITTEE OF THE ASHTABULA COUNTY HEALTH DEPARTMENT TO RAISE AWARENESS OF FOOD PANTRIES AND FARMERS' MARKETS, DISTRIBUTE INFORMATION ON WHERE TO OBTAIN FRESH FRUIT AND VEGETABLES, AND DEVELOP A UNIFIED HEALTH CHOICES CAMPAIGN TO INCLUDE PRINT AND SOCIAL MEDIADECREASE DRUG OVERDOSE DEATHS- CONTINUE TO COLLABORATE WITH, AND SUPPORT INITIATIVES OF, THE ASHTABULA COUNTY MENTAL HEALTH RECOVERY SERVICES BOARD AND THE ASHTABULA COUNTY SUBSTANCE ABUSE LEADERSHIP TEAM- EXPLORE THE INCORPORATION OF A SCREENING FOR DRUG USE AND ABUSE FOR ALL PATIENTS AGE 12 AND OLDER- PROVIDE TRAINING TO PROVIDERS ON GUIDELINES FOR OPIOID PRESCRIBINGDECREASE SUICIDE- COLLABORATE WITH ONE ASHTABULA COUNTY SCHOOL DISTRICT EACH YEAR TO IMPLEMENT THE SIGNS OF SUICIDE PREVENTION PROGRAM- CONTINUE TO COLLABORATE WITH, AND SUPPORT INITIATIVES OF, THE ASHTABULA COUNTY MENTAL HEALTH RECOVERY SERVICES BOARD AND THE ASHTABULA COUNTY PREVENTION COALITION ASHTABULA COUNTY MEDICAL CENTER CANNOT ADDRESS ALL OF THE HEALTH NEEDS PRESENT IN THE COMMUNITY. TO ENSURE ACMC REMAINS FINANCIALLY VIABLE AND IN A POSITION TO ENHANCE CURRENT SERVICES, DEVELOP NEW SERVICES AND CONTINUE TO PROVIDE A WIDE RANGE OF COMMUNITY BENEFITS, THE HOSPITAL'S IMPLEMENTATION STRATEGY FOCUS WILL NOT ADDRESS THE FOLLOWING NEEDS:- DENTAL SERVICES- TOBACCO USE- ALCOHOL CONSUMPTION- POVERTY- FOOD INSECURITY- ADVERSE CHILDHOOD EXPERIENCES |
| ASHTABULA COUNTY MEDICAL CENTER | PART V, SECTION B, LINE 20E: THE ORGANIZATION PROVIDES NOTIFICATION REGARDING THE FAP THROUGH SIGNAGE AND OTHER MECHANISMS. THERE ARE A NUMBER OF WRITTEN CORRESPONDENCES THAT GO OUT TO PATIENTS OVER THE COURSE OF 120 DAYS ONCE THE PATIENT RESPONSIBILITY IS DETERMINED FOR THE AMOUNT DUE RELATED TO SERVICES PROVIDED.PART V, SECTION B, LINE 20C: IF AN INCOMPLETE FAP APPLICATION IS RECEIVED, THE ORGANIZATION'S FINANCIAL COUNSELORS CONTACT THE PATIENT FOR ADDITIONAL INFORMATION. |
| ASHTABULA COUNTY MEDICAL CENTER | PART V, SECTION B, LINE 24: ALL PATIENTS ARE CHARGED THE SAME, STANDARD RATE, FOR A PARTICULAR SERVICE. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 9 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - JEFFERSON FAMILY HEALTH CENTER | ||||
| 234 NORTH CHESTNUT STREET | JEFFERSON | OH | 44047 | FAMILY HEALTH CENTER |
| 2 - CONNEAUT FAMILY HEALTH CENTER | ||||
| 354 W MAIN ROAD | CONNEAUT | OH | 44030 | FAMILY HEALTH CENTER |
| 4 - ACMC CENTER FOR DIGESTIVE HEALTH | ||||
| 2112 LAKE AVENUE | ASHTABULA | OH | 44004 | GASTROENTEROLOGY HEALTH CENTER |
| 5 - GENEVA FAMILY HEALTH CENTER | ||||
| 1028 S BROADWAY | GENEVA | OH | 44041 | FAMILY HEALTH CENTER |
| 6 - ASHTABULA FAMILY HEALTH CENTER | ||||
| 2259 LAKE AVENUE | ASHTABULA | OH | 44004 | FAMILY HEALTH CENTER |
| 7 - THE ASHTABULA CLINIC | ||||
| 2422 LAKE AVENUE | ASHTABULA | OH | 44004 | PAIN MANAGEMENT, OCCUPATIONAL HEALTH |
| 8 - ACMC OCCUPATIONAL HEALTH SERVICES | ||||
| 2422 LAKE AVENUE | ASHTABULA | OH | 44004 | OCCUPATIONAL HEALTH |
| 9 - ORWELL FAMILY HEALTH CENTER | ||||
| 8220 OH-45 | ORWELL | OH | 44076 | FAMILY HEALTH CENTER |
| 10 - ASHTABULA CENTER FOR SLEEP MEDICINE | ||||
| 2420 LAKE AVENUE | ASHTABULA | OH | 44004 | SLEEP CENTER |
Supplemental Information Detail SupplementalInformationDetail (19 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | TO QUALIFY FOR THE HOSPITAL CARE ASSURANCE PROGRAM, AN INDIVIDUAL MUST (A) BE A RESIDENT OF THE STATE OF OHIO, (B) NOT BE ENROLLED IN THE MEDICAID (INCLUDING MEDICAID HMO) PROGRAM, AND (C) HAVE FAMILY/HOUSEHOLD INCOME LESS THAN 200% OF FEDERAL POVERTY GUIDELINES. IN ADDITION, BEFORE GRANTING FINANCIAL ASSISTANCE, THE HOSPITAL HAS THE RIGHT TO REQUIRE (A) PROOF OF INCOME, (B) A WRITTEN STATEMENT FOR CLAIMS OF $0 INCOME, (C) INFORMATION ABOUT HSA AND HFSA ACCOUNTS, AND/OR (D) THAT AN INDIVIDUAL APPLY FOR MEDICAID. |
| PART I, LINE 6A: | N/A |
| PART I, LINE 7: | ACMC ESTIMATED CHARITY CARE COSTS BY CALCULATING A RATIO OF COST TO GROSS CHARGES AND THEN MULTIPLYING THAT RATIO BY THE GROSS UNCOMPENSATED CHARGES ASSOCIATED WITH PROVIDING CARE TO CHARITY PATIENTS.ACMC IS PAID A PROSPECTIVELY DETERMINED RATE FOR THE MAJORITY OF INPATIENT ACUTE CARE AND OUTPATIENT, SKILLED NURSING, AND REHABILITATION SERVICES PROVIDED FOR MEDICAID. THESE RATES VARY ACCORDING TO A PATIENT CLASSIFICATION SYSTEM THAT IS BASED ON CLINICAL, DIAGNOSTIC, AND OTHER FACTORS. MEDICAID PAYMENTS FOR CAPITAL ARE RECEIVED ON A COST REIMBURSEMENT METHODOLOGY. PAYMENTS ARE RECEIVED ON A PROSPECTIVE BASIS FOR ACMC'S MEDICAL EDUCATION COSTS, SUBJECT TO CERTAIN LIMITS. PROVISION FOR ESTIMATED RETROACTIVE ADJUSTMENTS, IF ANY, RESULTING FROM REGULATORY MATTERS OR OTHER ADJUSTMENTS UNDER PAYMENT AGREEMENTS ARE ESTIMATED IN THE PERIOD THE RELATED SERVICES ARE PROVIDED. |
| PART I, LINE 7G: | ACMC PROVIDES AN ATHLETIC TRAINER TO THREE HIGH SCHOOLS AT NO COST TO THE SCHOOL DISTRICTS FOR THIS SERVICE. |
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 133,482. |
| PART I, LINE 7C: | ACMC PARTICIPATES IN THE HOSPITAL CARE ASSURANCE PROGRAM (HCAP) TO FINANCIALLY SUPPORT THOSE HOSPITALS THAT SERVICE A DISPROPORTIONATE SHARE OF LOW-INCOME PATIENTS UNABLE TO PAY FOR CARE. HCAP FUNDS BASIC, MEDICALLY NECESSARY HOSPITAL SERVICES FOR PATIENTS WHOSE FAMILY INCOME IS AT OR BELOW THE FEDERAL POVERTY LEVEL, WHICH INCLUDES MEDICAID PATIENTS AND PATIENTS WITHOUT HEALTH INSURANCE. |
| PART I, LINE 7E: | ACMC PROVIDES A SIGNIFICANT RECRUITING SUBSIDY AND GUARANTEE FOR ALL NEW PHYSICIANS THE HOSPITAL RECRUITS. IN ADDITION, THE HOSPITAL PROVIDES A GUARANTEE AFTER THE INITIAL RECRUITMENT FOR SOME PHYSICIANS DUE TO THE PRESSING NEED FOR THE PHYSICIAN'S SPECIALTY. WITHOUT THE HOSPITAL DOING THIS, ACMC WOULD NOT BE ABLE TO PROVIDE MANY OF THESE SERVICES LOCALLY. THE RECRUITMENT AND GUARANTEE COSTS ACMC INCURS REDUCES GEOGRAPHIC AND FINANCIAL BARRIERS TO ACCESSING HEALTH CARE AND IMPROVES THE AVAILABILITY OF HEALTH SERVICES IN THE AREA ACMC SERVES. |
| PART III, LINE 2: | TOTAL BAD DEBT EXPENSE FOR THE ENTIRE HOSPITAL COMPLEX IS EQUAL TO THE TOTAL GROSS CHARGES WRITTEN OFF AS REPORTED ON THE 2022 MEDICARE COST REPORT. |
| PART III, LINE 3: | ASHTABULA COUNTY MEDICAL CENTER DOES NOT HAVE A METHOD TO REASONABLY ESTIMATE THE PORTION OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE BUT DID NOT COMPLETE AN APPLICATION. |
| PART II: | N/A |
| PART III, LINE 4: | SEE THE "PATIENT SERVICE REVENUE AND PATIENT RECEIVABLES" PARAGRAPHS IN NOTE 1 ON PAGES 12-15 IN THE ATTACHED AUDITED FINANCIAL STATEMENTS.ACMC PROVIDES CARE TO PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY AND WHO QUALIFY FOR CHARITY SERVICES PURSUANT TO ESTABLISHED POLICIES OF ACMC. CHARITY SERVICES ARE DEFINED AS THOSE FOR WHICH PATIENTS HAVE THE OBLIGATION AND WILLINGNESS TO PAY BUT DO NOT HAVE THE ABILITY TO DO SO. ACMC DOES NOT INCLUDE CHARITY CARE IN NET PATIENT SERVICE REVENUE. |
| PART III, LINE 8: | MEDICARE SURPLUS IS NOT TREATED AS COMMUNITY BENEFIT. THE AMOUNTS REPORTED WERE GENERATED FROM THE MEDICARE COST REPORT FILED FOR 2022. ACMC IS PAID A PROSPECTIVELY DETERMINED RATE FOR THE MAJORITY OF INPATIENT ACUTE CARE AND OUTPATIENT, SKILLED NURSING, AND REHABILITATION SERVICES PROVIDED FOR MEDICARE. THESE RATES VARY ACCORDING TO A PATIENT CLASSIFICATION SYSTEM THAT IS BASED ON CLINICAL, DIAGNOSTIC, AND OTHER FACTORS. MEDICARE PAYMENTS FOR CAPITAL ARE RECEIVED ON A PROSPECTIVE BASIS. PAYMENTS ARE RECEIVED ON A PROSPECTIVE BASIS FOR ACMC'S MEDICAL EDUCATION COSTS, SUBJECT TO CERTAIN LIMITS. ACMC IS PAID FOR COST REIMBURSABLE ITEMS AT A TENTATIVE RATE, WITH FINAL SETTLEMENT DETERMINED AFTER SUBMISSION OF ANNUAL COST REPORTS BY ACMC AND AUDITS THEREOF BY THE MEDICARE FISCAL INTERMEDIARY. PROVISION FOR ESTIMATED RETROACTIVE ADJUSTMENTS, IF ANY, RESULTING FROM REGULATORY MATTERS OR OTHER ADJUSTMENTS UNDER PAYMENT AGREEMENTS ARE ESTIMATED IN THE PERIOD THE RELATED SERVICES ARE PROVIDED.LAWS AND REGULATIONS GOVERNING MEDICARE ARE COMPLEX AND SUBJECT TO INTERPRETATION AS WELL AS SIGNIFICANT REGULATORY ACTION, AND, IN THE NORMAL COURSE OF BUSINESS, ACMC IS SUBJECT TO CONTRACTUAL REVIEWS AND AUDITS. AS A RESULT, THERE IS AT LEAST A REASONABLE POSSIBILITY THAT RECORDED ESTIMATES WILL CHANGE IN THE NEAR TERM. ACMC BELIEVES IT IS IN COMPLIANCE WITH APPLICABLE LAWS AND REGULATIONS GOVERNING THE MEDICARE PROGRAM AND THAT ADEQUATE PROVISIONS HAVE BEEN MADE FOR ANY ADJUSTMENTS THAT MAY RESULT FROM FINAL SETTLEMENTS. |
| PART III, LINE 9B: | REASONABLE EFFORTS ARE PERFORMED TO DETERMINE THE PATIENT'S ELIGIBILITY UNDER THE HOSPITAL'S FAP AND THE HOSPITAL DOES NOT PERFORM DEBT COLLECTION PROCEDURES BEFORE MAKING THESE REASONABLE EFFORTS. THIS IS ACHIEVED THROUGH THE HCAP APPLICATION. DOCUMENTATION OF THE PATIENT OR FAMILY INCOME FOR HCAP ELIGIBILITY WILL BE BASED UPON A BEST EVIDENCE METHODOLOGY. HOSPITAL EMPLOYEES WILL PROCEED THROUGH THE FOLLOWING IN AN EFFORT TO SECURE THE BEST EVIDENCE AVAILABLE FOR THE PATIENT OR GUARANTOR AT THE TIME OF THEIR ENCOUNTER. 1. A COMPLETED HCAP APPLICATION INCLUSIVE OF THE PATIENT OR GUARANTOR'S SIGNATURE. 2. A COMPLETED HCAP APPLICATION, WHICH INCLUDES THE SIGNATURE OF THE PATIENT REPRESENTATIVE SECURING THE INFORMATION FROM THE RESPONSIBLE PARTY. IF THE APPLICATION CANNOT BE SECURED AT THE TIME OF THE ENCOUNTER, THE RESPONSIBLE PARTY WILL BE PROVIDED WITH A RETURN ENVELOPE. THEY WILL BE ASKED TO PROVIDE THIS INFORMATION UPON THEIR RETURN TO THEIR HOME. IN THE EVENT THAT THE INFORMATION IS RECEIVED, IT IS TO BE REVIEWED AND CONSIDERED AGAINST THE ABOVE-DEFINED ELIGIBILITY DETERMINATION CRITERIA. IF IT IS NOT RETURNED WITHIN 14 DAYS OF DISCHARGE, ACMC CONTACTS THE PATIENT VIA TELEPHONE TO COMPLETE THE APPLICATION. FOR OUTPATIENT HOSPITAL SERVICES, THE ELIGIBILITY DETERMINATION IS EFFECTIVE FOR NINETY DAYS FROM THE INITIAL SERVICE DATE. DURING THIS PERIOD A NEW ELIGIBILITY DETERMINATION NEED NOT BE COMPLETED. ELIGIBILITY FOR INPATIENT HOSPITAL SERVICES MUST BE DETERMINED SEPARATELY FOR EACH ADMISSION, UNLESS THE PATIENT IS READMITTED WITHIN FORTY-FIVE DAYS OF DISCHARGE FOR THE SAME UNDERLYING CONDITION. ELIGIBILITY FOR RECIPIENTS OF THE DISABILITY ASSISTANCE PROGRAM MUST BE VERIFIED ON A MONTHLY BASIS. IN THE EVENT THE PATIENT DOES NOT COMPLETE AN APPLICATION DURING THE ENCOUNTER, AND AS A RESULT OF THE HCAP COMMUNICATION, PATIENT STATEMENTS, OR RESULT OF COLLECTION EFFORTS, HOSPITAL STAFF WILL COMPLETE THE HCAP APPLICATION, OVER THE TELEPHONE OR IN-PERSON, ON BEHALF OF THE RESPONSIBLE PARTY. |
| PART VI, LINE 2: | ACMC USES MARKET DATA THAT REFLECTS ACTUAL PATIENT VISITS (DATA THAT IS SUBMITTED TO THE OHIO HOSPITAL ASSOCIATION BY ALL HOSPITALS IN THE STATE). MANAGEMENT REVIEWS THE NUMBER OF PATIENTS FROM THE MARKET WHO LEAVE ASHTABULA COUNTY FOR HEALTHCARE, AND WHAT SERVICES THEY LEAVE FOR. ACMC CONDUCTS A MEDICAL STAFF DEVELOPMENT PLAN IN WHICH PHYSICIANS ARE ASKED ABOUT THEIR PRACTICE PLANS (PLANNING TO RETIRE, BECOME EMPLOYED, GO INDEPENDENT, EXPAND) AND WHAT SPECIALISTS ARE NEEDED IN THE COMMUNITY TO BETTER SERVE THEIR PATIENTS. THIS HELPS GUIDE THE PHYSICIAN RECRUITMENT EFFORTS TO ENSURE THE HOSPITAL IS MEETING THE HEALTH NEEDS OF THE MARKET. MEMBERS OF THE MANAGEMENT TEAM ACTIVELY SERVE ON THE BOARDS OF COMMUNITY ORGANIZATIONS, MANY OF WHICH HAVE A MISSION TO ADDRESS COMMUNITY NEED; HEALTHCARE BEING ONE OF THOSE NEEDS (COMMUNITY ACTION, SALVATION ARMY, UNITED WAY, CATHOLIC CHARITIES, SENIOR ADVOCACY AND PROTECTIVE NETWORK, ETC.). EVERY 3 YEARS ACMC CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT. THE FINDINGS FROM THAT ASSESSMENT ARE USED TO DEVELOP AN IMPLEMENTATION PLAN TO ADDRESS THE KEY HEALTH NEEDS IN THE COMMUNITY. |
| PART VI, LINE 3: | INFORMATION ABOUT ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS IS DESCRIBED ON THE PATIENT'S BILL, THE POLICY IS POSTED ON THE HOSPITAL'S WEBSITE AND IS ALSO AVAILABLE UPON REQUEST. THE NOTICE, BOTH IN ENGLISH AND SPANISH, IS POSTED AT THE FOLLOWING LOCATIONS: EMERGENCY DEPARTMENT, ALL ADMISSIONS/REGISTRATION AREAS, PATIENT FINANCIAL SERVICES DEPARTMENT. ACMC FINANCIAL COUNSELORS MEET WITH ANY PATIENT THAT MAY NEED ANY FORM OF FINANCIAL AID PRIOR TO DISCHARGE AND EDUCATE THEM ON FINANCIAL ASSISTANCE. |
| PART VI, LINE 4: | AFFILIATED WITH THE CLEVELAND CLINIC, ACMC IS THE LARGEST AND MOST ADVANCED HOSPITAL IN ASHTABULA COUNTY. ACMC OPENS THE DOOR TO THE WORLD'S BEST HEALTHCARE BY APPLYING CLEVELAND CLINIC'S CLINICAL INFORMATION AND STATE-OF-THE-ART STANDARDS OF CARE. THE PRIMARY MARKET IS COMPRISED OF THE FOLLOWING ZIP CODES: 44004, 44005, 44010, 44030, 44032, 44041, 44048, 44068, 44082. THE SECONDARY MARKET IS COMPRISED OF THE FOLLOWING ZIP CODES: 44003, 44076, 44084, 44085, 44093, 44099. THE PAYER MIX IS 50.71% MEDICARE, 24.06% MEDICAID, 23.62% COMMERCIAL, 1.61% SELF PAY. STATISTICS INCLUDED IN THE 2019 CHNA SHOW THAT ASHTABULA COUNTY'S POVERTY RATE IS 19.8% (AMONG THE HIGHEST IN THE STATE), 85.7% OF COUNTY RESIDENTS HAVE A HIGH SCHOOL DIPLOMA, THE MEDIAN HOUSEHOLD INCOME IS $43,017, AND THE MEDIAN PER CAPITA INCOME IS $21,936. |
| PART VI, LINE 5: | ACMC IS AN ACTIVE PARTICIPANT AND SPONSOR OF EVENTS LIKE RELAY FOR LIFE, WALK TO END ALZHEIMER'S AND AMERICAN HEART WALK AND SPONSOR OF HEALTH-RELATED EVENTS OF COMMUNITY ORGANIZATIONS (EXAMPLES: COMMUNITY ACTION HEALTH FAIR). ACMC PUBLISHES A COMMUNITY MAGAZINE TWICE A YEAR WITH HEALTHCARE INFORMATION AND TIPS FOR HEALTHY LIVING. THE WEBSITE CONTAINS HEALTH INFORMATION AND DOWNLOADABLE RESOURCES. THE HOSPITAL HOLDS A WOMEN'S HEART HEALTH EVENT EACH YEAR AND A COMMUNITY CONNECTION FAIR TO INTRODUCE RESIDENTS TO HEALTHCARE SERVICES AND OTHER SERVICES TO ADDRESS SDOH. ACMC PARTICIPATES IN NUMEROUS HEALTH FAIRS AND COMMUNITY EVENTS AT WHICH THE HOSPITAL PROVIDES FREE SCREENINGS (BLOOD PRESSURE, BLOOD SUGAR, BODY MASS INDEX, BACK STRENGTH, CHOLESTEROL). STAFF (PHYSICIANS, CLINICIANS, ETC.) APPEAR ON LOCAL CABLE TV SHOW 2X/MONTH TO SHARE HEALTH INFORMATION. ACMC ALSO PROVIDES AN ATHLETIC TRAINER TO THREE HIGH SCHOOLS (NO COST TO THE SCHOOL DISTRICTS FOR THIS SERVICE). ADDITIONALLY, ACMC PARTICIPATES WITH LOCAL SOCIAL SERVICE AGENCIES ON THEIR PROGRAMS THAT ARE DESIGNED TO IMPROVE THE HEALTH AND WELL-BEING OF ASHTABULA COUNTY RESIDENTS. EXAMPLES INCLUDE: FEED THE HOPE, BRIDGES OUT OF POVERTY, REMOTE AREA MEDICAL CLINIC. |
| PART VI, LINE 6: | ACMC IS AN AFFILIATE OF THE CLEVELAND CLINIC. THE CLEVELAND CLINIC HEALTH SYSTEM ENGAGES IN MANY COMMUNITY OUTREACH PROGRAMS, INCLUDING INITIATIVES DESIGNED TO SERVE THE VULNERABLE AND AT-RISK POPULATIONS IN OUR COMMUNITIES. CLEVELAND CLINIC'S OUTREACH PROGRAMS RANGE FROM FREE HEALTH SCREENINGS AND CLINICAL SERVICES TO ENROLLMENT ASSISTANCE FOR GOVERNMENT-FUNDED HEALTH PROGRAMS. COMMUNITY OUTREACH PROGRAMS ARE ALSO THOSE PROGRAMS THAT IMPROVE ACCESS TO HEALTH SERVICES. CLEVELAND CLINIC CAREGIVERS COLLABORATE WITH COMMUNITY ORGANIZATIONS TO PROVIDE A CONTINUUM OF CARE THAT SUPPORTS ECONOMICALLY AND MEDICALLY UNDERSERVED AREAS. THE 2021 COMMUNITY BENEFIT REPORT PUBLISHED BY THE CLEVELAND CLINIC STATED $1.41 BILLION WAS SPENT BY THE CLEVELAND CLINIC IN 2021 ON COMMUNITY BENEFIT PROGRAMS. |
| PART VI, LINE 7: | N/A |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ALEXANDER TAICH MD | ||||||||||||||
| CHIEF OF STAFF | $1,370,649 | $0 | $0 | $0 | $180 | $0 | $12,200 | $0 | $40,805 | $0 | $1,423,834 | $0 | $0 | $0 |
| SHINOJ PATTALI JAYAVALSAN MD | ||||||||||||||
| PHYSICIAN | $627,501 | $0 | $448,313 | $0 | $180 | $0 | $12,200 | $0 | $31,231 | $0 | $1,119,425 | $0 | $0 | $0 |
| JOHN LEE | ||||||||||||||
| PHYSICIAN | $715,819 | $0 | $103,356 | $0 | $1,188 | $0 | $12,200 | $0 | $212 | $0 | $832,775 | $0 | $0 | $0 |
| NATHANIEL S FRANLEY MD | ||||||||||||||
| PHYSICIAN | $744,660 | $0 | $31,956 | $0 | $164 | $0 | $12,200 | $0 | $22,639 | $0 | $811,619 | $0 | $0 | $0 |
| PAZHANIAANDI TIROUNILACANDIN MD | ||||||||||||||
| PHYSICIAN | $632,257 | $0 | $102,341 | $0 | $180 | $0 | $12,200 | $0 | $37,744 | $0 | $784,722 | $0 | $0 | $0 |
| SATHISH V ADIGOPULA | ||||||||||||||
| PHYSICIAN | $652,945 | $0 | $79,063 | $0 | $180 | $0 | $12,200 | $0 | $39,705 | $0 | $784,093 | $0 | $0 | $0 |
| EVANGELOS J BIBIDAKIS | ||||||||||||||
| VICE CHIEF OF STAFF | $556,805 | $0 | $23,962 | $0 | $774 | $0 | $12,113 | $0 | $37,955 | $0 | $631,609 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | SALARIES ARE REVIEWED APPROXIMATELY EVERY TWO YEARS. SALARIES ARE COMPARED TO LOCAL, REGIONAL, AND NATIONAL MARKET RATES AND IN CONJUNCTION WITH THE CEO AND CFO TO DETERMINE COMPENSATION. WHEN OPENINGS FOR KEY POSITIONS BECOME AVAILABLE, THE HUMAN RESOURCES DEPARTMENT EXAMINES THE MARKET RATES TO DETERMINE A STARTING SALARY. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OHIO HIGHER EDUCATIONAL FACILITY COMMISSION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 346849674 | BondIssuerEIN |
| CUSIP | 677510CY3 | CUSIPNum |
| Bond Issued | 2022-05-18 | BondIssuedDt |
| Issue Price | $76,303,245 | IssuePriceAmt |
| Purpose | HEALTHCARE FACILITY REVENUE BONDS, SERIES 2022 | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | $76,303,245 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $1,440,400 | IssuanceCostsFromProceedsAmt |
| Other Spent Proceeds | $6,501,545 | OtherSpentProceedsAmt |
| Unspent | $68,361,300 | UnspentAmt |
| Refunding Tax Exempt Bonds | 0 | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (1) | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | Yes (1) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| KIMBERLY GIANGOLA | |||
| FAMILY MEMBER OF JOSEPH GIANGOLA, ACMC TRUSTEE | $37,510 | EMPLOYMENT AGREEMENT WITH ACMC | 0 |
| BRITTANY COACH | |||
| FAMILY MEMBER OF PEG CARLO, ACMC TRUSTEE | $89,407 | EMPLOYMENT AGREEMENT WITH ACMC | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE CLEVELAND CLINIC FOUNDATION HOLDS AND EXERCISES A MANAGEMENT AGREEMENT WITH ACMC. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE CLEVELAND CLINIC FOUNDATION IS THE SOLE SPECIAL MEMBER OF ASHTABULA COUNTY MEDICAL CENTER. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE BOARD MEMBERS ARE APPOINTED BY THE CLEVELAND CLINIC FOUNDATION, THE SPECIAL MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE FOLLOWING MATTERS REQUIRE THE APPROVAL OF THE CLEVELAND CLINIC FOUNDATION, THE SPECIAL MEMBER: (A) CHANGES TO THE ARTICLES OF INCORPORATION OR THE CODE OF REGULATIONS THAT WOULD HAVE A MATERIAL ADVERSE IMPACT ON THE SPECIAL MEMBER'S RIGHTS; (B) ANY AFFILIATION OF ACMC OR ITS SUBSIDIARIES OR AFFILIATES WITH ANY OTHER HOSPITAL, HOSPITAL SYSTEM, OR HEALTH CARE SYSTEM WHICH INCLUDES HOSPITALS AS PART OF SUCH SYSTEM; (C) ANY MATERIAL CHANGE TO ACMC'S OPERATION OR PURPOSE SUCH THAT ACMC'S PRINCIPAL ACTIVITY CEASES TO BE AN ACUTE CARE INPATIENT HOSPITAL OF NO LESS THAN 200 LICENSED BEDS; (D) SELECTION OF ACMC'S PRESIDENT/CEO; AND (E) REVIEW AND COORDINATION WITH ACMC OF ALL MANAGED CARE AND EMPLOYER CONTRACTS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 REPORT IS PUBLISHED TO THE BOARD OF DIRECTORS' WEBSITE PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH TRUSTEE, PRINCIPAL OFFICER, MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS, AND KEY EMPLOYEE SHALL ANNUALLY SIGN A STATEMENT, WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE CORPORATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IF A PERSON COVERED BY THE CONFLICT OF INTEREST POLICY BELIEVES HE OR SHE HAS A POTENTIAL CONFLICT OF INTEREST, THAT PERSON IS TO DISCLOSE THE CONFLICT TO THE BOARD. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE OR SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. THE DISCLOSING PERSON MAY MAKE A PRESENTATION REGARDING THE PROPOSED TRANSACTION/POTENTIAL CONFLICT OF INTEREST AT THE BOARD OR COMMITTEE MEETING, BUT AFTER SUCH PRESENTATION, HE OR SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE PROPOSED TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE CONFLICT OF INTEREST. THE CHAIRPERSON OF THE BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE CORPORATION CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THE BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED TRUSTEES WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTEREST AND FOR ITS OWN BENEFIT AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO THE CORPORATION AND SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE MEMBER AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT THE MEMBER HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. |
| FORM 990, PART VI, SECTION B, LINE 15 | SALARIES ARE REVIEWED APPROXIMATELY EVERY TWO YEARS. SALARIES ARE COMPARED TO LOCAL, REGIONAL, AND NATIONAL MARKET RATES AND IN CONJUNCTION WITH THE CEO AND CFO TO DETERMINE COMPENSATION. WHEN OPENINGS FOR KEY POSITIONS BECOME AVAILABLE, THE HUMAN RESOURCES DEPARTMENT EXAMINES THE MARKET RATES TO DETERMINE A STARTING SALARY. |
| FORM 990, PART VI, SECTION C, LINE 19 | ALL REQUESTS ARE SENT TO THE CEO FOR DISTRIBUTION. |
| FORM 990, PART VII, SECTION A | THE FOLLOWING OFFICERS WORKING FULL-TIME FOR ACMC ARE EMPLOYED BY THE CLEVELAND CLINIC AND ARE COMPENSATED THROUGH EMPLOYMENT AGREEMENTS WITH THE CLEVELAND CLINIC: MICHAEL HABOWSKI, PRESIDENT/CEO; DON KEPNER, VP FINANCE/CFO; AMANDA CLARK, CNO. IN ADDITION, OTHER EXECUTIVES WORK FULL TIME FOR ACMC AND ARE EMPLOYED BY THE CLEVELAND CLINIC, THOSE EXECUTIVES ARE LEW HUTCHISON, VICE PRESIDENT OPERATIONS AND QUALITY AND JONATHAN FORBES, DIRECTOR, HUMAN RESOURCES. |
| FORM 990, PART IX, LINE 11G | PURCHASED MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 16,752,745. MANAGEMENT AND GENERAL EXPENSES 5,283,193. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,035,938. |
| FORM 990, PART XI, LINE 9: | EQUITY INCOME IN AFFLIATE 6,640,446. EFFECT OF RECOGNITION PROVISION AT MEASUREMENT DATE OF PENSION OBLIGATION 2,552,064. NET ASSET TRANSFER FROM A RELATED ENTITY |
| FEDERAL ELECTIONS | SECTION 1.263(A)-1(F) DE MINIMIS SAFE HARBOR ELECTION ASHTABULA COUNTY MEDICAL CENTER 2420 LAKE AVENUE ASHTABULA, OH 44004 EMPLOYER IDENTIFICATION NUMBER: 34-0726081 FOR THE YEAR ENDING DECEMBER 31, 2022. ASHTABULA COUNTY MEDICAL CENTER IS MAKING THE DE MINIMIS SAFE HARBOR ELECTION UNDER REG. SEC. 1.263(A)-1(F). |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| ASHTABULA COUNTY MEDICAL CENTER FOUNDATION | ||||||||||
| 2420 LAKE AVENUE | ASHTABULA | OH | 44004 | 341392784 | SUPPORT THE ASHTABULA COUNTY MEDICAL CENTER | OH | 501(C)(3) | LINE 12A, I | ASHTABULA COUNTY MEDICAL CENTER | Yes (1) |
| ROCK CREEK MEDICAL CENTER (DBA GLENBEIGH HEALTH SOURCES) | ||||||||||
| 2863 STATE ROUTE 45 | ROCK CREEK | OH | 44084 | 341789783 | OPERATE AND MAINTAIN A HOSPITAL AND OUTPATIENT CENTERS | OH | 501(C)(3) | LINE 3 | ASHTABULA COUNTY MEDICAL CENTER | Yes (1) |
| ASHTABULA REGIONAL HOME HEALTH SERVICES | ||||||||||
| 3949 JEFFERSON ROAD | ASHTABULA | OH | 44004 | 341143158 | HOME HEALTH SERVICES | OH | 501(C)(3) | LINE 10 | ASHTABULA COUNTY MEDICAL CENTER | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| ASHTABULA COUNTY MEDICAL CENTER FOUNDATION | ||
| Q | $226,845 | CASH RECEIVED |
| ASHTABULA REGIONAL HOME HEALTH SERVICES | ||
| Q | $199,663 | CASH RECEIVED |
| ROCK CREEK MEDICAL CENTER (DBA GLENBEIGH HEALTH SOURCES) | ||
| Q | $1,002,394 | CASH RECEIVED |
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