2021-10-28T13:52:35-05:00 2020-12-31 550486667 Arnett Carbis Toothman LLP P O Box 2629 Charleston WV 25329 990 2020-01-01 812817266 Adams County Regional Medical Center ADAM 8778295500 230 Medical Center Dr Seaman OH 45679 Pete R Dagenbach CFO 9373863001 2021-10-28 1 Pete Dagenbach 999009999 Dolores Rose P01286262 3043460441 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Pete R Dagenbach 230 Medical Center Dr Seaman OH 45679 38670161 0 X acrmc.com X 2016 OH To provide quality health care close to home and to meet community's needs, excel at customer service and be the first choice for healthcare needs. 7 7 269 25 0 0 12973 136181 7961651 33255389 8720 19757 546307 5258834 8529651 38670161 0 0 0 0 3185422 12174222 0 0 0 4891556 25339134 8076978 37513356 452673 1156805 36797475 44624639 28780820 35399708 8016655 9224931 To provide quality health care close to home. To meet the community's needs, to excel at customer service and to be your first choice for healthcare needs. 0 0 23853653 38514223 ACRMC has five locations and provides a wide range of services to meet the healthcare needs of Adams County and its surrounding communities. Health care services provided include, but are not limited to: surgical, orthopedic, women's health, rehabilitation, senior life solutions, sleep lab, advanced imaging and cardio/pulmonary. It is a critical access hospital with 25 beds and 24/7/365 emergency department and online care. ACRMC has provided 3,416 adult and pediatric beds, 1,450 swing-beds, 1,370 observation bed days. Charity care was provided in the amount of $87,381. An annual health fair provides affordable heatlh screenings and an opportunity for community members to share feedback on their thoughts and desires regarding the health and well-being of their communities, through a survey. 23853653 1 1 0 0 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 20 0 269 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 OH X Pete Dagenbach CFO 9373863007 230 Medical Center Dr Seaman OH 45679 Jack McCoy Chairman 1.50 X X 0 0 0 Sherri Spenser Vice-Chair 1.50 X X 0 0 0 Chad Wilson Treasurer 1.50 X X 0 0 0 Dane Clark Member 1.50 X 0 0 0 Spud Gustin Member 1.50 X 0 0 0 Matt Armstrong Member 1.50 X 0 0 0 Peggy Chalker Member 1.50 X 0 0 0 Alan Bird CEO 40.00 X 0 0 0 Pete Dagenbach CFO 40.00 X 143973 0 26279 Sarah Gerlach DO 40.00 X 248379 0 4863 Rachel D Cummings CNO 40.00 X 146267 0 0 538619 0 31142 3 0 1 0 Emergency Professional Services Inc PO Box 634850 Cincinnati OH 452634850 Staffing ER Physicians 731362 Rural Hospital Group 4770 N Bellview Ave Suite 205 Gladstone MO 64116 Hospital Management Group 580285 RDI 4350 Glandale-Milford Rd Suite 250 Cincinnati OH 45242 IT Support and Staffing 496560 Psychiatric Medical Care Inc PO Box 734606 Dallas TX 753734606 Senior Life Solution Program 423902 TKH Anesthesia LLC 3675 River Birch Ct Bellbrook OH 45305 Anesthesia Services 345640 8 35192 100989 136181 Patient Services 622110 33255389 33255389 33255389 19757 19757 Govt Stimulus Revenue 900099 3947991 3947991 Sales Tax Levy Income 900099 605113 605113 Cares Act 900099 283184 283184 422546 422546 5258834 38670161 38514223 0 19757 X 170252 73532 96720 10138513 4378824 5759689 759199 327898 431301 1106258 477793 628465 104864 104864 6535766 3789538 2746228 70252 70252 1643301 710242 933059 476920 205982 270938 33496 14467 19029 1816117 784381 1031736 1571513 678736 892777 249560 107785 141775 Bad Debt 8900725 8900725 Medical Supplies 2998632 2998632 Medicaid Assistance 514410 222174 292236 Dues and Subscriptions 125512 54209 71303 298066 128735 169331 37513356 23853653 13659703 0 4340706 10695009 1888850 5970556 3926907 303707 325141 33542 243377 24458627 1943211 23106106 22515416 58405 59122 2569846 2518139 89570 175464 325037 2277214 36797475 44624639 4153724 4629962 3878754 24003981 24050906 50842 64588 572273 2775498 28780820 35399708 X 7939852 9122925 76803 102006 8016655 9224931 36797475 44624639 X 1156805 2471 49000 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 19353100 742677 18610423 3381899 1141784 2240115 1723628 58750 1664878 22515416 Bond Indenture 2518139 C 2518139 Donor Restricted funds 102006 WV Family Med Building Restricted 2103955 Estimate Third Party Settlements 71253 2277214 Capital lease obligations 336464 PPP Loan 2439034 2775498 X 29729064 2471 2471 29726593 8943568 8943568 38670161 28594991 0 28594991 8918365 8918365 37513356 Part X, Line 2: The Hospital is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code (Code) and has been recognized as tax exempt under Section 501(a) of the Code. Accordingly, no provision for income taxes has been provided. The Center follows the guidance for accounting for uncertainty in income taxes recognized in a company's financial statements that prescribes a recognition threshold of more-likely-than-not to be sustained upon examination by the appropriate taxing authority. Measurement of the tax uncertainty occurs if the recognition threshold has been met. The Center's policy is to recognize interest related to unrecognized tax benefits in interest expense and penalties in operating expenses. There were no interest or penalties recognized on the statement of operations and changes in net assets in 2020. Part XI, Line 2d - Other Adjustments: Net asset increase for amount of consideration in excess of FV for purchase Transfer from County- donor restricted funds Part XI, Line 4b - Other Adjustments: Bad debt expense 8,900,725. Revenue netted with expense on fin. stmts. 17,640. Revenue reported on 990 not reported on fin. stmts. 25,203. Part XII, Line 4b - Other Adjustments: Bad debt expense 8,900,725. Revenue netted with expense on FS 17,640. 1 1 X 1 X 1 X 1 1 1 0 0 677845 516160 161685 0.00430 7379044 5260499 2118545 0.05650 8056889 5776659 2280230 0.06080 8056889 5776659 2280230 0.06080 5730347 5792871 -62524 X 1 1 1 1 Adams County Regional Medical Center Inc 230 Medical Center Drive Seaman OH 45679 https://acrmc.com/ X X X X Adams County Regional Medical Center 1 0 1 0 0 1 X 100.000000000000 300.000000000000 X X 1 1 X X X 1 X https://acrmc.com/financial-assistance/ X X X X X X 1 X 0 X X X 1 X 0 0 Adams County Regional Medical Center Part V, Section B, Line 2: The Center's nonprofit entity was organized and registered in the State of Ohio in 2016 and received 501(c)3 nonprofit status from the IRS effective May 31, 2016. However, the nonprofit Center did not acquire the County owned hospital until October 1, 2019.On October 1, 2019, the Center acquired all of the assets, the operations, and assumed all of the liabilities, excluding the Pension and OPEB liabilities of the Adams County Regional Medical Center (County Owned). The Center transitioned to the 501(c)3 nonprofit hospital as of October 1, 2019. The Center is in the process of conducting a community health needs assessment as of the filing date of the 990 tax return. 3 1 - Family Medicine - Georgetown 900 Mt Orab Pike Georgetown OH 45131 Clinic 2 - Family Medicine - West Union 211 North Wilson Drive West Union OH 45693 Clinic 3 - Family Medicine - Winchester 19262 State Route 136 Winchester OH 45697 Clinic Part III, Line 8: The Medicare cost report was used to calculate the Medicare allowable costs and reimbursements. Part VI, Line 2: The Center provides an annual health fair screening and asks the participants to complete a survey. Part VI, Line 3: All patients are informed of application process, prior to service. Part VI, Line 4: Adams County is a rural, medically underserved area, located approximately fifty miles east of Cincinnati along the Ohio River. Adams County has a population of approximately 28,550. In the County, the population is spread out, with 26.40% under the age of 18, 8.70% from 18 to 24, 28.20% from 25 to 44, 23.40% from 45 to 64, and 13.30% who were 65 years of age or older. The median age was 36 years. The median household income is $36,894. Approximately 20% of the population is in poverty. Part VI, Line 5: The community health fair and a rural health clinic with walk-in appointments. X 0 0 0 0 0 0 0 0 0 Sarah Gerlach DO 248379 0 0 0 0 0 0 0 4863 0 253242 0 0 0 Pete Dagenbach CFO 143973 0 0 0 0 0 0 0 26279 0 170252 0 0 0 Form 990, Part VII, Section A, Line 5 Unrelated Organization Officer Compensation: The Center has a management services agreement with Rural Hospital Group. The Rural Hospital Group provides a full-time Chief Executive Officer (CEO) to the Hospital. As of the filing date of the 990, Alan Bird is the CEO. The CEO's compensation for the period of 1/1/20 to 12/31/20 was $193,750. A County of Adams OH Series 2019 Bonds 00610PAH9 2019-09-27 25400000 To finance acquisition of existing hospital facilities in Adams County, OH 0 0 0 A 24892000 2075280 508000 1 0 0 1 A 0 0 0 0 0 0 0 0 0 A 0 Form 990, Part VI, Section B, line 11b The 990 will be distributed to all board members. It will be presented and discussed at a Board of Trustees meeting after the completion of Form 990. Form 990, Part VI, Section B, line 12c ACRMC Conflict of Interest Policy requires that all personnel shall upon hire and annually thereafter sign a statement which affirms the person's understanding and adherence to the policy. The compliance committee meets each quarter and the HIM Director performs HIPAA audits. Form 990, Part VI, Section B, line 15 Salary surveys and recommendations from the CEO are used to determine the organization's officers or key employees salaries. The salary recommendations are reviewed and approved by the CEO. Form 990, Part VI, Section C, line 19 The organization's governing documents, policies and financial statements are available upon request. Form 990, Part IX, line 11g Maintenance Contracts: Program service expenses 526,764. Management and general expenses 692,879. Fundraising expenses 0. Total expenses 1,219,643. Other Purchased Services: Program service expenses 1,561,065. Management and general expenses 2,053,349. Fundraising expenses 0. Total expenses 3,614,414. Contracted Medical Services: Program service expenses 1,701,709. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,701,709. Form 990, Part XI, line 9: Non-controlling interest of joint venture 49,000. Adams County Regional Medical Pain Management LLC 230 Medical Center Dr Seaman OH 45679 853030741 Healthcare OH Adams County Regional Medical Center Related -12907 50995 0 0 0.51000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0