2021-05-14T14:06:23-05:00 2020-06-30 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2019-07-01 200934451 AVITA HEALTH FOUNDATION AVIT 4194684841 269 PORTLAND WAY SOUTH GALION OH 44833 D ERIC DRAIME CFO 4194684841 2021-05-14 1 AMY CIMINELLO P00796388 6148493000 2021-05-11 2019 2022-09-23 18:48:47Z JERRY MORASKO 269 PORTLAND WAY SOUTH GALION OH 44833 780516 0 X N/A X 2004 OH INSPIRE 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. 13 13 0 13 0 0 427459 722337 0 0 29584 859 2999 32263 460042 755459 175722 74306 0 0 0 0 0 0 158300 122253 171541 297975 245847 162067 509612 1482251 2039772 3068 4515 1479183 2035257 TO 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. 0 0 74306 74306 0 SUPPORT AVITA HEALTH SYSTEM, GALION, BUCYRUS, AND ONTARIO HOSPITALS AND SUBSIDIARY ORGANIZATIONS THAT PROMOTE HEALTH CARE IN CRAWFORD COUNTY, OHIO AND SURROUNDING COUNTIES. 74306 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 13 13 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 X D ERIC DRAIME 4194685501 269 PORTLAND WAY SOUTH GALION OH 44833 JERRY MORASKO PRESIDENT 0.20 40.60 X X 0 722458 3318 D ERIC DRAIME CFO 0.20 40.60 X X 0 322212 0 CHANEL HIPP VICE CHAIR 0.20 0.00 X X 0 0 0 DAWN RATLIFF CHAIR 0.20 0.00 X X 0 0 0 BOYD EPPERSON DIRECTOR 0.20 0.20 X 0 0 0 ERIC GEYER DIRECTOR 0.20 0.00 X 0 0 0 ERIC HAUS DIRECTOR 0.20 0.00 X 0 0 0 LARRY MORRISON DIRECTOR 0.20 0.00 X 0 0 0 MARYLYN STRANG DIRECTOR 0.20 0.00 X 0 0 0 MATT HORN DIRECTOR 0.20 0.00 X 0 0 0 MYLES CREED SECRETARY/TREASURER 0.20 0.00 X 0 0 0 NICHOLAS GESOURAS DIRECTOR 0.20 0.00 X 0 0 0 RANDY MCDONALD DIRECTOR 0.20 0.00 X 0 0 0 RICHARD HARER DIRECTOR 0.20 0.00 X 0 0 0 TROY SAPP DIRECTOR 0.20 0.00 X 0 0 0 0 1044670 3318 0 0 1 0 0 492083 187512 40000 2742 722337 859 859 57320 492083 25057 32263 32263 755459 0 0 33122 74306 74306 112597 112597 3807 3807 16462 16462 888 888 36746 9434 27312 1041 1041 245847 74306 13241 158300 496106 999236 15917 986145 1024619 1482251 2039772 3068 4515 3068 4515 X 980649 1098772 498534 936485 1479183 2035257 1482251 2039772 509612 46462 0 X X 0 1 X 1 0 X 512569 377025 388606 420419 722337 2420956 512569 377025 388606 420419 722337 2420956 223827 2197129 20017 9553 27243 29584 859 87256 133395 117445 71422 118531 57320 498113 3006325 0.73080 0.77960 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 HELD FOR FUTURE INVESTMENTS 1024619 1024619 OH CRISIS FUND 175288 175288 COMPREHENSIVE CAMPAIGN 138568 138568 1 235547 178227 57320 4152 3608 17297 549403 492083 57320 4152 3608 17297 25057 32263 1 GALION COMMUNITY HOSPITAL 269 PORTLAND WAY SOUTH GALION OH 448332399 344451872 501(C)(3) 74306 SUPPORT THE HOSPITAL'S TAX EXEMPT PURPOSE 1 0 PART I, LINE 2: GRANTS ARE USED TO SUPPORT THE TAX-EXEMPT PURPOSE OF RELATED ENTITIES. THESE ARE MONITORED INTERNALLY. 0 0 0 0 0 0 0 0 0 JERRY MORASKO PRESIDENT 0 663542 0 58916 0 0 0 0 0 3318 0 725776 0 0 D ERIC DRAIME CFO 0 279962 0 42250 0 0 0 0 0 0 0 322212 0 0 PART I, LINE 3: AVITA 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 COMMITTEE FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION SHALL, AT ALL TIMES, BE GALION COMMUNITY HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS OR DIRECTORS SHALL HAVE THE APPROVAL OF THE BOARD OF DIRECTORS OF GALION COMMUNITY HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B THE 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 8B THE ORGANIZATION DOES NOT HAVE SUB-COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE 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 12C GALION 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 19 NO 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 2C THE ORGANIZATION HAS A FINANCE COMMITTEE WHICH OVERSEES THE AUDIT OF THE FINANCIAL STATEMENTS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. GALION COMMUNITY HOSPITAL 269 PORTLAND WAY SOUTH GALION OH 44833 344451872 HOSPITAL SERVICES OH 501(C)(3) LINE 3 AVITA HEALTH SYSTEM 1 COMMUNITY HEALTH ASSOCIATES INC 955 BUCYRUS ROAD GALION OH 44833 341784017 PHYSICIAN OFFICE OH 501(C)(3) LINE 12A, I GALION COMMUNITY HOSPITAL 1 NORTH CENTRAL OHIO FAMILY CARE CENTER INC 269 PORTLAND WAY SOUTH GALION OH 44833 341807906 PHYSICIAN OFFICE OH 501(C)(3) LINE 12A, I GALION COMMUNITY HOSPITAL 1 AVITA HEALTH SYSTEM 269 PORTLAND WAY SOUTH GALION OH 44833 274385692 HEALTHCARE OH 501(C)(3) LINE 12B, II N/A 0 CRAWFORD COUNTY SHARED HEALTH SERVICES INC 1220 NORTH MARKET STREET GALION OH 44833 341484014 HOME HEALTH & HOSPICE OH 501(C)(3) LINE 11 GALION COMMUNITY HOSPITAL 1 GALION COMMUNITY PAIN MANAGEMENT LLC 269 PORTLAND WAY SOUTH GALION OH 44833 300602607 HOSPITAL SUPPORT OH N/A GALION COMMUNITY VASCULAR SERVICES LLC 269 PORTLAND WAY SOUTH GALION OH 44833 611613817 HOSPITAL SUPPORT OH N/A AMERICAN SURGICAL SPINE SERVICES 629 N SANDUSKY AVE BUCYRUS OH 44820 371786727 HOSPITAL SUPPORT OH N/A 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1