JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL (EIN 34-1623770)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-11-13
- IRS object ID
- 201843179349306909
- Schema version
- 2017v2.3
- 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 G
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-11-13T15:45:40-06:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 381357951 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 65 EAST STATE STREET SUITE 600 | AddressLine1Txt |
| City | COLUMBUS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43215 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 341623770 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOINT TOWNSHIP DISTRICT | BusinessNameLine1Txt |
| Business Name Line2 | MEMORIAL HOSPITAL | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | JOIN | BusinessNameControlTxt |
| Phone | 4193943387 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 ST CLAIR STREET | AddressLine1Txt |
| City | ST MARYS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45885 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEFFREY W VOSSLER | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 4193943387 | PhoneNum |
| Signature | 2018-11-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | BERNIE OSTROWSKI | PreparerPersonNm |
| PTIN | P00366367 | PTIN |
| Phone | 6148493000 | PhoneNum |
| Preparation | 2018-11-12 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 67.59.56.30 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-11-12 | IPDt |
| IP Tm | 12:15:56 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 591040A78CBC3F75C461B288E321443036B4F4D8 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAND LAKE HEALTH SYSTEM | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KEVIN HARLAN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 ST CLAIR STREET | AddressLine1Txt |
| City | ST MARYS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45885 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $77,339,157 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.GRANDLAKEHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1989 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | TO OPTIMIZE THE HEALTH STATUS OF THOSE WE SERVE BY PROVIDING THE HIGHEST QUALITY, VALUE AND SERVICE WHILE REMAINING FINANCIALLY STRONG. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 674 | TotalEmployeeCnt |
| Total Volunteers | 148 | TotalVolunteersCnt |
| Total Gross UBI | $47,554 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $17,257 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $481,258 | PYContributionsGrantsAmt |
| CY Contributions Grants | $338,872 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $73,890,404 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $75,232,028 | CYProgramServiceRevenueAmt |
| PY Investment Income | $194,046 | PYInvestmentIncomeAmt |
| CY Investment Income | $544,848 | CYInvestmentIncomeAmt |
| PY Other Revenue | $600,319 | PYOtherRevenueAmt |
| CY Other Revenue | $759,086 | CYOtherRevenueAmt |
| PY Total Revenue | $75,166,027 | PYTotalRevenueAmt |
| CY Total Revenue | $76,874,834 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $114,383 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $64,523 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $29,209,665 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $30,609,702 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $30,000 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $29,996 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $177,840 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $39,764,841 | PYOtherExpensesAmt |
| CY Other Expenses | $40,653,454 | CYOtherExpensesAmt |
| PY Total Expenses | $69,118,889 | PYTotalExpensesAmt |
| CY Total Expenses | $71,357,675 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $6,047,138 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,517,159 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $72,272,389 | TotalAssetsBOYAmt |
| Total Assets EOY | $71,601,089 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $18,816,436 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $18,343,551 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $53,455,953 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $53,257,538 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO OPTIMIZE THE HEALTH STATUS OF THOSE WE SERVE BY PROVIDING THE HIGHEST QUALITY, VALUE AND SERVICE WHILE REMAINING FINANCIALLY STRONG.VISION:TO BE:-THE REGION'S LEADER AND PREFERRED CHOICE FOR HEALTHCARE;-THE MOST DESIRED PLACE FOR EMPLOYMENT;-THE RECOGNIZED SOURCE FOR HEALTH AND WELLNESS; AND-THE COORDINATOR OF PATIENT SERVICES THAT EXCEED THE SCOPE OF OUR HEALTH SYSTEM.VALUES:COMPASSION - TO SERVE WITH DIGNITY, CONCERN, TRUST AND KINDNESSRESPECT - FOR OUR PATIENTS, FAMILIES, COMMUNITIES AND EACH OTHERSTEWARDSHIP - MAKING THE BEST USE OF OUR HUMAN AND ECONOMIC RESOURCESSERVICE EXCELLENCE - ANTICIPATING CUSTOMER NEEDS, CONTINUOUSLY IMPROVING AND CONSISTENTLY EXCEEDING EXPECTATIONSCOLLABORATION - TO WORK IN PARTNERSHIP, INTERNALLY AND EXTERNALLY, TO BETTER SERVE OUR COMMUNITIESWORKFORCE - TO VALUE AND RESPECT THE TALENTED, COMMITTED AND DIVERSE PEOPLE WHO MAKE UP OUR HEALTH SYSTEM | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $58,928,190 | ExpenseAmt |
| Grant | $64,523 | GrantAmt |
| Revenue | $75,367,193 | RevenueAmt |
| Desc | JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL IS LOCATED IN ST. MARYS (AUGLAIZE COUNTY), A RURAL SMALL TOWN ENVIRONMENT DOMINATED BY AGRICULTURE AND SMALL MANUFACTURING. JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL'S CORE SERVICE AREA OF ST. MARYS, MINSTER, NEW BREMEN AND NEW KNOXVILLE ZIP CODES INCLUDES A POPULATION OF 24,632. THE ADJACENT COMMUNITY OF CELINA (ZIP CODE POPULATION OF 19,621) IS ALSO SERVED BY THE HOSPITAL. THE HOSPITAL ALSO PROVIDES SERVICES TO THE WAPAKONETA COMMUNITY (POPULATION 18,258) ALTHOUGH THE TRADITIONAL SERVICE PATTERNS SEND THAT COMMUNITY'S PATIENTS TO LIMA. THE ABOVE COMMUNITIES ACCOUNT FOR OVER 80% OF JTDMH'S PATIENTS. THOSE ZIP CODES HAVE A TOTAL POPULATION OF 62,511 WITH 15% IN THE MEDICARE AGE GROUP (65+).JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL PROVIDES A FULL RANGE OF ACUTE AND OUTPATIENT SERVICES INCLUDING A 24-HOUR EMERGENCY ROOM AND OBSTETRICAL SERVICE. MAJOR SERVICES INCLUDE SURGICAL; MEDICAL; SKILLED NURSING UNIT; ICU/CCU; DIAGNOSTIC RADIOLOGY INCLUDING CT AND MRI; PHYSICAL THERAPY; OCCUPATIONAL MEDICINE; CARDIAC SERVICES, URGENT CARE, HOME HEALTH SERVICES, HOSPICE, WOUND CARE AND VEIN CLINIC SERVICES.DURING 2017, JTDMH PROVIDED SERVICES TO THE FOLLOWING BY CATEGORY:ACUTE PATIENTS ADMITTED: 1,717SNF PATIENTS ADMITTED: 200BIRTHS: 332OUTPATIENT VISITS: 72,017E.R. VISITS: 13,592HOME HEALTH VISITS: 7,393OCCUPATIONAL HEALTH VISITS: 12,447URGENT CARE: 7,912JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL AND GRAND LAKE HEALTH SYSTEM IS THE HUB OF THE LOCAL HEALTH CARE DELIVERY SYSTEM IN ST. MARYS AND SURROUNDING COMMUNITIES. THE NON-PROFIT COMMUNITY HOSPITAL ALSO HAS A MAJOR ECONOMIC IMPACT ON THE LOCAL COMMUNITY BY PROVIDING EMPLOYMENT TO OVER 600 INDIVIDUALS. THE GRAND LAKE HEALTH SYSTEM INCLUDES PHYSICIAN PRACTICES AND FACILITIES IN CELINA, ST. MARYS, WAPAKONETA, AND MINSTER. IN 2017, THESE PRACTICES HAD OVER 63,199 PATIENT VISITS.GRAND LAKE HEALTH SYSTEMGRAND LAKE HEALTH SYSTEM AND AFFILIATED HEALTH CENTERS ARE ORGANIZED AS A CHARITABLE, NON-PROFIT COMMUNITY HOSPITAL OFFERING A WIDE RANGE OF PRIMARY, ACUTE AND REHABILITATIVE SERVICES TO THE RESIDENTS OF THE GRAND LAKE REGION.THE ANCHOR OF GRAND LAKE HEALTH SYSTEM IS JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL IN ST. MARYS OHIO. JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL OPENED ITS DOORS ON MAY 5, 1953 AND TODAY AS THE GRAND LAKE HEALTH SYSTEM, HAS GROWN TO A STATE-OF-THE-ART COMMUNITY HOSPITAL INCLUDING OVER 800 MEDICAL PROFESSIONALS, 200 + PHYSICIANS AND 16 AFFILIATES.THE GRAND LAKE HEALTH SYSTEM PROVIDES A WIDE RANGE OF SERVICES INCLUDING THE FOLLOWING CENTERS OF EXCELLENCE: EMERGENCY CARDIAC CARE HOME HEALTH BIRTHING CENTER TRANSITIONAL CARE INPATIENT REHABILITATION SURGICAL SERVICES OUTPATIENT SERVICES URGENT CARE WOMEN'S IMAGING WOUND CAREGRAND LAKE AFFILIATES INCLUDE: JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL GRAND LAKE FAMILY PRACTICE & PEDIATRICS AT THE CELINA MEDICAL CENTER WAPAKONETA PRIMARY CARE AT THE WAPAKONETA MEDICAL CENTER GRAND LAKE HOME HEALTH GRAND LAKE HOSPICE GRAND LAKE PRIMARY CARE AT ST. MARYS GRAND LAKE OB/GYN GRAND LAKE OCCUPATIONAL MEDICINE MIAMI & ERIE FAMILY PRACTICE & PEDIATRICS GRAND LAKE SLEEP CENTER NEW DAY PAIN MANAGEMENT CENTER GRAND LAKE NEUROLOGICAL CENTER VANAN ENT & SINUS CENTER JTDMH TRANSITIONAL CARE UNIT JTDMH INPATIENT REHAB UNIT JAMES REICHERT, D.O. GENERAL & BARIATRIC SURGERY URGENT CARE AT JTDMH AUGLAIZE MERCER UROLOGY CLEAR PASSAGE GERIATRIC PSYCHIATRIC CENTER CANCER CENTER OF NORTHWEST OHIO WEST CENTRAL OHIO REGIONAL HEALTHCARE ALLIANCE GRAND LAKE PEDIATRICSGRAND LAKE HEALTH SYSTEM IS THE RECIPIENT OF MANY DISTINGUISHED QUALITY AWARDS.MEDICARE 2017 5-STAR RATING, HOSPITAL COMPARE CONSUMER-ORIENTED WEBSITEBIRTHING CENTER2015 OHIO FIRST STEPS FOR HEALTHY BABIES, ONE STAR AWARD2015 ANTHEM BLUE DISTINCTION CENTER FOR MATERNITY CAREEMERGENCY DEPARTMENT 2015 DNV ACUTE STROKE READY CERTIFICATION 2015 WOMEN'S CHOICE AWARD FOR EMERGENCY DEPARTMENT 2016 WOMEN'S CHOICE AWARD FOR EMERGENCY DEPARTMENT 2017 WOMEN'S CHOICE AWARD FOR EMERGENCY DEPARTMENTTRANSITIONAL CARE UNIT PERFECT SURVEY AWARD PRESENTED BY THE OHIO ACADEMY NURSING HOMES 2011 RECOGNIZED BY OHIO HEALTH CARE ASSOCIATION FOR DEFICIENCY FREE SURVEY 2010RANKED 4TH IN THE STATE OF OHIO IN PATIENT SATISFACTION SURVEY CONDUCTED BY THE DEPARTMENT OF AGING - 2011RANKED 5 STAR IN "NURSING HOME COMPARE" CMS. 2010-2012 FOR OVERALL RATING, HEALTH INSPECTIONS, AND STAFFING STATE OF OHIO PATIENT SATISFACTION SURVEY, TOP 20 2013 2014 RECOGNITION FOR INPATIENT SERVICES TCU DEFICIENCY FREE SURVEY TCU 5-STAR RATINGWOUND CARE CENTER 2015 HEALOGICS CENTER OF DISTINCTION AWARD 2015 ROBERT A WARRINER III CENTER OF EXCELLENCE AWARD 2016 HEALOGICS CENTER OF DISTINCTION AWARD 2016 ROBERT A WARRINER III CENTER OF EXCELLENCE AWARD 2017 ROBERT A WARRINER III CENTER OF EXCELLENCE AWARDCARDIAC CARE FIVE-STAR RECIPIENT FOR TREATMENT OF HEART FAILURE FOR 9 YEARS IN A ROW (2005-2013)ORTHOPEDIC CARE FIVE-STAR RECIPIENT FOR HIP FRACTURE TREATMENT FOR 3 YEARS IN A ROW (2011-2013)PULMONARY CARE RECIPIENT OF THE HEALTHGRADES PULMONARY CARE EXCELLENCE AWARD IN 2013 RANKED IN THE TOP 10% IN THE NATION FOR OVERALL PULMONARY SERVICES IN 2013 FIVE-STAR RECIPIENT FOR OVERALL PULMONARY SERVICES FOR 2 YEARS IN A ROW (2012-2013) FIVE-STAR RECIPIENT FOR TREATMENT OF PNEUMONIA FOR 7 YEARS IN A ROW (2007-2013)GENERAL SURGERY RECIPIENT OF THE HEALTHGRADES GASTROINTESTINAL CARE EXCELLENCE AWARD IN 2013 RECIPIENT OF THE HEALTHGRADES GENERAL SURGERY EXCELLENCE AWARD IN 2013 RANKED IN THE TOP 10% IN THE NATION FOR OVERALL GI SERVICES IN 2013 RANKED IN THE TOP 10% IN THE NATION FOR GENERAL SURGERY IN 2013 RANKED #8 IN OHIO FOR GI SERVICES IN 2013 RANKED #4 IN OHIO FOR GENERAL SURGERY IN 2013 RANKED IN THE TOP 10 IN OHIO FOR GI SERVICES IN 2013 (RANKED 8 IN 2013) RANKED IN THE TOP 5 IN OHIO FOR GENERAL SURGERY IN 2013 (RANKED 4 IN 2013) FIVE-STAR RECIPIENT FOR CHOLECYSTECTOMY IN 2013CRITICAL CARE FIVE-STAR RECIPIENT FOR TREATMENT OF RESPIRATORY FAILURE FOR 5 YEARS IN A ROW (2009-2013)HOME HEALTH & HOSPICE AWARDS2011 OUTSTANDING HOME HEALTH AIDE AWARD, WEST CENTRAL OHIO HOME HEALTH ORGANIZATION 2012 COMMUNITY SERVICE AWARD, OTTERBEIN (HOSPICE) 2012 PRESIDENT'S AWARD FOR CUSTOMER SATISFACTION 2012 HOME CARE ELITE AWARD 2012 HOME CARE ELITE TOP 500 AGENCIES NATIONWIDE 2013 HOME CARE ELITE 2013 DAILY POINT OF LIGHT AWARD FOR HOSPICE VOLUNTEERS 2013 LEVEL ONE FOR "WE HONOR VETERANS" PROGRAM 2014 HOME CARE ELITE 2015 HOME CARE ELITE AWARD OF EXCELLENCE 2017 CERTIFIED HOSPICE AND PALLIATIVE NURSE (CHPN) JANE STEINEMANN 2017 CAHPS HOSPICE SURVEY, SCORES SIGNIFICANTLY EXCEED NATIONAL AVERAGEINFORMATION SYSTEMS HEALTH CARE'S MOST WIRED 2013 MOST IMPROVED HEALTH CARE'S MOST WIRED 2014 MOST IMPROVED HEALTH CARE'S MOST WIRED 2015 MOST IMPROVED HEALTH CARE'S MOST WIRED 2016 - SMALL & RURAL HEALTH CARE'S MOST WIRED 2017 | Desc |
| Total Program Service Expenses | $58,928,190 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| 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 | 0 | 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 | Yes (1) | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | 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 | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | 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 | 145 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 674 | 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | 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 | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JEFFREY W VOSSLER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4193943387 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 ST CLAIR ST | AddressLine1Txt |
| City | ST MARYS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45885 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| CHRIS SCHROER | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| RAJENDRA KAKARLA MD | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $203,652 | $0 | $0 | |||
| SUSAN INGRAHAM | |||||||||
| DIRECTOR - PART YEAR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| CLAUDIA COE | |||||||||
| DIRECTOR (SEPTEMBER-PRESENT) | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| ANITA GREEN | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| JEREMIE KOENIG | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| SEETARAM RAVIPATI MD | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $2,400 | $0 | $0 | |||
| ROBIN BRANDT | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| DALE LUEBKE | |||||||||
| CHAIRMAN | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| KRAIG NOBLE | |||||||||
| VICE CHAIR | 1.50 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| KEVIN HARLAN | |||||||||
| PRESIDENT | 26.50 | 13.50 | $386,773 | $188,367 | $86,351 | Yes (X) | |||
| JEFFREY VOSSLER | |||||||||
| TREASURER | 35.00 | 5.00 | $230,618 | $0 | $35,861 | Yes (X) | |||
| JILL DICKMAN | |||||||||
| SECRETARY | 35.00 | 5.00 | $80,930 | $0 | $35,251 | Yes (X) | |||
| DEB MCKEE | |||||||||
| VP OF PATIENT CARE SERVICE | 40.00 | 0.00 | $207,930 | $0 | $49,571 | Yes (X) | |||
| ART SWAIN | |||||||||
| VP OF SUPPORT SERVICES | 40.00 | 0.00 | $184,050 | $0 | $46,712 | Yes (X) | |||
| LANA HINDERS | |||||||||
| DIRECTOR OF EMERGENCY AND AMBULATORY CARE | 40.00 | 0.00 | $116,793 | $0 | $39,081 | Yes (X) | |||
| TYLER KROEGER | |||||||||
| DIRECTOR OF PHARMACY | 40.00 | 0.00 | $117,679 | $0 | $29,211 | Yes (X) | |||
| CINDY BERNING | |||||||||
| EXECUTIVE DIRECTOR SYSTEM ENGINEERING AND PROCESS | 40.00 | 0.00 | $138,630 | $0 | $16,377 | Yes (X) | |||
| JILL ENGEL | |||||||||
| DIRECTOR OF INPATIENT SERVICES | 40.00 | 0.00 | $119,678 | $0 | $39,500 | Yes (X) | |||
| LINDA HAINES | |||||||||
| EXECUTIVE DIRECTOR | 40.00 | 0.00 | $115,092 | $0 | $38,979 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,904,225 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $188,367 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $416,894 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 14 | 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 |
|---|---|---|---|---|---|
| JTDM FAMILY PRACTICE INC | |||||
| 200 SAINT CLAIR ST | ST MARYS | OH | 45885 | MEDICAL SERVICES | $7,420,260 |
| EMERGENCY PROFESSIONAL SVCS | |||||
| PO BOX 634850 | CINCINNATI | OH | 452634850 | MEDICAL SERVICES | $2,914,728 |
| NEW VISION MEDICAL LABORATORIES INC | |||||
| 750 W HIGH STREET | LIMA | OH | 45801 | MEDICAL SERVICES | $1,580,093 |
| WEIGANDT DEVELOPMENT | |||||
| 90 N MAIN STREET | MINSTER | OH | 45865 | CONSTRUCTION SERVICES | $1,306,615 |
| THERAPY SOLUTIONS | |||||
| 120 W MAIN STREET | VAN WERT | OH | 45891 | MEDICAL SERVICES | $1,266,046 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 22 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $303,913 | RelatedOrganizationsAmt |
| All Other Contributions | $34,959 | AllOtherContributionsAmt |
| Noncash Contributions | $31,401 | NoncashContributionsAmt |
| Total Contributions | $338,872 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT REVENUE | 622110 | $75,286,565 | $75,286,565 |
| PASSTHROUGH INCOME | 622110 | -$54,537 | -$54,537 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $75,232,028 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $556,974 | TotalRevenueColumnAmt |
| Exclusion | $556,974 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $621,156 | RealAmt |
| Personal | $2,004 | PersonalAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $381,397 | RealAmt |
| Personal | $0 | PersonalAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $239,759 | RealAmt |
| Personal | $2,004 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $241,763 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $23,316 | UnrelatedBusinessRevenueAmt |
| Exclusion | $218,447 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $70,800 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $82,926 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$12,126 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$12,126 | TotalRevenueColumnAmt |
| Exclusion | -$12,126 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| CAFETERIA AND VENDING SALES | 722514 | $345,953 | $345,953 | |
| COMMUNITY OUTREACH | 622110 | $53,718 | $53,718 | |
| ELECTRONIC HEALTH RECORD INCENTIV | 622110 | $43,946 | $43,946 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $73,706 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $37,501 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $24,238 | UnrelatedBusinessRevenueAmt |
| Exclusion | $11,967 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $517,323 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $76,874,834 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $75,367,193 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $47,554 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,121,215 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,523 | TotalAmt |
| Program Services | $64,523 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,507,071 | TotalAmt |
| Management And General | $1,507,071 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,853,866 | TotalAmt |
| Program Services | $16,751,742 | ProgramServicesAmt |
| Management And General | $1,987,224 | ManagementAndGeneralAmt |
| Fundraising | $114,900 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,135,263 | TotalAmt |
| Program Services | $977,586 | ProgramServicesAmt |
| Management And General | $157,677 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,489,003 | TotalAmt |
| Program Services | $5,994,265 | ProgramServicesAmt |
| Management And General | $1,494,738 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,624,499 | TotalAmt |
| Program Services | $1,283,354 | ProgramServicesAmt |
| Management And General | $332,355 | ManagementAndGeneralAmt |
| Fundraising | $8,790 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $167,303 | TotalAmt |
| Management And General | $167,303 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $121,060 | TotalAmt |
| Management And General | $121,060 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,996 | TotalAmt |
| Fundraising | $29,996 | FundraisingAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,430 | TotalAmt |
| Management And General | $50,430 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,654,197 | TotalAmt |
| Program Services | $15,272,385 | ProgramServicesAmt |
| Management And General | $2,381,812 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $483,360 | TotalAmt |
| Program Services | $28,672 | ProgramServicesAmt |
| Management And General | $434,436 | ManagementAndGeneralAmt |
| Fundraising | $20,252 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,356,567 | TotalAmt |
| Program Services | $1,794,525 | ProgramServicesAmt |
| Management And General | $560,550 | ManagementAndGeneralAmt |
| Fundraising | $1,492 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,537,385 | TotalAmt |
| Program Services | $3,270,652 | ProgramServicesAmt |
| Management And General | $1,266,733 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $156,258 | TotalAmt |
| Program Services | $135,237 | ProgramServicesAmt |
| Management And General | $21,021 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $364,617 | TotalAmt |
| Program Services | $350,377 | ProgramServicesAmt |
| Management And General | $14,240 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $179,543 | TotalAmt |
| Management And General | $179,543 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,322,930 | TotalAmt |
| Program Services | $3,933,866 | ProgramServicesAmt |
| Management And General | $389,064 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $754,973 | TotalAmt |
| Management And General | $754,973 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $6,279,477 | $6,270,893 | $8,584 |
| BAD DEBT EXPENSE | $2,771,600 | $2,771,600 | |
| PHYSICIAN RECRUITMENT | $371,192 | $371,192 | |
| COMMUNITY OUTREACH | $17,852 | $15,766 | $2,086 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,710 | TotalAmt |
| Program Services | $12,747 | ProgramServicesAmt |
| Management And General | $49,553 | ManagementAndGeneralAmt |
| Fundraising | $2,410 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,357,675 | TotalAmt |
| Program Services | $58,928,190 | ProgramServicesAmt |
| Management And General | $12,251,645 | ManagementAndGeneralAmt |
| Fundraising | $177,840 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,740 | BOYAmt |
| EOY | $2,840 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,210,630 | BOYAmt |
| EOY | $8,572,498 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,236,671 | BOYAmt |
| EOY | $10,730,490 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,006,872 | BOYAmt |
| EOY | $1,100,362 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $986,532 | BOYAmt |
| EOY | $801,392 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $91,271,882 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $54,685,911 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,783,061 | BOYAmt |
| EOY | $36,585,971 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,526,426 | BOYAmt |
| EOY | $12,007,444 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,187,267 | BOYAmt |
| EOY | $1,149,062 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,332,190 | BOYAmt |
| EOY | $651,030 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,272,389 | BOYAmt |
| EOY | $71,601,089 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,809,014 | BOYAmt |
| EOY | $8,354,243 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,802,564 | BOYAmt |
| EOY | $3,589,744 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,142,852 | BOYAmt |
| EOY | $3,268,316 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,062,006 | BOYAmt |
| EOY | $3,131,248 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,816,436 | BOYAmt |
| EOY | $18,343,551 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,455,953 | BOYAmt |
| EOY | $53,257,538 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,455,953 | BOYAmt |
| EOY | $53,257,538 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,272,389 | BOYAmt |
| EOY | $71,601,089 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $5,517,159 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $820,955 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$6,536,529 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| 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
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | Yes (1) | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $1,179 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,179 | 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 | LINE 1(G): EXECUTIVE OFFICERS OF JTD MEMORIAL HOSPITAL PLACED CALLS WITH THEIR LEGISLATORS TO HELP EDUCATE THE LEGISLATORS ON VARIOUS HEALTH CARE RELATED ISSUES. LINE 1(I): THE HOSPITAL PAID DUES TO OHA, A PORTION OF WHICH IS ATTRIBUTABLE TO LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,732,459 | OtherCostOrOtherBasisAmt |
| Book Value | $1,732,459 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $53,508,767 | OtherCostOrOtherBasisAmt |
| Depreciation | $33,858,756 | DepreciationAmt |
| Book Value | $19,650,011 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $34,586,286 | OtherCostOrOtherBasisAmt |
| Depreciation | $20,827,155 | DepreciationAmt |
| Book Value | $13,759,131 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,444,370 | OtherCostOrOtherBasisAmt |
| Book Value | $1,444,370 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $36,585,971 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| PROFESSIONAL LIABILITY | $1,362,808 |
| OTHER LONG TERM LIABILITIES | $1,307,504 |
| COST REPORT SETTLEMENT PAYABLE | $460,936 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,131,248 | TotalLiabilityAmt |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Solicitation Of Non Govt Grants | Yes (X) | SolicitationOfNonGovtGrantsInd |
| Solicitation Of Govt Grants | Yes (X) | SolicitationOfGovtGrantsInd |
| Agrmt Prof Fundraising Acty | Yes (1) | AgrmtProfFundraisingActyInd |
Fundraiser Activity Info FundraiserActivityInfoGrp
Organization Business Name OrganizationBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BUTLER CONSULTING INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 270 S BROADMOOR BLVD | AddressLine1Txt |
| City | SPRINGFIELD | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45504 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activity | GRANT WRITER | ActivityTxt |
| Fundraiser Control Of Funds | 0 | FundraiserControlOfFundsInd |
| Gross Receipts | $1,000 | GrossReceiptsAmt |
| Retained By Contractor | $29,996 | RetainedByContractorAmt |
| Net To Organization | $1,000 | NetToOrganizationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Gross Receipts | $1,000 | TotalGrossReceiptsAmt |
| Total Retained By Contractors | $29,996 | TotalRetainedByContractorsAmt |
| Total Net To Organization | $1,000 | TotalNetToOrganizationAmt |
| Licensed States | OH | LicensedStatesCd |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 120.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 3105 | PersonsServedCnt |
| Total Community Benefit Expns | $390,025 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $390,025 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00570 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 10974 | PersonsServedCnt |
| Total Community Benefit Expns | $10,417,295 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,326,540 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,090,755 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05960 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 14079 | PersonsServedCnt |
| Total Community Benefit Expns | $10,807,320 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,326,540 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,480,780 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06530 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 57 | ActivitiesOrProgramsCnt |
| Persons Served | 38604 | PersonsServedCnt |
| Total Community Benefit Expns | $377,776 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,204 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $366,572 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00530 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 5 | ActivitiesOrProgramsCnt |
| Persons Served | 9 | PersonsServedCnt |
| Total Community Benefit Expns | $38,694 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $38,694 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $57,884 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $57,884 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 50 | PersonsServedCnt |
| Total Community Benefit Expns | $74,960 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $74,960 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 67 | ActivitiesOrProgramsCnt |
| Persons Served | 38663 | PersonsServedCnt |
| Total Community Benefit Expns | $549,314 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,204 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $538,110 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00780 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 67 | ActivitiesOrProgramsCnt |
| Persons Served | 52742 | PersonsServedCnt |
| Total Community Benefit Expns | $11,356,634 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,337,744 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,018,890 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07310 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 7 | ActivitiesOrProgramsCnt |
| Persons Served | 15913 | PersonsServedCnt |
| Total Community Benefit Expns | $17,753 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $630 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $17,123 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $8,110 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $8,110 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $1,298 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,298 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 392 | PersonsServedCnt |
| Total Community Benefit Expns | $7,764 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $7,764 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 14 | ActivitiesOrProgramsCnt |
| Persons Served | 16305 | PersonsServedCnt |
| Total Community Benefit Expns | $34,925 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $630 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $34,295 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,771,600 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $16,874 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $12,087,306 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $16,857,583 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$4,770,277 | 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 | JTD MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 SAINT CLAIR STREET | AddressLine1Txt |
| City | ST MARYS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45885 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.GRANDLAKEHEALTH.ORG | WebsiteAddressTxt |
| State License | STATE REG. NO. 1111 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | INPATIENT REHAB UNIT, TRANSITIONAL CARE UNIT | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JTD MEMORIAL HOSPITAL | 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 | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTPS://WWW.GRANDLAKEHEALTH.ORG/NEWS-AND-EVENTS/COMMUNITY-HEALTH-ASSESSMENT | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | 0 | StrategyPostedWebsiteInd |
| Strategy Attached | Yes (1) | StrategyAttachedInd |
| 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 | 120.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| 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 |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.GRANDLAKEHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.GRANDLAKEHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.GRANDLAKEHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE | 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 |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| 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 |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| JTD MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: JTD MEMORIAL HOSPITAL CREATED A COMMUNITY HEALTH NEEDS ASSESSMENT STEERING COMMITTEE THAT MET ON OCTOBER 25, 2016. PARTICIPANTS INCLUDED THE AUGLAIZE COUNTY HEALTH DEPARTMENT, THE MERCER COUNTY HEALTH DEPARTMENT, THE AUGLAIZE COUNTY COUNCIL ON AGING, AND THE FOLLOWING GROUPS FROM JTD MEMORIAL HOSPITAL:-PATIENT CARE SERVICES-HOSPITAL FOUNDATION AND GRAND LAKE HOME HEALTH/HOSPICE-EMPLOYED PHYSICIAN PRACTICES-COMMUNITY OUTREACH-ADMINISTRATIONPARTICIPANTS WERE PROVIDED A REPORT COMPILED BY AN INDEPENDENT CONSULTANT, WHICH DREW DATA FROM VARIOUS WEB SOURCES WITH BOTH AUGLAIZE AND MERCER COUNTY HEALTH INDICATORS AND HEALTH STATUS PROFILES FROM 2016. THERE WERE THREE MAIN SOURCES FOR THIS DATA - INSTITUTE FOR PEOPLE, PLACE AND POSSIBILITY (IP3) COMMUNITY COMMONS, UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE SCHOOL OF MEDICINE AND PUBLIC HEALTH'S COUNTY HEALTH RANKINGS, AND GRAND LAKE HEALTH SYSTEM/JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL COMMUNITY HEALTH ASSESSMENT 2013. PARTICIPANTS REVIEWED ALL DATA AND INFORMATION IDENTIFIED IN THE CHNA IN ORDER TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY. PARTICIPANTS IDENTIFIED THE HEALTH NEEDS OF THE COMMUNITY BY CONSIDERING THOSE REQUISITES FOR THE IMPROVEMENT OR MAINTENANCE OF HEALTH STATUS IN THE COMMUNITY USING ALL FACTS AND CIRCUMSTANCES PRESENTED. PARTICIPANTS CONSIDERED THE SEVERITY OF EACH NEED, EFFECTIVENESS OF INTERVENTION, HEALTH DISPARITIES ASSOCIATED WITH THE NEED, AND IMPORTANCE THE COMMUNITY PLACES ON ADDRESSING THE NEED. |
| JTD MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6B: AUGLAIZE COUNTY HEALTH DEPARTMENT, MERCER COUNTY HEALTH DEPARTMENT, AUGLAIZE COUNTY COUNCIL ON AGING |
| JTD MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: THE FOLLOWING ACTIONS THAT WERE TAKEN DURING THE 2017 TAX YEAR ARE ASSOCIATED WITH THE 2016 CHNA:SIGNIFICANT HEALTH NEED 1: MENTAL HEALTH - COLEMAN BEHAVIORAL HEALTH PARTNERSHIP: ONGOING INTEGRATION OF COLEMAN STAFF INTO THE GRAND LAKE PHYSICIAN PRACTICES THAT BEGAN IN 2014 CONTINUED THROUGH 2017. COLEMAN REFERRALS FROM THE ED INCREASED BY 12% AND INDIVIDUAL COUNSELING SESSIONS INCREASED BY 58.3% FROM 2016 TO 2017. - HORIZON HEALTH PARTNERSHIP: JTDMH OPENED AN INPATIENT GERO-PSYCH UNIT IN COLLABORATION WITH HORIZON HEALTH, WITH CMS CERTIFICATION EFFECTIVE JANUARY 1, 2018. - TELE MENTAL HEALTH PILOT: PILOT PROGRAM LED BY A CONSORTIUM MEMBER HOSPITAL TO ASSESS BEHAVIORAL HEALTH ED PATIENTS VIA TELEMEDICINE DEVICE HAS BEEN SUCCESSFUL AT A PEER HOSPITAL; INCORPORATION AT JTDMH IS BEING EXPLORED. SIGNIFICANT HEALTH NEED 2: OBESITY - HEALTH SMART: CONTINUED TO SPONSOR HEALTH SMART PROGRAM IN CONJUNCTION WITH THE EMPLOYER-SPONSORED HEALTH PLAN WITH IMPROVED BIOMETRICS NOTED DURING 2017 IN MULTIPLE CATEGORIES FOR THOSE JTDMH EMPLOYEES AND THEIR SPOUSES AND DEPENDENTS WHO PARTICIPATE. - GRAND HEALTH CHALLENGE: 11TH ANNUAL GRAND HEALTH CHALLENGE WAS HELD JANUARY THRU MAY 2017 IN WHICH 537 PARTICIPANTS LOST 3,409.1 POUNDS.SIGNIFICANT HEALTH NEED 3: RISKY BEHAVIORS - SUPPORT FOR HEROIN ADDICTS DRUG TRIAL: THE MEDICATION ASSISTED TREATMENT PROGRAM (MATS) CONTINUED THROUGH 2017 WITH A 63% SUCCESS RATE REPORTED. 29 OUT OF 46 CLIENTS WERE SUCCESSFUL, DEFINED AS NO VIOLATIONS WITHIN THE PAST YEAR. A T-CAP GRANT (TARGETED COMMUNITY ALTERNATIVES TO PRISON) WAS RECEIVED BY THE PROGRAM IN 2017 TO ALLOW IT TO CONTINUE FROM JUNE 2017-2019. - SMOKING CESSATION PROGRAM: SMOKING CESSATION PROGRAM FOR JTDMH/GLHS EMPLOYEES AND DEPENDENTS BEING INVESTIGATED. THE JTDMH OUTREACH SUPPORT SPECIALIST HAS OBTAINED CERTIFICATION AS A SMOKING CESSATION INSTRUCTOR TO ASSIST WITH THIS INITIATIVE.SIGNIFICANT HEALTH NEED 4: ACCESS TO CARE - JTDMH/GLHS PRIMARY CARE SERVICES EDUCATION: COLLABORATED WITH AUGLAIZE COUNTY HEALTH DEPARTMENT IN DISTRIBUTION OF COMPREHENSIVE AUGLAIZE COUNTY PRIMARY CARE PROVIDER LISTINGS, WITH LOCATION, CONTACT INFO, OFFICE HOURS, AND MEDICAID ACCEPTANCE TO PARENTS OF YOUNG CHILDREN AT IMMUNIZATION APPOINTMENTS. - PROMOTION OF JTDMH/GLHS SERVICES VIA WEBSITE AND SOCIAL MEDIA OUTLETS: TRACKING OF PAGE VIEWS AND SOCIAL MEDIA SESSIONS BEGAN IN COLLABORATION WITH JTDMH'S MARKETING FIRM TO ASSIST IN ASSESSING COMMUNITY REACH OF SERVICES PROMOTION. SIGNIFICANT HEALTH NEED 5: EDUCATION/PREVENTION/HEALTH PROMOTION - HEALTH SCREENINGS AT COMMUNITY FUNCTIONS: COMMUNITY OUTREACH EFFORTS TO INCREASE BLOOD PRESSURE SCREENINGS WITHIN THE COMMUNITY RESULTED IN A 16.5% INCREASE IN SCREENING PARTICIPATION FROM 2016 TO 2017. IN ADDITION, OSTEOPOROSIS SCREENINGS INCREASED 57.9% OVER THE SAME TIMEFRAME. - COLORECTAL SCREENINGS: COMMUNITY OUTREACH EFFORTS IN 2017 RESULTED IN A 10% INCREASE IN COLORECTAL SCREENING KIT DISTRIBUTION OVER 2015. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - URGENT CARE AT JTDMH | ||||
| 200 ST CLAIR STREET | ST MARYS | OH | 45885 | URGENT CARE |
| 2 - GRAND LAKE HOME HEALTH | ||||
| 1122 EAST SPRING STREET | ST MARYS | OH | 45885 | HOME HEALTH |
| 3 - GRAND LAKE HOSPICE | ||||
| 1122 EAST SPRING STREET | ST MARYS | OH | 45885 | HOSPICE |
| 5 - GRAND LAKE OCCUPATIONAL MEDICINE | ||||
| 200 ST CLAIR STREET | ST MARYS | OH | 45885 | OCCUPATIONAL MEDICINE |
| 6 - CELINA PRO HEALTH DIAGNOSTIC CENTER | ||||
| 801 PRO DRIVE | CELINA | OH | 45822 | DIAGNOSTIC CENTER |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | THE HOSPITAL USED THE MEDICARE COST REPORT AS THEIR BASIS FOR CALCULATING THE AMOUNTS REPORTED IN LINE 7A & 7B. ON THE COST REPORT, IT FIRST ALLOCATES OVERHEAD DEPARTMENTS VIA A COST STEP DOWN METHODOLOGY AND THEN CALCULATES A COST TO CHARGE RATIO. FOR LINES 7E, 7F,7G & 7I ACTUAL COSTS WERE USED. |
| PART I, LN 7 COL(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 $2,771,600. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL PARTICIPATED IN SEVERAL COMMUNITY BUILDING ACTIVITIES IN 2017 RANGING FROM PARTICIPATION IN COMMUNITY BOARDS, COMMITTEES AND CLUBS THAT WERE ENGAGED IN IMPROVING THE OVERALL COMMUNITY INCLUDING THE COMMUNITY'S HEALTH/MEDICAL NEEDS TO OFFERING BABYSITTING TRAINING CLASSES TO ASSURE THE CHILDREN OF THE COMMUNITY ARE WELL CARED FOR IN THEIR PARENT'S ABSENCE. OTHER EXAMPLES OF COMMUNITY BUILDING ACTIVITIES INCLUDE BUT ARE NOT LIMITED TO PARTICIPATING IN WORKFORCE DEVELOPMENT OF HEALTH CARE CAREERS THROUGH JOB SHADOWING AND SEMINARS AND ACTIVE PARTICIPATION IN THE COMMITTEE THAT IS WORKING TO RESTORE CLEAN AND HEALTHY WATER TO THE COMMUNITIES LARGEST RECREATION RESOURCE, GRAND LAKE ST. MARYS. |
| PART III, LINE 2: | JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL RECORDS BAD DEBT EXPENSE WHEN AN ACCOUNT IS DEEMED UNCOLLECTIBLE AT THE VALUE OF CHARGES. IF IT BECOMES NECESSARY TO ESTIMATE BAD DEBT EXPENSE, ESTIMATES ARE DONE BASED UPON HISTORIC RELATIONSHIPS BETWEEN CHARGES AND BAD DEBT. |
| PART III, LINE 3: | THE HOSPITAL ESTIMATES THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY BASED UPON A HISTORIC REVIEW OF THE APPLICABLE BAD DEBT ACCOUNTS. EVERY EFFORT IS MADE TO IDENTIFY THESE ACCOUNTS PRIOR TO BEING WRITTEN OFF AS UNCOLLECTIBLE, INCLUDING MULTIPLE EFFORTS TO CONTACT THE PATIENT. AS SOON AS THESE ACCOUNTS ARE DEEMED UNCOLLECTIBLE, ALL COLLECTION WORK AND ACTIVITY IS IMMEDIATELY CEASED. THESE ACCOUNTS ARE THEN TREATED THE SAME AS ANY OTHER ACCOUNT QUALIFYING FOR FINANCIAL ASSISTANCE. |
| PART III, LINE 4: | ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. |
| PART III, LINE 8: | THE HOSPITAL USED A COST STEP DOWN METHODOLOGY FROM THE MEDICARE COST REPORT TO CALCULATE THE AMOUNTS REPORTED IN LINE 6. THE COST OF PROVIDING CARE TO THE MEDICARE POPULATION IN 2017 WAS $16,857,583. THE PAYMENTS RELATED TO THESE SERVICES WERE $12,087,306. LEAVING A MEDICARE SHORTFALL OF $4,770,277 FOR THE YEAR. THE MEDICARE SHORTFALL IS A COMMUNITY BENEFIT BECAUSE PROVIDING SERVICES TO THE ELDERLY IS A TAX EXEMPT PURPOSE CONSISTENT WITH JTD MEMORIAL HOSPITAL'S OVERALL EXEMPT STATUS, AND THE HOSPITAL ACCEPTS THESE PATIENTS REGARDLESS OF ITS IMPACT ON OVERALL PROFITABILITY. |
| PART III, LINE 9B: | JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL FOLLOWS THE SAME COLLECTION PRACTICES NO MATTER THE TYPE OF PATIENT. ALL PATIENTS ARE TREATED EQUALLY. COLLECTION PRACTICES ARE NOT PURSUED FOR PATIENTS THAT THE ORGANIZATION KNOWS QUALIFY FOR FINANCIAL ASSISTANCE/CHARITY CARE. |
| PART VI, LINE 2: | N/A - ALL NEEDS WERE ASSESSED WHILE CONDUCTING THE COMMUNITY HEALTH NEEDS ASSESSMENT. |
| PART VI, LINE 3: | PATIENTS ARE INFORMED ABOUT THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE THROUGH SIGNS POSTED AT REGISTRATION, IN ER/WAITING ROOMS, ON THE WEBSITE, THROUGH INFORMATION INCLUDED IN THE PATIENT HANDBOOK, THROUGH INFORMATION PRINTED ON THE REVERSE SIDE OF THE STATEMENTS THEY RECEIVE FOR SERVICES, AND IS AVAILABLE UPON REQUEST. |
| PART VI, LINE 4: | JTD MEMORIAL HOSPITAL IS LOCATED IN ST. MARYS (AUGLAIZE COUNTY), A RURAL SMALL TOWN ENVIRONMENT DOMINATED BY AGRICULTURE AND SMALL MANUFACTURING. JTD MEMORIAL HOSPITAL'S CORE SERVICE AREA OF ST. MARYS, MINSTER, NEW BREMEN AND NEW KNOXVILLE ZIP CODES INCLUDES A POPULATION OF 24,632. THE ADJACENT COMMUNITY OF CELINA (ZIP CODE POPULATION OF 19,621) IS ALSO SERVED BY THE HOSPITAL. THE HOSPITAL ALSO PROVIDES SERVICES TO THE WAPAKONETA COMMUNITY (POPULATION 18,258) ALTHOUGH THE TRADITIONAL SERVICE PATTERNS SEND THAT COMMUNITY'S PATIENTS TO LIMA. THE ABOVE COMMUNITIES ACCOUNT FOR OVER 80% OF JTD MEMORIAL HOSPITAL'S PATIENTS. THOSE ZIP CODES HAVE A TOTAL POPULATION OF 62,511 WITH 15% IN THE MEDICARE AGE GROUP (65+). |
| PART VI, LINE 5: | JTD MEMORIAL HOSPITAL/GRAND LAKE HEALTH COMMUNITY OUTREACH PART OF THE HOSPITAL'S PHILOSOPHY HAS BEEN TO PROMOTE THE HEALTH AND WELLNESS OF COMMUNITY MEMBERS. THE HOSPITAL HAS A HISTORY OF REACHING OUT TO THE COMMUNITY TO PROMOTE WELLNESS AND PREVENTIVE MEDICINE AND HAS AN OFFICE THAT IS DEDICATED TO COORDINATING COMMUNITY HEALTHCARE, OUTREACH, AND EDUCATION.FOLLOWING IS A LISTING OF THE WIDE VARIETY OF OUTREACH PROGRAMS THAT ARE SPONSORED BY GRAND LAKE HEALTH SYSTEM. - MONTHLY BLOOD PRESSURE CHECKS (4 SITES) - BREASTFEEDING CLASSES - CHILDBIRTH CLASSES - CALL A NURSE - CPR CLASSES - DIABETIC SUPPORT GROUP - HEALING MEMORIES SUPPORT GROUP - STROKE SUPPORT GROUP - PARKINSON'S SUPPORT GROUP - COMMUNITY HEALTH FAIRS/ROTARY BLOOD TEST CLINICS - SCHOOL HEALTH FAIRS - MAKE BELIEVE HOSPITAL (KINDERGARTEN PROGRAM TO ALLEVIATE FEARS OF HOSPITAL)] - NEW BREMEN SENIOR CITIZEN PROGRAM - FREE PROSTATE SCREENING - SENIOR SUPPER HOUR - SENIORCISE - AMERICAN SIGN LANGUAGE CLASSES (I & II) - SPEAKERS BUREAU - SUPERSITTERS CLASSES - FREE MONTHLY WELLNESS EDUCATION & SCREENING (WRIGHT STATE, AGAPE, WAGNERS IGA) - WOMEN'S WALK FOR WELLNESS - COORDINATION OF THE UNITED WAY CAMPAIGN FOR THE HOSPITAL - ROAD TO FITNESS PROGRAM (12 MONTHS) - MAN TO MAN PROSTATE SUPPORT GROUP - DRUG TAKEBACK PROGRAM - PRE-DIABETES CLASSESIN ADDITION, WE SUPPORT THE WELLNESS OF THE COMMUNITY BY PARTICIPATING IN EVENTS HOSTED AT VARIOUS LOCATIONS THROUGHOUT THE COMMUNITY. FOLLOWING IS A LIST OF TOPICS THAT ARE COVERED: - NUTRITION - HEART EDUCATION - SKIN CANCER - OSTEOPOROSIS SCREEN - BREAST CANCER AWARENESS - CHOLESTEROL AWARENESS - ASSESSMENT OF DIABETES - ALCOHOL EDUCATON - COLORECTAL CANCER EDUCATION - ASTHMA EDUCATION - PERIPHERAL SCREENING - SLEEP APNEA INFORMATION - STROKE EDUCATIONWE ALSO PARTNER WITH TWO LOCAL RADIO STATIONS PROVIDING MONTHLY INTERVIEWS ON A WIDE VARIETY OF HEALTHCARE TOPICS.SINCE 2007, WE HAVE SPONSORED A WEIGHT LOSS/WELLNESS PROGRAM, ENTITLED, "THE GRAND HEALTH CHALLENGE." IN THE PAST 12 YEARS, THIS PROGRAM HAS SERVED ALMOST 4,848 RESIDENTS OF BOTH MERCER AND AUGLAIZE COUNTIES, LOSING ALMOST 43,597.30 LBS. WE ARE AGAIN IN THE PLANNING STAGE FOR OUR 13TH YEAR, 2019. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| AUGLAIZE-MERCER COUNTY YMCA | |||||||
| 7590 STATE ROUTE 703 | CELINA | OH | 45822 | 341371829 | 501(C)(3) | $21,500 | GENERAL SUPPORT TO PROMOTE HEALTHY LIVING WITHIN THE COMMUNITY, HEALTHY KIDS DAY SPONSORSHIP |
| WAPAKONETA FAMILY YMCA | |||||||
| 1100 DEFIANCE STREET | WAPAKONETA | OH | 45895 | 311568315 | 501(C)(3) | $19,368 | WALKING PROGRAM AND SAFE KIDS-SAFE POOLS INITIATIVE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL MAKES GRANTS TO COMMUNITY ORGANIZATIONS. GRANTS ARE MONITORED THROUGH DIRECT INVOLVEMENT AND CONTACT WITH THE ORGANIZATION OR EVENT IN WHICH THE GRANT WAS GIVEN. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | 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 | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RAJENDRA KAKARLA MD | ||||||||||||||
| DIRECTOR | $0 | $0 | $0 | $0 | $203,652 | $0 | $0 | $0 | $0 | $0 | $203,652 | $0 | $0 | $0 |
| KEVIN HARLAN | ||||||||||||||
| PRESIDENT | $386,773 | $126,689 | $0 | $0 | $0 | $61,678 | $28,335 | $41,921 | $14,990 | $1,105 | $430,098 | $231,393 | $0 | $39,530 |
| JEFFREY VOSSLER | ||||||||||||||
| TREASURER | $221,798 | $0 | $8,820 | $0 | $0 | $0 | $24,207 | $0 | $11,654 | $0 | $266,479 | $0 | $0 | $0 |
| DEB MCKEE | ||||||||||||||
| VP OF PATIENT CARE SERVICE | $199,110 | $0 | $8,820 | $0 | $0 | $0 | $21,929 | $0 | $27,642 | $0 | $257,501 | $0 | $0 | $0 |
| ART SWAIN | ||||||||||||||
| VP OF SUPPORT SERVICES | $176,330 | $0 | $7,720 | $0 | $0 | $0 | $19,254 | $0 | $27,458 | $0 | $230,762 | $0 | $0 | $0 |
| LANA HINDERS | ||||||||||||||
| DIRECTOR OF EMERGENCY AND AMBULATORY | $116,793 | $0 | $0 | $0 | $0 | $0 | $12,068 | $0 | $27,013 | $0 | $155,874 | $0 | $0 | $0 |
| CINDY BERNING | ||||||||||||||
| EXECUTIVE DIRECTOR SYSTEM ENGINEERIN | $130,910 | $0 | $7,720 | $0 | $0 | $0 | $5,400 | $0 | $10,977 | $0 | $155,007 | $0 | $0 | $0 |
| JILL ENGEL | ||||||||||||||
| DIRECTOR OF INPATIENT SERVICES | $119,678 | $0 | $0 | $0 | $0 | $0 | $12,445 | $0 | $27,055 | $0 | $159,178 | $0 | $0 | $0 |
| LINDA HAINES | ||||||||||||||
| EXECUTIVE DIRECTOR | $108,472 | $0 | $6,620 | $0 | $0 | $0 | $12,008 | $0 | $26,971 | $0 | $154,071 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL PROVIDES A PORTION OF YMCA DUES TO THE OFFICERS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES; HOWEVER, THIS IS AN EMPLOYEE BENEFIT AVAILABLE TO ALL ELIGIBLE EMPLOYEES OF JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL TO PROMOTE COMMUNITY WELLNESS (2 OF THE PEOPLE LISTED IN PART VII, SECTION A, LINE 1A RECEIVED THIS BENEFIT). THE YMCA DUES WERE NOT INCLUDED IN THE RECIPIENT'S COMPENSATION. |
| PART I, LINE 4B | LINE 4B: KEVIN HARLAN CONTRIBUTED $13,000 INTO THE PLAN IN 2017 AND THE HOSPITAL MADE A $41,921 CONTRIBUTION INTO THE PLAN DURING 2017. THIS AMOUNT HAS NOT YET VESTED. IN ADDITION, A PREVIOUS CONTRIBUTION TO THE PLAN OF $39,530 VESTED DURING 2017 IN THE AMOUNT OF $48,678. THE VESTED CONTRIBUTION IS REPORTED ON SCHEDULE J, PART II, COLUMN B(III). THE PLAN IS A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN MAINTAINED BY A RELATED ORGANIZATION FOR KEY EMPLOYEES OF THE RELATED ORGANIZATION. THERE IS AN INCENTIVE BONUS PLAN AND A PRODUCTION COMPENSATION PLAN. VESTING HAPPENS OVER A 3 OR A 5 YEAR TIME FRAME DEPENDING IF THE CONTRIBUTION WAS MADE TO THE INCENTIVE BONUS PLAN OR THE PRODUCTION COMPENSATION PLAN. THERE ARE CERTAIN CIRCUMSTANCES WHERE A PARTICIPANT WILL FORFEIT ANY AND ALL OF THE COMPANY CONTRIBUTIONS MADE INTO THE PLAN INCLUDING ENGAGING IN ACTIVITIES WHICH ARE DEEMED TO BE SIGNIFICANTLY COMPETITIVE WITH THE COMPANY WITHIN A 50 MILE RADIUS OF ANY EXISTING OFFICE, IF IT IS DEEMED THE PARTICIPANT ACTED IN A DISHONEST WAY, BREACHES HIS OR HER FIDUCIARY OBLIGATIONS, CONVICTED OF A FELONY INVOLVING SIGNIFICANT MORAL TURPITUDE, OR OTHER ACTS WHICH WOULD CAUSE THE COMPANY SUBSTANTIAL HARM. |
| PART I, LINE 7 | EMPLOYEE'S BONUSES ARE DETERMINED AT THE DISCRETION OF THE CEO. |
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 | HOSPITAL FACILITIES REVENUE IMPROVEMENT BONDS SERIES 2012 | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 341623770 | BondIssuerEIN |
| Bond Issued | 2012-12-14 | BondIssuedDt |
| Issue Price | $8,500,000 | IssuePriceAmt |
| Purpose | ASU BUILDING PROJECT AND CAPITAL EQUIPMENT | 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 | $8,500,000 | TotalProceedsAmt |
| Capital Expenditures | $8,500,000 | CapitalExpendituresAmt |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | 0 | 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 | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | 0 | ProceduresCorrectiveActionInd |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | MEDICAL EQUIPMENT | Desc |
| Contribution | 6 | ContributionCnt |
| Noncash Contributions Rpt F990 | $31,398 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | A DIRECTOR WORKS AT MINSTER BANK, WHILE ANOTHER DIRECTOR IS SERVING ON MINSTER BANK'S BOARD. TWO DIRECTORS ALSO BOTH SERVE ON ELM GROVE CEMETERY'S BOARD. |
| FORM 990, PART VI, SECTION B, LINE 11B | A COPY OF FORM 990 IS PROVIDED TO THE BOARD-DESIGNATED COMMITTEE FOR THEIR REVIEW PRIOR TO FILING. THE BOARD-DESIGNATED COMMITTEE WILL REPORT THEIR REVIEW AND APPROVAL OF FORM 990 TO THE FULL BOARD OF DIRECTORS. A PAPER COPY OF THE FORM 990 WAS PROVIDED TO ALL BOARD MEMBERS FOR THEIR INDEPENDENT REVIEW PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY COVERS ALL BOARD MEMBERS, OFFICERS, AND MANAGERS OF GRAND LAKE HEALTH SYSTEM. ANNUALLY THESE INDIVIDUALS, AS WELL AS NEW BOARD MEMBERS WHEN THEY FIRST JOIN, PROVIDE THE PRESIDENT OF THE CORPORATION AN UPDATED LISTING OF ALL BUSINESSES OR OTHER ORGANIZATIONS OF WHICH HE OR SHE IS A TRUSTEE, OFFICER, DIRECTOR, MEMBER, PARTNER, OWNER, GENERAL MANAGER, SUBSTANTIAL SHAREHOLDER, EMPLOYEE OR FOR WHICH HE OR SHE ACTS AS AN AGENT. WHEN A CONFLICT OF INTEREST IS IDENTIFIED THE DETERMINATION IS MADE AND DISCUSSED OPENLY AT THE BOARD LEVEL. THE INDIVIDUAL IS THEN PROHIBITED FROM PARTICIPATING IN THE BOARD'S DELIBERATIONS AND DECISIONS. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE SALARY AMOUNT FOR THE PRESIDENT IS REVIEWED AND APPROVED BY JTDMH'S BOARD EXECUTIVE COMMITTEE. THE EXEC COMMITTEE USES THE OHIO HOSPITAL ASSOCIATION'S ANNUAL CHIEF EXECUTIVE OFFICER COMPENSATION SURVEY, INTEGRATED HEALTHCARE STRATEGIES (AN INDEPENDENT COMPENSATION CONSULTANT), ANNUAL NATIONAL HEALTHCARE LEADERSHIP COMPENSATION SURVEY, OTHER 990'S FILED BY OTHER HOSPITALS AND INPUT FROM THE BOARD OF TRUSTEES AND BOARD EXEC COMMITTEE TO DETERMINE THE PRESIDENT'S SALARY. THE BOARD CHAIR SIGNS THE CHANGE OF PAY FORM AS WELL AS WRITES A MEMO TO THE DIRECTOR OF FINANCIAL SERVICES. DOCUMENTATION REGARDING THE PRESIDENT'S SALARY AND RECORD KEEPING REGARDING DELIBERATIONS IS KEPT BY THE BOARD EXEC COMMITTEE. SALARY AMOUNTS FOR OFFICERS AND OTHER KEY EMPLOYEES ARE REVIEWED AND APPROVED BY THE PRESIDENT. THE PRESIDENT REFERENCES THE OHA COMPENSATION SALARY SURVEY. THE PRESIDENT IS APPROVED BY THE BOARD OF DIRECTORS TO PERFORM THIS PROCESS. FURTHERMORE, THE PRESIDENT IS COMPLETELY INDEPENDENT FROM ALL OFFICERS AND KEY EMPLOYEES. THIS PROCESS WAS LAST COMPLETED IN DECEMBER 2017. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | OTHER CONTRACTED LABOR: PROGRAM SERVICE EXPENSES 8,680,430. MANAGEMENT AND GENERAL EXPENSES 1,657,999. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,338,429. OTHER CONTRACTED PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 4,910,315. MANAGEMENT AND GENERAL EXPENSES 545,493. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,455,808. FAMILY PRACTICE PHYSICIAL FEES: PROGRAM SERVICE EXPENSES 1,681,640. MANAGEMENT AND GENERAL EXPENSES 178,320. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,859,960. |
| FORM 990, PART XI, LINE 9: | CAPITAL CONTRIBUTION IN JTD FAMILY PRACTICE, INC. -6,552,860. DIFFERENCE BETWEEN BOOK AND TAX PASS THROUGH INCOME 16,331. |
| FORM 990, PART XII, LINE 2C: | THE FINANCE COMMITTEE ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JTD HOSPITAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 ST CLAIR STREET | AddressLine1Txt |
| City | ST MARYS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45885 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 341623769 | EIN |
| Primary Activities | TO RAISE FUNDS FOR JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL. | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 7 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JTDMH PAIN MANAGEMENT LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 ST CLAIR ST | AddressLine1Txt |
| City | ST MARYS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45885 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 465353958 | EIN |
| Primary Activities | PAIN MANAGEMENT SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | RELATED | PredominantIncomeTypeTxt |
| Share Of Total Income | -$4,738 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $189,437 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | Yes (1) | GeneralOrManagingPartnerInd |
| Ownership | 0.51000 | OwnershipPct |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JTDM FAMILY PRACTICE LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 ST CLAIR STREET | AddressLine1Txt |
| City | ST MARYS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45885 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 341689161 | EIN |
| Primary Activities | PHYSICIANS PROVIDING MEDICAL SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | 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 | Yes (1) | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | 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 | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (6 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| JTDM FAMILY PRACTICE LLC | ||
| A | $413,601 | CASH TRANSACTION |
| JTDM FAMILY PRACTICE LLC | ||
| B | $5,165,000 | CASH TRANSACTION |
| JTDM FAMILY PRACTICE LLC | ||
| O | $3,917,532 | CASH TRANSACTION |
| JTDM FAMILY PRACTICE LLC | ||
| Q | $1,269,053 | CASH TRANSACTION |
| JTD HOSPITAL FOUNDATION | ||
| C | $303,913 | CASH TRANSACTION |
| JDTMH PAIN MANAGEMENT LLC | ||
| J | $62,854 | AMOUNT INVOICED |
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