2018-10-17T13:03:15-07:00 2017-12-31 990 2017-01-01 341531817 ALLIANCE COMMUNITY HOSPITAL FOUNDATION ALLI 3305966000 200 E STATE ST ALLIANCE OH 44601 Michael Hoover Board President 3308212150 2018-10-17 174.232.134.150 2017 2018-06-14 16:35:46Z Michael S Hoover 119 E State St Alliance OH 44601 61256683 0 X X 1986 OH The Alliance Community Hospital Foundation's mission is to contribute to hospital fundraising, maintain community involvement and healthcare awareness, and grow as a philanthropic spirit of Alliance Community Hospital. 4 3 0 193 0 0 159387 27724055 0 0 67579 2171733 22347 16880 249313 29912668 208157 1232380 0 0 0 0 0 0 0 8736 85408 216893 1317788 32420 28594880 2885818 31553574 0 0 2885818 31553574 To promote the purposes of Alliance Community Hospital, Alliance Citizens Health Association and their subsidiaries through fund raising and other charitable activities. 0 0 1199520 1199520 0 Alliance Community Hospital Foundation supports Alliance Community Hospital (ACH) for building and medical equipment expenses. Major purchases in 2017 include Hospice renovations and electronic medical record system expenses of $51,000, building safety improvements of 20,000, In-house printing equipment of $10,000 and Nutritional Services equipment of $14,000. Medical equipment purchased in 2017 includes Nursing educational equipment of $13,000, and Therapy equipment of $7,000. The Foundation also provides money for Pastoral support of $68,000. Smaller amounts (less than $5,000 each) for equipment and patient supplies at the Skilled Nursing facility and other ACH departments were also disbursed in the current year. In 2017, ACHF made a $1 million contribution in support of ACH and its exempt purpose. 32860 32860 0 The Foundation supports ACH by providing funds for indigent patient care and in 2017 they contributed nearly $33,000 for prescription drug and medical expense assistance. 0 0 0 1232380 1 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 1 0 0 0 0 0 0 1 0 0 1 1 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 0 0 0 0 0 X 4 3 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Lisa Geiger 3305967528 200 E STATE ST ALLIANCE OH 44601 Mike Hoover President 1 3 X X 0 0 0 Ron Lyons Vice President 1 3 X X 0 0 0 David Lundgren Secretary 1 3 X X 0 0 0 Dale Wells Treasurer; CFO/COO, Alliance Community Hospital 2 50 X X 0 229351 35287 Stan Jonas CEO, Alliance Community Hospital 1 51 X 0 411375 24497 0 640726 59784 0 0 1 0 0 X 0 0 32850 27627077 0 64128 2150 27724055 0 285788 0 0 285788 0 0 0 0 0 0 0 0 0 0 33207410 0 31321465 0 1885945 0 1885945 0 0 1885945 39430 32850 22550 16880 0 16880 0 29912668 0 0 2188613 1199520 1199520 32860 32860 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 38941 0 38941 0 0 0 0 0 0 0 0 0 0 0 43520 0 43520 0 0 0 0 0 0 0 0 0 237 0 237 0 2482 0 2482 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 228 0 228 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1317788 1232380 85408 0 X 26612 15617 2859206 31537957 2885818 31553574 0 0 X 700890 29397930 1324407 1295123 860521 860521 2885818 31553574 2885818 31553574 28594880 72876 0 0 0 0 X 0 1 X 1 0 X X 1 Alliance Community Hospital 340714581 3 1 1232380 0 1 1232380 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 860521 0 0 0 0 0 860521 857971 2550 0 0 0 0 860521 857796 175 0 0 0 0 857971 857746 50 0 0 0 0 857796 857746 0 0 0 0 0 857746 0 1 0 0 0 Assets Limited As to Use: Internally Designated 18899 F Assets Limited As to Use: Externally Restricted 2155644 F Long-Term Investments 29363414 F 31537957 Schedule D, Part V, Line 4 The intended use of the organization's endowment funds is to hold the principal in perpetuity and use the interest for the general operations of the organization. Casino Night 26867 13960 12907 0 2965 3799 3823 0 65 Hospice 5K 24145 14855 9290 500 1339 0 1658 350 4896 1 21268 4035 17233 250 0 300 675 1700 230 72280 32850 39430 750 4304 4099 6156 2050 5191 22550 16880 1 Alliance Community Hospital 200 E State St Alliance OH 44601 340714581 501 (c)(3) 1199520 0 actual cost Medical equipment, renovations, systems updates, pastoral care, general patient care. 1 0 Indigent patient care 25 32650 210 FMV Voice monitors Schedule I, Part I, Line 2 Alliance Community Hospital Foundation was created to benefit Alliance Community Hospital's (ACH) mission which is to provide care to all, regardless of ability to pay. Funds given to ACH are used to purchase medical equipment, contribute to hospital building improvements, and provide for patients' needs. Alliance Community Hospital Foundation has not provided grants to organizations outside its control. Should ACHF provide grants outside its control, then ACHF will rely on the policy of lump sum funding preceeded by a grant application, approval from the Board, and then followed by a 6-month and annual evaluation of the project if needed and/or grant application funding based on reimbursement of actual expense(s) along with Board approval. 0 0 0 0 0 0 0 0 0 Stan Jonas CEO, Alliance Community Hospital 0 393183 0 200 0 17992 0 6750 0 19953 0 438078 0 0 Dale Wells Treasurer; CFO/COO, Alliance Community Hospital 0 211151 0 200 0 18000 0 5698 0 31046 0 266095 0 0 Schedule J, Part I, Line 3 Alliance Community Hospital Foundation's Schedule J lists Dale Wells and Stan Jonas, employees of Alliance Community Hospital, a related organization. Their compensation is determined using all six methods listed in Part I, line 3. Form 990, Part VI, Section A, Line 1a The governing body of Alliance Community Hospital Foundation (per its Code of Regulations) has delegated authority to the Board of Alliance Citizens' Health Association (the Member), a related organization. Form 990, Part VI, Section A, Line 4 Excerpt from December, 2017 Board Resolution: The Code of Regulations of ACHF shall be amended in its entirety. The corporation shall be governed by a Board of Trustees of up to five persons, the majority of which shall be at all times persons other than substantial contributors. During the time period between January 1, 2018 and December 31, 2022, one seat on the ACHF Board shall be filled by appointment by Aultman Health Foundation (AHF), with AFH retaining exclusive right to make such appointment. Form 990, Part VI, Section A, Line 6 Alliance Citizens' Health Association is the sole member of Alliance Community Hospital Foundation. Form 990, Part VI, Section A, Line 7a The governing body of Alliance Community Hospital Foundation (per its Code of Regulations) has delegated authority to the Board of Alliance Citizens' Health Association (the Member) the power to elect and remove members of the Board of Trustees and/or Officers of the corporation. Form 990, Part VI, Section A, Line 7b The governing body of Alliance Community Hospital Foundation (per its Code of Regulations) has delegated authority to the Board of Alliance Citizens' Health Association (the Member), a related organization, as follows: 1.) Approve the annual operating budgets; capital expenditures budgets; capital expenditures or dispositions of capital assets with a value in excess of such limits as shall be set from time to time by the Member; any action which requires Certificate of Need approval from the State Health Planning Development Agency; and any purchase, sale, lease, disposition, or hypothecation of real property; 2.) The incurrence of any obligation(s), liability(ies), and/or debt(s) requiring a mortgage on or security interest in any part of the assets of the corporation; 3.) Power to determine, upon dissolution of the corporation, the organization or organizations to which its remaining assets will be distributed. Form 990, Part VI, Section B, Line 11b The Form 990 is reviewed by the CFO of Alliance Community Hospital, a related organization. Prior to filing, the 990 is also distributed to the Board of Trustees for their review and comments. It is then discussed as part of the financial report at the next Board meeting where any questions/concerns can be addressed. Form 990, Part VI, Section B, Line 12c Members of the Board of Trustees are required to annually review and sign a conflict of interest policy. Under that policy, the Board member (i) has a duty to disclose any conflict, and (ii) must recuse themselves from a vote and or decision when such conflict arises. If this policy is violated, then the Board shall take appropriate action which may include an investigation and disciplinary action. Form 990, Part VI, Section B, Line 15 No compensation is paid directly by Alliance Community Hospital Foundation; however, certain officers and top officials of this organization are compensated by Alliance Community Hospital, a related organization. That compensation is determined by an independent (noncompensated) committee from the Board of Trustees. This committee annually reviews compensation by obtaining market surveys of the positions. Form 990, Part VI, Section C, Line 17 Ohio does not require the Form 990 to be filed with the Ohio Attorney General's Office. Instead, a "Verification of Filing with the Internal Revenue Service" form is completed stating that we did file Form 990 by the required due date. Form 990, Part VI, Section C, Line 19 The organization makes its governing documents available to the public via the Ohio Secretary of State's website. The financial statements and conflict of interest policy are available upon request. Form 990, Part VIII, Line 1d At the May, 2017 Board Executive Session of Alliance Citizen's Health Association (ACHA), ACHF's sole member, it was determined that ACHF would receive investment assets from AHI, a related organization. AHI and ACHF are both supporting organizations of Alliance Community Hospital. Form 990, Part X, Line 13 At the May, 2017 Board Executive Session of Alliance Citizen's Health Association (ACHA), ACHF's sole member, it was determined that ACHF would receive investment assets from AHI, a related organization. AHI and ACHF are both supporting organizations of Alliance Community Hospital. Alliance Citizens' Health Association 200 E State St Alliance OH 44601 341531815 Manage Health Facil OH 501(C)(3) Sch A, 12b, II N/A 0 Alliance Community Hospital 200 E State St Alliance OH 44601 340714581 Community Hospital OH 501(C)(3) Sch A, Ln 3 Alliance Citizens' Health Assn 0 Alliance Comm Hospital Auxiliary 200 E State St Alliance OH 44601 340777659 Volunteer Services OH 501(C)(3) Sch A, 12c, III-FI N/A 0 Alliance Health Institute 200 E State St Alliance OH 44601 341932972 Support ACH OH 501(C)(3) Sch A, 12a, I Alliance Citizens' Health Assn 0 Caring Hands 885 Sawburg Rd Alliance OH 44601 341505340 Private Duty Nursing OH 501(C)(3) Sch A, Line 10 Alliance Citizens' Health Assn 0 Alliance Health Partners 200 E State St Alliance OH 44601 341884059 PHO OH N/A C 0 Alliance Medical Associates Inc 200 E State St Alliance OH 44601 911889215 ER Physicians OH N/A C 0 Health Alliance Inc 200 E State St Alliance OH 44601 341531993 Urgent Care Centers OH N/A C 0 0 1 1 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 0