ASHTABULA COUNTY MEDICAL CENTER: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- ASHTABULA COUNTY MEDICAL CENTER (EIN 34-0726081)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-14
- IRS object ID
- 201733189349310808
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-14T16:23:32-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 388 S MAIN STREET SUITE 403 | AddressLine1Txt |
| City | AKRON | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44311 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 340726081 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASHTABULA COUNTY MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ASHT | BusinessNameControlTxt |
| Phone | 4409972262 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2420 LAKE AVENUE | AddressLine1Txt |
| City | ASHTABULA | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44004 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DON KEPNER | PersonNm |
| Person Title | VP FINANCE/CFO | PersonTitleTxt |
| Phone | 4409972262 | PhoneNum |
| Signature | 2017-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | LISA HILLING | PreparerPersonNm |
| PTIN | P01624111 | PTIN |
| Phone | 3303760100 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 67.137.57.251 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-14 | IPDt |
| IP Tm | 12:34:54 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | A79143C56F2E978A8BC5D93EC8E46E458654AD2B | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | B70C6DEBCE2ADC8DDB6B1F4429B1A1ED1473E18D | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MICHAEL HABOWSKI | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2420 LAKE AVENUE | AddressLine1Txt |
| City | ASHTABULA | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44004 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $155,949,531 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 6026 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.ACMCHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1902 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE THE BEST POSSIBLE MEDICAL CARE THROUGH ALL PHASES OF LIFE TO THOSE SEEKING HELP. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 1221 | TotalEmployeeCnt |
| Total Volunteers | 165 | TotalVolunteersCnt |
| Total Gross UBI | $298,790 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $7,076,771 | PYContributionsGrantsAmt |
| CY Contributions Grants | $15,207,469 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $110,488,865 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $136,809,625 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,243,942 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,509,736 | CYInvestmentIncomeAmt |
| PY Other Revenue | $6,034,780 | PYOtherRevenueAmt |
| CY Other Revenue | $495,613 | CYOtherRevenueAmt |
| PY Total Revenue | $124,844,358 | PYTotalRevenueAmt |
| CY Total Revenue | $154,022,443 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $150,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $3,653,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $67,156,156 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $72,204,878 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $49,738,916 | PYOtherExpensesAmt |
| CY Other Expenses | $61,742,972 | CYOtherExpensesAmt |
| PY Total Expenses | $117,045,072 | PYTotalExpensesAmt |
| CY Total Expenses | $137,600,850 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $7,799,286 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $16,421,593 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $113,927,164 | TotalAssetsBOYAmt |
| Total Assets EOY | $136,482,719 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $61,331,440 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $63,128,741 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $52,595,724 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $73,353,978 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE THE BEST POSSIBLE MEDICAL CARE THROUGH ALL PHASES OF LIFE TO THOSE SEEKING HELP. THE ASHTABULA COUNTY MEDICAL CENTER HEALTH CARE TEAM IS COMMITTED TO PRESERVING THE HUMAN RIGHTS AND DIGNITY OF THOSE WHO RECEIVE OUR CARE AND THOSE WHO PROVIDE IT. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $115,244,353 | ExpenseAmt |
| Grant | $3,653,000 | GrantAmt |
| Revenue | $136,809,625 | RevenueAmt |
| Desc | ASHTABULA COUNTY MEDICAL CENTER (ACMC) IS A PRIVATE, NOT-FOR-PROFIT, COMMUNITY-ORIENTED MEDICAL CENTER THAT PROVIDES THE BEST POSSIBLE MEDICAL CARE THROUGH ALL PHASES OF LIFE TO THOSE SEEKING HELP. IN 2016 WE MET OUR MISSION OF MEETING OUR COMMUNITY'S HEALTH CARE NEEDS AS EVIDENCED BY APPROXIMATELY 34,498 EMERGENCY DEPARTMENT VISITS, 6,104 INPATIENT DISCHARGES, 1,289 INPATIENT SURGERIES, 6,899 OUTPATIENT SURGERIES, 358 BIRTHS, AND 76,029 RADIOLOGY PROCEDURES. | Desc |
| Total Program Service Expenses | $115,244,353 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| 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 | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | Yes (1) | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 122 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 1221 | 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 | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 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 | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DON KEPNER VP FINANCECFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4409972262 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2420 LAKE AVENUE | AddressLine1Txt |
| City | ASHTABULA | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44004 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| SUSAN STOCKER PHD | ||||||||
| CHAIRPERSON | 0.30 | 0.60 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| NANCY KISTER | ||||||||
| VICE-CHAIRPERSON | 0.30 | 0.30 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JOE GIANGOLA | ||||||||
| SECRETARY/TREASURER | 0.30 | 0.30 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MICHAEL HABOWSKI | ||||||||
| PRESIDENT/CEO | 40.00 | 0.30 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| PEG CARLO | ||||||||
| BOARD MEMBER | 0.30 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| BILL DINGLEDINE | ||||||||
| BOARD MEMBER | 0.30 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| ELENA MARQUETTI | ||||||||
| BOARD MEMBER | 0.30 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| REV VERNON PALO | ||||||||
| BOARD MEMBER | 0.30 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| MARLENE SARTINI | ||||||||
| BOARD MEMBER | 0.30 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| JIM TIMONERE | ||||||||
| BOARD MEMBER | 0.30 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| KELLY HANCOCK | ||||||||
| BOARD MEMBER/CCF REPRESENTATIVE | 0.30 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| JASON HERGENROEDER | ||||||||
| BOARD MEMBER/CCF REPRESENTATIVE | 0.30 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| JOSHUA MILLER | ||||||||
| BOARD MEMBER/CCF REPRESENTATIVE | 0.30 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| JUDE CAUWENBERGH DO | ||||||||
| BOARD MEMBER/CHIEF OF STAFF | 60.00 | 0.30 | Yes (X) | $281,448 | $0 | $12,998 | ||
| DANIEL KEATON MD | ||||||||
| BOARD MEMBER/VICE-CHIEF OF STAFF | 60.00 | 0.30 | Yes (X) | $176,469 | $0 | $10,745 | ||
| DON KEPNER | ||||||||
| VP FINANCE/CFO | 40.00 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| KEN FRAME | ||||||||
| CHIEF NURSING OFFICER | 40.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| ALEXANDER TAICH MD | ||||||||
| PHYSICIAN | 60.00 | 0.00 | $1,084,436 | $0 | $11,520 | Yes (X) | ||
| ASHOK KONDRU MD | ||||||||
| PHYSICIAN | 60.00 | 0.00 | $889,121 | $0 | $14,433 | Yes (X) | ||
| LAXMAN R CINGIREDDI MD | ||||||||
| PHYSICIAN | 60.00 | 0.00 | $744,564 | $0 | $14,333 | Yes (X) | ||
| AMAR B MUTNAL MD | ||||||||
| PHYSICIAN | 60.00 | 0.00 | $642,015 | $0 | $14,597 | Yes (X) | ||
| SUK K CHOI MD | ||||||||
| PHYSICIAN | 60.00 | 0.00 | $642,246 | $0 | $14,224 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,460,299 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $92,850 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 73 | 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 |
|---|---|---|---|---|---|
| CLEVELAND CLINIC FOUNDATION | |||||
| PO BOX 931760 | CLEVELAND | OH | 44193 | ADMINISTRATIVE AND CLINICAL SERVICES | $5,934,056 |
| ANESTHESIA CONSULTANTS EFT | |||||
| 5168 STANSBURG ROAD | SOLON | OH | 44139 | MEDICAL | $2,380,584 |
| ARAMARK CORP | |||||
| 24863 NETWORK PLACE | CHICAGO | IL | 60673 | CAFETERIA AND DIETARY SERVICES | $1,826,280 |
| MEDIC MANAGEMENT GROUP INC | |||||
| 275 SPRINGSIDE DRIVE SUITE 100 | AKRON | OH | 44333 | PHYSICIAN BILLING | $1,148,095 |
| AMICON MEDICAL GROUP INC | |||||
| 51 MEADOW LANE SUITE A | NORTHFIELD | OH | 44067 | MEDICAL | $565,447 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 25 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $15,000,000 | RelatedOrganizationsAmt |
| Government Grants | $100,000 | GovernmentGrantsAmt |
| All Other Contributions | $107,469 | AllOtherContributionsAmt |
| Total Contributions | $15,207,469 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 624100 | $129,392,850 | $129,392,850 |
| MISC OPERATING REVENUE | 624100 | $7,176,106 | $7,176,106 |
| REBATES AND REFUNDS | 624100 | $240,669 | $240,669 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $136,809,625 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,428,743 | TotalRevenueColumnAmt |
| Exclusion | $1,428,743 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $196,823 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $196,823 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $196,823 | TotalRevenueColumnAmt |
| Exclusion | $196,823 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,008,081 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,924,899 | SecuritiesAmt |
| Other | $2,189 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $83,182 | SecuritiesAmt |
| Other | -$2,189 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $80,993 | TotalRevenueColumnAmt |
| Exclusion | $80,993 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PREMIER FITNESS | Desc |
| Business | 713940 | BusinessCd |
| Total Revenue Column | $298,790 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $298,790 | UnrelatedBusinessRevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $298,790 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $154,022,443 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $136,809,625 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $298,790 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,706,559 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,653,000 | TotalAmt |
| Program Services | $3,653,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,583,543 | TotalAmt |
| Program Services | $1,298,505 | ProgramServicesAmt |
| Management And General | $285,038 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,490,734 | TotalAmt |
| Program Services | $45,502,402 | ProgramServicesAmt |
| Management And General | $9,988,332 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,056,295 | TotalAmt |
| Program Services | $2,506,162 | ProgramServicesAmt |
| Management And General | $550,133 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,343,570 | TotalAmt |
| Program Services | $6,841,727 | ProgramServicesAmt |
| Management And General | $1,501,843 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,730,736 | TotalAmt |
| Program Services | $3,059,204 | ProgramServicesAmt |
| Management And General | $671,532 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,048,859 | TotalAmt |
| Program Services | $3,320,064 | ProgramServicesAmt |
| Management And General | $728,795 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $164,680 | TotalAmt |
| Program Services | $135,038 | ProgramServicesAmt |
| Management And General | $29,642 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,358 | TotalAmt |
| Program Services | $37,194 | ProgramServicesAmt |
| Management And General | $8,164 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,990,855 | TotalAmt |
| Program Services | $8,192,501 | ProgramServicesAmt |
| Management And General | $1,798,354 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,670,947 | TotalAmt |
| Program Services | $1,370,177 | ProgramServicesAmt |
| Management And General | $300,770 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,589 | TotalAmt |
| Program Services | $76,743 | ProgramServicesAmt |
| Management And General | $16,846 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,049 | TotalAmt |
| Program Services | $11,520 | ProgramServicesAmt |
| Management And General | $2,529 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,304,794 | TotalAmt |
| Program Services | $3,529,931 | ProgramServicesAmt |
| Management And General | $774,863 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,832,515 | TotalAmt |
| Program Services | $1,502,662 | ProgramServicesAmt |
| Management And General | $329,853 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| SUPPLIES | $20,014,469 | $16,411,865 | $3,602,604 | $0 |
| BAD DEBT EXPENSE | $9,745,089 | $9,745,089 | $0 | $0 |
| EQUIPMENT RENTAL/MAINTE | $4,731,598 | $3,879,910 | $851,688 | $0 |
| LICENSES & PERMITS | $1,823,214 | $1,495,035 | $328,179 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,262,956 | TotalAmt |
| Program Services | $2,675,624 | ProgramServicesAmt |
| Management And General | $587,332 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $137,600,850 | TotalAmt |
| Program Services | $115,244,353 | ProgramServicesAmt |
| Management And General | $22,356,497 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,773,146 | BOYAmt |
| EOY | $16,962,440 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,847,539 | BOYAmt |
| EOY | $1,580,843 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,604,042 | BOYAmt |
| EOY | $23,594,231 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,358 | BOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,079,385 | BOYAmt |
| EOY | $1,259,526 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,525,391 | BOYAmt |
| EOY | $1,882,212 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $108,319,696 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $83,610,008 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,103,143 | BOYAmt |
| EOY | $24,709,688 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $42,846,005 | BOYAmt |
| EOY | $55,923,668 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,741,373 | BOYAmt |
| EOY | $2,812,827 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,365,782 | BOYAmt |
| EOY | $7,757,284 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $113,927,164 | BOYAmt |
| EOY | $136,482,719 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,178,580 | BOYAmt |
| EOY | $14,609,973 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $211,618 | BOYAmt |
| EOY | $169,053 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $718,184 | BOYAmt |
| EOY | $346,331 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,223,058 | BOYAmt |
| EOY | $48,003,384 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $61,331,440 | BOYAmt |
| EOY | $63,128,741 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,580,749 | BOYAmt |
| EOY | $73,339,003 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,975 | BOYAmt |
| EOY | $14,975 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,595,724 | BOYAmt |
| EOY | $73,353,978 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $113,927,164 | BOYAmt |
| EOY | $136,482,719 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $16,421,593 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,618,366 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $2,718,295 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,518,862 | OtherCostOrOtherBasisAmt |
| Book Value | $2,518,862 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $31,214,017 | OtherCostOrOtherBasisAmt |
| Depreciation | $22,051,919 | DepreciationAmt |
| Book Value | $9,162,098 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,164,859 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,604,620 | DepreciationAmt |
| Book Value | $1,560,239 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $69,843,451 | OtherCostOrOtherBasisAmt |
| Depreciation | $58,953,469 | DepreciationAmt |
| Book Value | $10,889,982 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $578,507 | OtherCostOrOtherBasisAmt |
| Book Value | $578,507 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $24,709,688 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| SELF-INSURANCE INVESTMENTS | $5,044,507 |
| DEFERRED COMPENSATION | $2,535,701 |
| DUE FROM AFFLIATES | $177,076 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $7,757,284 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)
| DescDesc | AmtAmt |
|---|---|
| RESERVE FOR SELF-INSURANCE LIABILITIES | $9,659,374 |
| DEFERRED COMPENSATION | $2,535,701 |
| ACCRUED PENSION LIABILITY | $13,847,389 |
| DISTRIBUTION PAYABLE TO THE CLEVELAND CLINIC FOUNDATION | $3,653,000 |
| INVESTMENT FROM CLEVELAND CLINIC FOUNDATION | $15,000,000 |
| THIRD-PARTY PAYABLES | $3,307,920 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $48,003,384 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | WHEN TAX RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD BE ULTIMATELY SUSTAINED. IN ACCORDANCE WITH THE INCOME TAXES TOPIC OF THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION, THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS TAKEN ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY OF BEING REALIZED UPON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS RECORDED AS A LIABILITY FOR UNRECOGNIZED TAX BENEFITS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| Most Hospitals Policy | Yes (X) | MostHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,438,055 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,438,055 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01120 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $23,896,954 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $18,634,848 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,262,106 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04120 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | -$519,133 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $293,121 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $24,815,876 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $18,927,969 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,700,161 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05240 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,448,028 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,448,028 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04260 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $37,350 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $37,350 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $63,821 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $63,821 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,925 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,925 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,554,124 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,554,124 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04340 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $30,370,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $18,927,969 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $12,254,285 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09580 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $9,745,089 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $31,101,996 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $31,207,332 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$105,336 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASHTABULA COUNTY MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2420 LAKE AVENUE | AddressLine1Txt |
| City | ASTHABULA | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44004 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.ACMCHEALTH.ORG | WebsiteAddressTxt |
| State License | 360125 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASHTABULA COUNTY MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.ACMCHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.ACMCHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS ASSESSMENT/ | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.ACMCHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-SERVICES/ | FAPAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| ASHTABULA COUNTY MEDICAL CENTER | PART V, SECTION B, LINE 5: THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT RELIED ON MULTIPLE DATA SOURCES AND COMMUNITY INPUT GATHERED BETWEEN JANUARY AND JULY 2016. INPUT FROM 15 PERSONS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY WAS TAKEN INTO ACCOUNT THROUGH KEY INFORMANT INTERVIEWS. INTERVIEWS INCLUDED INDIVIDUALS WITH SPECIAL KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH, LOCAL PUBLIC HEALTH DEPARTMENTS, AGENCIES WITH CURRENT DATA OR INFORMATION ABOUT THE HEALTH AND SOCIAL NEEDS OF THE COMMUNITY, REPRESENTATIVES OF SOCIAL SERVICE ORGANIZATIONS, AND LEADERS, REPRESENTATIVES AND MEMBER OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. SEE PAGE 60 OF THE 2016 CHNA REPORT FOR A LIST OF PARTICIPATING ORGANIZATIONS AND AGENCIES. |
| ASHTABULA COUNTY MEDICAL CENTER | PART V, SECTION B, LINE 11: ASHTABULA COUNTY MEDICAL CENTER HAS A 109-YEAR HISTORY OF PROVIDING SIGNIFICANT AMOUNTS OF COMMUNITY BENEFIT TO THE COMMUNITIES IT SERVES. ACMC WILL CONTINUE THIS COMMITMENT BY ALLOCATING APPROPRIATE HUMAN AND FINANCIAL RESOURCES TO MEET THOSE NEEDS THROUGH THE IMPLEMENTATION OF THE FOLLOWING STRATEGY:1. IMPROVE ACCESS TO CARE, INCLUDING BOTH PRIMARY AND SPECIALTY CARE BY:A. CONTINUING TO RECRUIT PRIMARY CARE (FAMILY MEDICINE, INTERNAL MEDICINE, PEDIATRICS, OBSTETRICS & GYNECOLOGY) PHYSICIANS TO THE COMMUNITY AND PLACING OFFICES IN SHORTAGE AREAS.B. CONTINUING TO RECRUIT SPECIALTY PHYSICIANS TO THE COMMUNITY TO ENSURE COMMUNITY RESIDENTS DO NOT HAVE TO LEAVE THE COMMUNITY TO RECEIVE CARE FROM A SPECIALIST.C. CONTINUING TO COLLABORATE WITH CLEVELAND CLINIC TO PROVIDE SPECIALTY CLINICS FOR SERVICES NOT AVAILABLE IN THE COMMUNITY.D. CONTINUING TO PROVIDE THE ACMC HEALTH EXPRESS FREE SHUTTLE SERVICE.E. EXPLORING COLLABORATION OPPORTUNITIES WITH ASHTABULA COUNTY DEPARTMENT OF JOB AND FAMILY SERVICES TO USE THE ASHTABULA COUNTY TRANSIT SYSTEM (ACTS) FOR MEDICAL APPOINTMENTS.F. COLLABORATING WITH ASHTABULA COUNTY DEPARTMENT OF JOB AND FAMILY SERVICES TO DEVELOP AND IMPLEMENT A PLAN TO ACCOMMODATE THE INCREASE IN MEDICAID RECIPIENTS IN MID-2014.G. CONTINUING TO OFFER FINANCIAL COUNSELING SERVICES TO ASSIST RESIDENTS IN QUALIFYING FOR PUBLIC ASSISTANCE AND ACMC'S CHARITY CARE PROGRAM.2. DECREASE THE PREVALENCE OF DIET AND EXERCISE-RELATED ISSUES, INCLUDING HIGH RATES OF OBESITY BY:A. COLLABORATING WITH SCHOOLS TO OFFER AFTER-SCHOOL PROGRAMMING TO INCLUDE NUTRITION EDUCATION AND PHYSICAL ACTIVITY.B. CONTINUING TO PARTICIPATE IN COMMUNITY-BASED PROGRAMS (INCLUDING LONGEST DAY OF PLAY, PARTNERSHIP FOR A REVOLUTION) WITH A FOCUS ON HEALTHY LIFESTYLE HABITS.C. CONTINUING TO OFFER HEALTHY FOOD OPTIONS IN THE ACMC CAFETERIA AND VENDING MACHINES.D. CONTINUING TO OFFER COMMUNITY MEMBERSHIPS AT THE ACMC-OWNED FITNESS FACILITY, INCLUDING EXPLORING A PLAN TO OPEN THE FACILITY FREE OF CHARGE ON A LIMITED BASIS.E. CONTINUING TO OFFER EXERCISE CLASSES FOR CHILDREN (KID FIT, ZUMBAKIDS, ZUMBATOMIC, MOMMY AND ME) AT THE ACMC-OWNED FITNESS FACILITY.F. CONTINUING TO PUBLISH DIET AND NUTRITION-FOCUSED EDUCATIONAL ARTICLES IN THE MEDIA AND IN ACMC-PRODUCED PUBLICATIONS.G. IMPLEMENTING AN INCENTIVE PROGRAM FOR ACMC EMPLOYEES TO RECEIVE DISCOUNT/REBATE ON HEALTH INSURANCE PREMIUMS FOR ATTAINING SPECIFIED HEALTH METRICS,AND CONTINUING THE SHAPE UP AND GO PROGRAM FOR EMPLOYEES.3. IMPROVE THE EFFECTIVENESS OF HEALTH EDUCATION INITIATIVES THAT EMPHASIZE THE RAMIFICATIONS OF HIGH-RISK HEALTH BEHAVIORS BY:A. LAUNCHING PROMOTION CAMPAIGNS TO TEACH CHILDREN AND ADULTS THE RISKS ASSOCIATED WITH SMOKING, DRINKING, AND OBESITY.4. DECREASE THE INCIDENCE OF WOMEN NOT RECEIVING FIRST TRIMESTER PRE-NATAL CARE AND THE INCIDENCE OF SMOKING IN PREGNANT WOMEN BY:A. COLLABORATING WITH HIGH SCHOOL GUIDANCE COUNSELORS AND NURSES TO PROVIDE EDUCATION REGARDING THE IMPORTANCE OF PRE-NATAL CARE.B. B. PROVIDING A FREE PREGNANCY TEST THROUGH SPLIT FLOW IN THE ACMC EMERGENCY DEPARTMENT, WITH REFERRAL AND APPOINTMENT SCHEDULING FOR OB/GYN FOLLOW UP.C. COLLABORATING WITH ASHTABULA DEPARTMENT OF JOB AND FAMILY SERVICES AND SOCIAL SERVICE AGENCIES (CATHOLIC CHARITIES, UNITED WAY) IN PROVIDING EDUCATION TO CLIENTS.D. OFFERING A SERIES OF SMOKING CESSATION CLASSES GEARED SPECIFICALLY TO PREGNANT WOMEN.E. PROVIDING FREE NICOTINE REPLACEMENT PATCHES TO PREGNANT WOMEN UNDER THE CARE OF AN ACMC PHYSICIAN.5. IMPROVE HEALTH OUTCOMES, SPECIFICALLY MORBIDITY AND MORTALITY RATES, FOR HEART DISEASE AND CANCER BY:A. CONTINUING TO MAINTAIN CERTIFICATIONS IN STROKE, HEART FAILURE AND CHEST PAIN.B. EXPLORING EXPANDING ACCESS TO CARDIOLOGIST OFFICE VISITS BY PLACING A PHYSICIAN IN SATELLITE OFFICES IN VARIOUS PARTS OF THE COMMUNITY.C. CONTINUING TO OPERATE THE COMMUNITY'S ONLY DIAGNOSTIC CARDIAC CATHETERIZATION LABORATORY.D. RECRUITING A THIRD INVASIVE CARDIOLOGIST TO REDUCE WAIT TIME FOR INITIAL PHYSICIAN APPOINTMENT.E. EXPANDING HEART CARE SPECIALTY SERVICES TO INCLUDE A MONTHLY ELECTROPHYSIOLOGY SPECIALTY CLINIC.F. COLLABORATING WITH HIGH SCHOOLS TO OFFER SCREENING PROGRAMS FOR HIGH SCHOOL ATHLETES TO IDENTIFY HYPERTROPHIC CARDIOMYOPATHY.G. CONTINUING STAFF TRAINING IN THE USE OF ADVANCED TECHNOLOGY, INCLUDING CT, MRI AND PET CT, FOR EARLY DIAGNOSIS OF EARLY-STAGE HEART DISEASE AND CANCER.H. CONTINUING TO OFFER ANNUAL WOMEN'S HEART HEALTH AND WOMEN'S CANCER AWARENESS LUNCHEONS WITH A FOCUS ON PREVENTION AND TREATMENT TOPICS.I. EXPLORING TRANSPORTATION COLLABORATIONS WITH AMERICAN CANCER SOCIETY TO ASSIST COMMUNITY IN TRAVELING TO RADIATION ONCOLOGY APPOINTMENTS.J. EXPLORING COLLABORATION WITH CLEVELAND CLINIC TO ENROLL COMMUNITY RESIDENTS IN CLINICAL CANCER TRIALS.K. EXPLORING OPPORTUNITIES TO OFFER ADDITIONAL FREE SCREENINGS, INCLUDING HEMOCULT AND COLONOSCOPY.THE ADDITION OF THE NEW OR EXPANDED STRATEGIC INITIATIVES TO ADDRESS COMMUNITY HEALTH NEEDS WILL NOT DIMINISH ACMC'S COMMITMENT TO ITS CURRENT COMMUNITY BENEFIT PROGRAMS. THESE CURRENT PROGRAMS INCLUDE:A. CONTINUE TO OFFER DIABETES EDUCATION CLASSES AND SUPPORT GROUPS.B. CONTINUE TO PROVIDE LANGUAGE SUPPORT SERVICES TO NON-ENGLISH SPEAKING PATIENTS TO ENSURE EFFECTIVE COMMUNICATION AND APPROPRIATENESS OF CARE.C. CONTINUE TO SUPPORT A TOBACCO-FREE ENVIRONMENT THROUGH ACMC'S SMOKE FREE CAMPUS, HIRING POLICIES, AND SMOKING CESSATION PROGRAMS.D. CONTINUE TO PROVIDE INPATIENT AND OUTPATIENT MENTAL HEALTH SERVICES, AS WELL AS AN INTENSIVE OUTPATIENT PSYCHIATRY PROGRAM.E. CONTINUE TO PROVIDE FREE HEALTH SCREENINGS AND REFERRAL FOR TREATMENT.F. CONTINUE TO PROVIDE FINANCIAL COUNSELOR SERVICES TO ASSIST PATIENTS IN QUALIFYING FOR MEDICAL ASSISTANCE.G. CONTINUE TO OFFER A CHARITY CARE PROGRAM.ASHTABULA COUNTY MEDICAL CENTER CANNOT ADDRESS ALL OF THE HEALTH NEEDS PRESENT IN THE COMMUNITY. TO ENSURE ACMC REMAINS FINANCIALLY VIABLE AND IN A POSITION TO ENHANCE CURRENT SERVICES, DEVELOP NEW SERVICES AND CONTINUE TO PROVIDE A WIDE RANGE OF COMMUNITY BENEFITS, THE HOSPITAL'S IMPLEMENTATION STRATEGY FOCUS WILL NOT ADDRESS THE FOLLOWING NEEDS:DENTAL HEALTH: AS AN ACUTE CARE HOSPITAL, ACMC DOES NOT HAVE THE EXPERTISE TO ADDRESS BASIC DENTAL HEALTH.ACCIDENTS/UNINTENTIONAL INJURIES: THIS COMMUNITY HEALTH ISSUE IS BEYOND THE SCOPE OF ACMC, AND IS BEING ADDRESSED BY OTHERS.BIRTHS TO UNWED MOTHERS: THIS COMMUNITY HEALTH ISSUE IS BEYOND THE SCOPE OF ACMC, AND IS BEING ADDRESSED BY FAITH-BASED AND SOCIAL SERVICE AGENCIES.ALCOHOL ABUSE/EXCESSIVE BINGE DRINKING: THIS ISSUE IS BEYOND THE SCOPE OF ACMC AND IS BEING ADDRESSED BY OTHERS.SUICIDE: THIS COMMUNITY HEALTH ISSUE IS BEING ADDRESSED BY OTHERS, INCLUDING THE ASHTABULA COUNTY DEPARTMENT OF HEALTH AND A TASK FORCE FORMED FOLLOWING THE COMPLETION OF THE COUNTY'S COMMUNITY NEEDS ASSESSMENT.ACCESS TO HEALTHY FOODS: OTHER THAN WHAT IS OFFERED INSIDE THE WALLS OF OUR FACILITY, THIS ISSUE IS BEYOND THE SCOPE OF THE HOSPITAL AND THE HOSPITAL DOES NOT HAVE SUFFICIENT RESOURCES TO MAKE A MEANINGFUL IMPACT. |
| ASHTABULA COUNTY MEDICAL CENTER | PART V, SECTION B, LINE 20E: LINE 20C: IF AN INCOMPLETE FAP APPLICATION IS RECEIVED, THE ORGANIZATION'S FINANCIAL COUNSELORS CONTACT THE PATIENT FOR ADDITIONAL INFORMATION.LINE 20E: THE ORGANIZATION PROVIDES NOTIFICATION REGARDING THE FAP THROUGH SIGNAGE AND OTHER MECHANISMS. THERE ARE A NUMBER OF WRITTEN CORRESPONDENCES THAT GO OUT TO PATIENTS OVER THE COURSE OF 120 DAYS ONCE THE PATIENT RESPONSIBILITY IS DETERMINED FOR THE AMOUNT DUE RELATED TO SERVICES PROVIDED. |
| ASHTABULA COUNTY MEDICAL CENTER | PART V, SECTION B, LINE 24: ALL PATIENTS ARE CHARGED THE SAME, STANDARD RATE, FOR A PARTICULAR SERVICE. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 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 - JEFFERSON FAMILY HEALTH CENTER | ||||
| 234 NORTH CHESTNUT ST | JEFFERSON | OH | 44047 | FAMILY HEALTH CENTER |
| 2 - CONNEAUT FAMILY HEALTH CENTER | ||||
| 354 W MAIN ROAD | CONNEAUT | OH | 44030 | FAMILY HEALTH CENTER |
| 3 - NORTH KINGSVILLE FAMILY HEALTH CENTER | ||||
| 6441 S MAIN ST | NORTH KINGSVILLE | OH | 44068 | FAMILY HEALTH CENTER |
| 4 - ASHTABULA WOMEN'S HEALTH CENTER | ||||
| 524 W 24TH STREET | ASHTABULA | OH | 44004 | WOMEN'S HEALTH CENTER |
| 5 - GASTROENTEROLOGY HEALTH CENTER | ||||
| 2112 LAKE AVENUE | ASHTABULA | OH | 44004 | GASTROENTEROLOGY HEALTH CENTER |
Supplemental Information Detail SupplementalInformationDetail (19 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | TO QUALIFY FOR THE HOSPITAL CARE ASSURANCE PROGRAM, AN INDIVIDUAL MUST (A) BE A RESIDENT OF THE STATE OF OHIO, (B) NOT BE ENROLLED IN THE MEDICAID (INCLUDING MEDICAID HMO) PROGRAM, AND (C) HAVE FAMILY/HOUSEHOLD INCOME LESS THAN 200% OF FEDERAL POVERTY GUIDELINES. IN ADDITION, BEFORE GRANTING FINANCIAL ASSISTANCE, THE HOSPITAL HAS THE RIGHT TO REQUIRE (A) PROOF OF INCOME, (B) A WRITTEN STATEMENT FOR CLAIMS OF $0 INCOME, (C) INFORMATION ABOUT HSA AND HFSA ACCOUNTS, AND/OR (D) THAT AN INDIVIDUAL APPLY FOR MEDICAID. |
| PART I, LINE 6A: | N/A |
| PART I, LINE 7: | ACMC ESTIMATED CHARITY CARE COSTS BY CALCULATING A RATIO OF COST TO GROSS CHARGES AND THEN MULTIPLYING THAT RATIO BY THE GROSS UNCOMPENSATED CHARGES ASSOCIATED WITH PROVIDING CARE TO CHARITY PATIENTS.ACMC IS PAID A PROSPECTIVELY DETERMINED RATE FOR THE MAJORITY OF INPATIENT ACUTE CARE AND OUTPATIENT, SKILLED NURSING, AND REHABILITATION SERVICES PROVIDED FOR MEDICAID. THESE RATES VARY ACCORDING TO A PATIENT CLASSIFICATION SYSTEM THAT IS BASED ON CLINICAL, DIAGNOSTIC, AND OTHER FACTORS. MEDICAID PAYMENTS FOR CAPITAL ARE RECEIVED ON A COST REIMBURSEMENT METHODOLOGY. PAYMENTS ARE RECEIVED ON A PROSPECTIVE BASIS FOR ACMC'S MEDICAL EDUCATION COSTS, SUBJECT TO CERTAIN LIMITS. PROVISION FOR ESTIMATED RETROACTIVE ADJUSTMENTS, IF ANY, RESULTING FROM REGULATORY MATTERS OR OTHER ADJUSTMENTS UNDER PAYMENT AGREEMENTS ARE ESTIMATED IN THE PERIOD THE RELATED SERVICES ARE PROVIDED. |
| PART I, LINE 7G: | ACMC PROVIDES AN ATHLETIC TRAINER TO THREE HIGH SCHOOLS AT NO COST TO THE SCHOOL DISTRICTS FOR THIS SERVICE. |
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 9,745,089. |
| PART I, LINE 7C | ACMC PARTICIPATES IN THE HOSPITAL CARE ASSURANCE PROGRAM (HCAP) TO FINANCIALLY SUPPORT THOSE HOSPITALS THAT SERVICE A DISPROPORTIONATE SHARE OF LOW-INCOME PATIENTS UNABLE TO PAY FOR CARE. HCAP FUNDS BASIC, MEDICALLY NECESSARY HOSPITAL SERVICES FOR PATIENTS WHOSE FAMILY INCOME IS AT OR BELOW THE FEDERAL POVERTY LEVEL, WHICH INCLUDES MEDICAID PATIENTS AND PATIENTS WITHOUT HEALTH INSURANCE. |
| PART I, LINE 7E | ACMC PROVIDES A SIGNIFICANT RECRUITING SUBSIDY AND GUARANTEE FOR ALL NEW PHYSICIANS THE HOSPITAL RECRUITS. IN ADDITION, THE HOSPITAL PROVIDES A GUARANTEE AFTER THE INITIAL RECRUITMENT FOR SOME PHYSICIANS DUE TO THE PRESSING NEED FOR THE PHYSICIAN'S SPECIALTY. WITHOUT THE HOSPITAL DOING THIS, ACMC WOULD NOT BE ABLE TO PROVIDE MANY OF THESE SERVICES LOCALLY. THE RECRUITMENT AND GUARANTEE COSTS ACMC INCURS REDUCES GEOGRAPHIC AND FINANCIAL BARRIERS TO ACCESSING HEALTH CARE AND IMPROVES THE AVAILABILITY OF HEALTH SERVICES IN THE AREA ACMC SERVES. |
| PART III, LINE 2: | TOTAL BAD DEBT EXPENSE FOR THE ENTIRE HOSPITAL COMPLEX IS EQUAL TO THE TOTAL GROSS CHARGES WRITTEN OFF AS REPORTED ON THE 2016 MEDICARE COST REPORT. |
| PART III, LINE 3: | ASHTABULA COUNTY MEDICAL CENTER DOES NOT HAVE A METHOD TO REASONABLY ESTIMATE THE PORTION OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE BUT DID NOT COMPLETE AN APPLICATION. |
| PART II | N/A |
| PART III, LINE 4: | SEE THE "NET PATIENT SERVICE REVENUE AND PATIENT RECEIVABLES" PARAGRAPHS IN NOTE 1 ON PAGES 11-12 IN THE ATTACHED AUDITED FINANCIAL STATEMENTS.ACMC PROVIDES CARE TO PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY AND WHO QUALIFY FOR CHARITY SERVICES PURSUANT TO ESTABLISHED POLICIES OF ACMC. CHARITY SERVICES ARE DEFINED AS THOSE FOR WHICH PATIENTS HAVE THE OBLIGATION AND WILLINGNESS TO PAY BUT DO NOT HAVE THE ABILITY TO DO SO. ACMC DOES NOT INCLUDE CHARITY CARE IN NET PATIENT SERVICE REVENUE. |
| PART III, LINE 8: | MEDICARE SURPLUS IS NOT TREATED AS COMMUNITY BENEFIT. THE AMOUNTS REPORTED WERE GENERATED FROM THE MEDICARE COST REPORT FILED FOR 2016. ACMC IS PAID A PROSPECTIVELY DETERMINED RATE FOR THE MAJORITY OF INPATIENT ACUTE CARE AND OUTPATIENT, SKILLED NURSING, AND REHABILITATION SERVICES PROVIDED FOR MEDICARE. THESE RATES VARY ACCORDING TO A PATIENT CLASSIFICATION SYSTEM THAT IS BASED ON CLINICAL, DIAGNOSTIC, AND OTHER FACTORS. MEDICARE PAYMENTS FOR CAPITAL ARE RECEIVED ON A PROSPECTIVE BASIS. PAYMENTS ARE RECEIVED ON A PROSPECTIVE BASIS FOR ACMC'S MEDICAL EDUCATION COSTS, SUBJECT TO CERTAIN LIMITS. ACMC IS PAID FOR COST REIMBURSABLE ITEMS AT A TENTATIVE RATE, WITH FINAL SETTLEMENT DETERMINED AFTER SUBMISSION OF ANNUAL COST REPORTS BY ACMC AND AUDITS THEREOF BY THE MEDICARE FISCAL INTERMEDIARY. PROVISION FOR ESTIMATED RETROACTIVE ADJUSTMENTS, IF ANY, RESULTING FROM REGULATORY MATTERS OR OTHER ADJUSTMENTS UNDER PAYMENT AGREEMENTS ARE ESTIMATED IN THE PERIOD THE RELATED SERVICES ARE PROVIDED.LAWS AND REGULATIONS GOVERNING MEDICARE ARE COMPLEX AND SUBJECT TO INTERPRETATION AS WELL AS SIGNIFICANT REGULATORY ACTION, AND, IN THE NORMAL COURSE OF BUSINESS, ACMC IS SUBJECT TO CONTRACTUAL REVIEWS AND AUDITS. AS A RESULT, THERE IS AT LEAST A REASONABLE POSSIBILITY THAT RECORDED ESTIMATES WILL CHANGE IN THE NEAR TERM. ACMC BELIEVES IT IS IN COMPLIANCE WITH APPLICABLE LAWS AND REGULATIONS GOVERNING THE MEDICARE PROGRAM AND THAT ADEQUATE PROVISIONS HAVE BEEN MADE FOR ANY ADJUSTMENTS THAT MAY RESULT FROM FINAL SETTLEMENTS. |
| PART III, LINE 9B: | REASONABLE EFFORTS ARE PERFORMED TO DETERMINE THE PATIENT'S ELIGIBILITY UNDER THE HOSPITAL'S FAP AND THE HOSPITAL DOES NOT PERFORM DEBT COLLECTION PROCEDURES BEFORE MAKING THESE REASONABLE EFFORTS. THIS IS ACHIEVED THROUGH THE HCAP APPLICATION. DOCUMENTATION OF THE PATIENT OR FAMILY INCOME FOR HCAP ELIGIBILITY WILL BE BASED UPON A BEST EVIDENCE METHODOLOGY. HOSPITAL EMPLOYEES WILL PROCEED THROUGH THE FOLLOWING IN AN EFFORT TO SECURE THE BEST EVIDENCE AVAILABLE FOR THE PATIENT OR GUARANTOR AT THE TIME OF THEIR ENCOUNTER. 1. A COMPLETED HCAP APPLICATION INCLUSIVE OF THE PATIENT OR GUARANTOR'S SIGNATURE. 2. A COMPLETED HCAP APPLICATION, WHICH INCLUDES THE SIGNATURE OF THE PATIENT REPRESENTATIVE SECURING THE INFORMATION FROM THE RESPONSIBLE PARTY. IF THE APPLICATION CANNOT BE SECURED AT THE TIME OF THE ENCOUNTER, THE RESPONSIBLE PARTY WILL BE PROVIDED WITH A RETURN ENVELOPE. THEY WILL BE ASKED TO PROVIDE THIS INFORMATION UPON THEIR RETURN TO THEIR HOME. IN THE EVENT THAT THE INFORMATION IS RECEIVED, IT IS TO BE REVIEWED AND CONSIDERED AGAINST THE ABOVE-DEFINED ELIGIBILITY DETERMINATION CRITERIA. IF IT IS NOT RETURNED WITHIN 14 DAYS OF DISCHARGE, ACMC CONTACTS THE PATIENT VIA TELEPHONE TO COMPLETE THE APPLICATION. FOR OUTPATIENT HOSPITAL SERVICES, THE ELIGIBILITY DETERMINATION IS EFFECTIVE FOR NINETY DAYS FROM THE INITIAL SERVICE DATE. DURING THIS PERIOD A NEW ELIGIBILITY DETERMINATION NEED NOT BE COMPLETED. ELIGIBILITY FOR INPATIENT HOSPITAL SERVICES MUST BE DETERMINED SEPARATELY FOR EACH ADMISSION, UNLESS THE PATIENT IS READMITTED WITHIN FORTY-FIVE DAYS OF DISCHARGE FOR THE SAME UNDERLYING CONDITION. ELIGIBILITY FOR RECIPIENTS OF THE DISABILITY ASSISTANCE PROGRAM MUST BE VERIFIED ON A MONTHLY BASIS. IN THE EVENT THE PATIENT DOES NOT COMPLETE AN APPLICATION DURING THE ENCOUNTER, AND AS A RESULT OF THE HCAP COMMUNICATION, PATIENT STATEMENTS, OR RESULT OF COLLECTION EFFORTS, HOSPITAL STAFF WILL COMPLETE THE HCAP APPLICATION, OVER THE TELEPHONE OR IN-PERSON, ON BEHALF OF THE RESPONSIBLE PARTY. |
| PART VI, LINE 2: | ACMC USES MARKET DATA THAT REFLECTS ACTUAL PATIENT VISITS (DATA THAT IS SUBMITTED TO THE OHIO HOSPITAL ASSOCIATION BY ALL HOSPITALS IN THE STATE). MANAGEMENT REVIEWS THE NUMBER OF PATIENTS FROM THE MARKET WHO LEAVE ASHTABULA COUNTY FOR HEALTHCARE, AND WHAT SERVICES THEY LEAVE FOR. ACMC CONDUCTS A PHYSICIAN SATISFACTION SURVEY EVERY OTHER YEAR; ONE COMPONENT OF THE SURVEY IS TO OBTAIN PHYSICIAN INPUT INTO WHAT SERVICES/SPECIALTIES ARE NEEDED. ACMC CONDUCTS A MEDICAL STAFF DEVELOPMENT PLAN (APPROXIMATELY EVERY THREE YEARS) IN WHICH COMMUNITY PHYSICIANS ARE ASKED ABOUT THEIR PRACTICE PLANS (PLANNING TO RETIRE, BECOME EMPLOYED, GO INDEPENDENT, EXPAND) AND WHAT SPECIALISTS ARE NEEDED IN THE COMMUNITY TO BETTER SERVE THEIR PATIENTS. THIS HELPS GUIDE THE PHYSICIAN RECRUITMENT EFFORTS TO ENSURE THE HOSPITAL IS MEETING THE HEALTH NEEDS OF THE MARKET. EVERYONE ON THE ADMINISTRATIVE TEAM IS ASSIGNED TO 8-12 PHYSICIANS WITH WHOM THEY HAVE REGULAR CONVERSATIONS ABOUT THEIR PRACTICE NEEDS, COMMUNITY NEEDS, ETC. MEMBERS OF THE MANAGEMENT TEAM ACTIVELY SERVE ON THE BOARDS OF COMMUNITY ORGANIZATIONS, MANY OF WHICH HAVE A MISSION TO ADDRESS COMMUNITY NEED; HEALTHCARE BEING ONE OF THOSE NEEDS (COMMUNITY ACTION, SALVATION ARMY, UNITED WAY, CATHOLIC CHARITIES, SENIOR ADVOCACY AND PROTECTIVE NETWORK, ETC.). |
| PART VI, LINE 3: | INFORMATION ABOUT ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS IS DESCRIBED ON THE PATIENT'S BILL, THE POLICY IS POSTED ON THE HOSPITAL'S WEBSITE AND IS ALSO AVAILABLE UPON REQUEST. THE NOTICE, BOTH IN ENGLISH AND SPANISH, IS POSTED AT THE FOLLOWING LOCATIONS: EMERGENCY DEPARTMENT, ALL ADMISSIONS/REGISTRATION AREAS, PATIENT FINANCIAL SERVICES DEPARTMENT. ACMC FINANCIAL COUNSELORS MEET WITH ANY PATIENT THAT MAY NEED ANY FORM OF FINANCIAL AID PRIOR TO DISCHARGE AND EDUCATE THEM ON FINANCIAL ASSISTANCE. |
| PART VI, LINE 4: | AFFILIATED WITH THE CLEVELAND CLINIC, ACMC IS THE LARGEST AND MOST ADVANCED HOSPITAL IN ASHTABULA COUNTY. ACMC OPENS THE DOOR TO THE WORLD'S BEST HEALTHCARE BY APPLYING CLEVELAND CLINIC'S CLINICAL INFORMATION AND STATE-OF-THE-ART STANDARDS OF CARE. THE PRIMARY MARKET IS COMPRISED OF THE FOLLOWING ZIP CODES: 44004, 44005, 44010, 44030, 44032, 44041, 44048, 44068, 44082. THE SECONDARY MARKET IS COMPRISED OF THE FOLLOWING ZIP CODES: 44003, 44076, 44084, 44085, 44093, 44099. THE PAYER MIX IS 50.8% MEDICARE, 26.90% MEDICAID, 18.9% COMMERCIAL, 2.7% SELF PAY, 0.8% OTHER. 80% OF THE MARKET HAS ONLY A HIGH SCHOOL DIPLOMA; 11% HAVE A COLLEGE DEGREE. THE MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $40,000; WITH PER CAPITA INCOME AT APPROXIMATELY $19,000. |
| PART VI, LINE 5: | ACMC IS AN ACTIVE PARTICIPANT AND SPONSOR OF EVENTS LIKE RELAY FOR LIFE AND AMERICAN HEART WALK AND SPONSOR OF HEALTH-RELATED EVENTS OF COMMUNITY ORGANIZATIONS (EXAMPLE: ZONTA WOMEN'S HEALTH DAY). ACMC PUBLISHES A COMMUNITY MAGAZINE 2X/YEAR WITH HEALTHCARE INFORMATION AND TIPS FOR HEALTHY LIVING. THE WEBSITE CONTAINS HEALTH INFORMATION AND DOWNLOADABLE RESOURCES. THE HOSPITAL HOLDS TWO WOMEN'S HEALTH LUNCHEONS EACH YEAR (HEART AND CANCER). ACMC PARTICIPATES IN NUMEROUS HEALTH FAIRS AND COMMUNITY EVENTS AT WHICH THE HOSPITAL PROVIDES FREE SCREENINGS (BLOOD PRESSURE, BLOOD SUGAR, BODY MASS INDEX, BACK STRENGTH, CHOLESTEROL). THE HOSPITAL HOLDS MONTHLY DINNER EVENTS FOR THE COMMUNITY AT WHICH A PHYSICIAN DISCUSSES SPECIFIC HEALTH ISSUES. STAFF (PHYSICIANS, CLINICIANS, ETC.) APPEAR ON LOCAL CABLE TV SHOW 2X/MONTH TO SHARE HEALTH INFORMATION. ACMC OFFERS SUPPORT GROUPS (EXAMPLES DIABETES AND COPD). THE HOSPITAL IS WORKING WITH AMERICAN CANCER SOCIETY TO OFFER REACH TO RECOVERY, LOOK GOOD FEEL BETTER AND OTHER PROGRAMS IN ASHTABULA COUNTY. ACMC ALSO PROVIDES AN ATHLETIC TRAINER TO THREE HIGH SCHOOLS (NO COST TO THE SCHOOL DISTRICTS FOR THIS SERVICE). |
| PART VI, LINE 6: | ACMC IS AN AFFILIATE OF THE CLEVELAND CLINIC. THE CLEVELAND CLINIC HEALTH SYSTEM ENGAGES IN MANY COMMUNITY OUTREACH PROGRAMS, INCLUDING INITIATIVES DESIGNED TO SERVE THE VULNERABLE AND AT-RISK POPULATIONS IN OUR COMMUNITIES. CLEVELAND CLINIC'S OUTREACH PROGRAMS RANGE FROM FREE HEALTH SCREENINGS AND CLINICAL SERVICES TO ENROLLMENT ASSISTANCE FOR GOVERNMENT-FUNDED HEALTH PROGRAMS. COMMUNITY OUTREACH PROGRAMS ARE ALSO THOSE PROGRAMS THAT IMPROVE ACCESS TO HEALTH SERVICES. CLEVELAND CLINIC CAREGIVERS COLLABORATE WITH COMMUNITY ORGANIZATIONS TO PROVIDE A CONTINUUM OF CARE THAT SUPPORTS ECONOMICALLY AND MEDICALLY UNDERSERVED AREAS. THE 2016 COMMUNITY BENEFIT REPORT PUBLISHED BY THE CLEVELAND CLINIC STATED $808.7 MILLION WAS SPENT BY THE CLEVELAND CLINIC IN 2016 ON COMMUNITY BENEFIT PROGRAMS. |
| PART VI, LINE 7 | N/A |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLEVELAND CLINIC FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 9500 EUCLID AVENUE | AddressLine1Txt |
| City | CLEVELAND | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 441950001 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 340714585 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $3,653,000 | CashGrantAmt |
| Purpose Of Grant | GENERAL OPERATING SUPPORT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | 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 | DON KEPNER, THE VICE PRESIDENT AND CFO OF THE ASHTABULA COUNTY MEDICAL CENTER, IS AN EMPLOYEE OF THE CLEVELAND CLINIC. THIS OVERLAP IN RESPONSIBILITY ENSURES PROPER USE OF DISTRIBUTED FUNDS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JUDE CAUWENBERGH DO | ||||||||||||||
| BOARD MEMBER/CHIEF OF STAFF | $281,178 | $0 | $0 | $0 | $270 | $0 | $8,379 | $0 | $4,619 | $0 | $294,446 | $0 | $0 | $0 |
| DANIEL KEATON MD | ||||||||||||||
| BOARD MEMBER/VICE-CHIEF OF STAFF | $158,199 | $0 | $0 | $0 | $18,270 | $0 | $6,923 | $0 | $3,822 | $0 | $187,214 | $0 | $0 | $0 |
| ALEXANDER TAICH MD | ||||||||||||||
| PHYSICIAN | $1,084,274 | $0 | $0 | $0 | $162 | $0 | $10,600 | $0 | $920 | $0 | $1,095,956 | $0 | $0 | $0 |
| ASHOK KONDRU MD | ||||||||||||||
| PHYSICIAN | $887,813 | $0 | $0 | $0 | $1,308 | $0 | $10,600 | $0 | $3,833 | $0 | $903,554 | $0 | $0 | $0 |
| LAXMAN R CINGIREDDI MD | ||||||||||||||
| PHYSICIAN | $744,294 | $0 | $0 | $0 | $270 | $0 | $9,714 | $0 | $4,619 | $0 | $758,897 | $0 | $0 | $0 |
| AMAR B MUTNAL MD | ||||||||||||||
| PHYSICIAN | $642,015 | $0 | $0 | $0 | $0 | $0 | $10,600 | $0 | $3,997 | $0 | $656,612 | $0 | $0 | $0 |
| SUK K CHOI MD | ||||||||||||||
| PHYSICIAN | $640,339 | $0 | $0 | $0 | $1,907 | $0 | $10,600 | $0 | $3,624 | $0 | $656,470 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | SALARIES ARE REVIEWED APPROXIMATELY EVERY TWO YEARS. SALARIES ARE COMPARED TO LOCAL, REGIONAL, AND NATIONAL MARKET RATES AND IN CONJUNCTION WITH THE CEO AND CFO TO DETERMINE COMPENSATION. WHEN OPENINGS FOR KEY POSITIONS BECOME AVAILABLE, THE HR DEPARTMENT EXAMINES THE MARKET RATES TO DETERMINE A STARTING SALARY. EVERY YEAR THE TYPICAL SALARY HAS A 2% MERIT RATE INCREASE. | ExplanationTxt |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ASHOK KONDRU MD | PersonNm |
| Relationship With Org | EMPLOYEE OF ACMC | RelationshipWithOrgTxt |
| Loan Purpose | PART OF EMPLOYMENT AGREEMENT. REPAYMENT BEGAN IN 2014. | LoanPurposeTxt |
| Loan From Organization | Yes (X) | LoanFromOrganizationInd |
| Original Principal | $150,000 | OriginalPrincipalAmt |
| Balance Due | $0 | BalanceDueAmt |
| Default | 0 | DefaultInd |
| Board Or Committee Approval | Yes (1) | BoardOrCommitteeApprovalInd |
| Written Agreement | Yes (1) | WrittenAgreementInd |
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (5 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| KIMBERLY GIANGOLA | |||
| FAMILY MEMBER OF JOSEPH GIANGOLA, ACMC TRUSTEE | $31,486 | EMPLOYMENT AGREEMENT WITH ACMC | 0 |
| JENINE ENGLISH | |||
| FAMILY MEMBER OF PEG CARLO, ACMC TRUSTEE | $56,943 | EMPLOYMENT AGREEMENT WITH ACMC | 0 |
| BRITTANY GILBERT | |||
| FAMILY MEMBER OF PEG CARLO, ACMC TRUSTEE | $64,064 | EMPLOYMENT AGREEMENT WITH ACMC | 0 |
| JENNIFER CAUWENBERGH | |||
| FAMILY MEMBER OF JUDE CAUWENBERGH, D.O., ACMC TRUSTEE | $27,640 | EMPLOYMENT AGREEMENT WITH ACMC | 0 |
| PENNY PALFY | |||
| FAMILY MEMBER OF SUSAN STOCKER, PH.D., ACMC TRUSTEE | $51,683 | EMPLOYMENT AGREEMENT WITH ACMC | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE CLEVELAND CLINIC FOUNDATION HOLDS AND EXERCISES A MANAGEMENT AGREEMENT WITH ACMC. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 REPORT IS PUBLISHED TO THE BOARD OF DIRECTORS' WEBSITE. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH TRUSTEE, PRINCIPAL OFFICER, MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS, AND KEY EMPLOYEE SHALL ANNUALLY SIGN A STATEMENT, WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE CORPORATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IF A PERSON COVERED BY THE CONFLICT OF INTEREST POLICY BELIEVES HE OR SHE HAS A POTENTIAL CONFLICT OF INTEREST, THAT PERSON IS TO DISCLOSE THE CONFLICT TO THE BOARD. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE OR SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. THE DISCLOSING PERSON MAY MAKE A PRESENTATION REGARDING THE PROPOSED TRANSACTION/POTENTIAL CONFLICT OF INTEREST AT THE BOARD OR COMMITTEE MEETING, BUT AFTER SUCH PRESENTATION, HE OR SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE PROPOSED TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE CONFLICT OF INTEREST. THE CHAIRPERSON OF THE BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE CORPORATION CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THE BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED TRUSTEES WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTEREST AND FOR ITS OWN BENEFIT AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO THE CORPORATION AND SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE MEMBER AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT THE MEMBER HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. |
| FORM 990, PART VI, SECTION B, LINE 15 | SALARIES ARE REVIEWED APPROXIMATELY EVERY TWO YEARS. SALARIES ARE COMPARED TO LOCAL, REGIONAL, AND NATIONAL MARKET RATES AND IN CONJUNCTION WITH THE CEO AND CFO TO DETERMINE COMPENSATION. WHEN OPENINGS FOR KEY POSITIONS BECOME AVAILABLE, THE HR DEPARTMENT EXAMINES THE MARKET RATES TO DETERMINE A STARTING SALARY. EVERY YEAR THE TYPICAL SALARY HAS A 2% MERIT RATE INCREASE. |
| FORM 990, PART VI, SECTION C, LINE 19 | ALL REQUESTS ARE SENT TO THE CEO FOR DISTRIBUTION. |
| FORM 990, PART VII, SECTION A | THE FOLLOWING OFFICERS WORKING FULL-TIME FOR ACMC ARE EMPLOYED BY THE CLEVELAND CLINIC AND ARE COMPENSATED THROUGH EMPLOYMENT AGREEMENTS WITH THE CLEVELAND CLINIC: MICHAEL HABOWSKI, PRESIDENT/CEO; DON KEPNER, VP FINANCE/CFO; KEN FRAME, CHIEF NURSING OFFICER. |
| FORM 990, PART XI, LINE 9: | EQUITY INCOME IN AFFLIATE 71,454. EFFECT OF RECOGNITION PROVISION AT MEASUREMENT DATE OF PENSION OBLIGATION 2,646,841. |
| FEDERAL ELECTIONS | SECTION 1.263(A)-1(F) DE MINIMIS SAFE HARBOR ELECTION ASHTABULA COUNTY MEDICAL CENTER 2420 LAKE AVENUE ASHTABULA, OH 44004 EMPLOYER IDENTIFICATION NUMBER: 34-0726081 FOR THE YEAR ENDING DECEMBER 31, 2016. ASHTABULA COUNTY MEDICAL CENTER IS MAKING THE DE MINIMIS SAFE HARBOR ELECTION UNDER REG. SEC. 1.263(A)-1(F). |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| ASHTABULA COUNTY MEDICAL CENTER FOUNDATION | ||||||||||
| 2420 LAKE AVENUE | ASHTABULA | OH | 44004 | 341392784 | SUPPORT THE ASHTABULA COUNTY MEDICAL CENTER | OH | 501(C)(3) | LINE 12A, I | ASHTABULA COUNTY MEDICAL CENTER | Yes (1) |
| ROCK CREEK MEDICAL CENTER DBA GLENBEIGH HEALTH SOURCES | ||||||||||
| 2863 STATE ROUTE 45 | ROCK CREEK | OH | 44084 | 341789783 | OPERATE AND MAINTAIN A HOSPITAL AND OUTPATIENT CENTERS | OH | 501(C)(3) | LINE 3 | ASHTABULA COUNTY MEDICAL CENTER | Yes (1) |
| ASHTABULA REGIONAL HOME HEALTH SERVICES | ||||||||||
| 3949 JEFFERSON ROAD | ASHTABULA | OH | 44004 | 341143158 | HOME HEALTH SERVICES | OH | 501(C)(3) | LINE 10 | ASHTABULA COUNTY MEDICAL CENTER | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (4 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| ASHTABULA COUNTY MEDICAL CENTER FOUNDATION | ||
| Q | $154,788 | CASH RECEIVED |
| ASHTABULA REGIONAL HOME HEALTH SERVICES | ||
| Q | $178,989 | CASH RECEIVED |
| ROCK CREEK MEDICAL CENTER DBA GLENBEIGH HEALTH SERVICES | ||
| Q | $950,140 | CASH RECEIVED |
| ROCK CREEK MEDICAL CENTER DBA GLENBEIGH HEALTH SERVICES | ||
| C | $15,000,000 | CASH RECEIVED |