2017-11-14T08:09:39-07:00 2016-12-31 990 2016-01-01 340714771 THE UNION HOSPITAL ASSOCIATION UNIO 3303433311 659 Boulevard Dover OH 44622 Eugene A Thorn III CFO 3303640805 2017-04-10 98.103.157.92 2016 2018-03-14 21:41:22Z Union Hospital Eugene A Thorn III 659 Boulevard Dover OH 44622 120003242 0 X www.unionhospital.org X 1906 OH To provide excellent quality health care to the community at a competitive price through highly competent people and an integrated provider network. 17 13 1208 120 91046 -14461 725360 361033 89472612 86286350 2430690 3967330 13272858 17461543 105901520 108076256 0 0 0 0 55673832 57663884 0 0 116408 44871229 47647882 100545061 105311766 5356459 2764490 195834042 193889586 64247479 59555888 131586563 134333698 Patient Care: The Union Hospital Association provides quality medical health care regardless of race, creed, sex, national origin, handicap, age or ability to pay. 0 0 69762900 86286349 The Union Hospital Association provided quality medical health care regardless of race, creed, age, sex, national origin, handicap, or the ability to pay. Hospital medical services provided 4,944 inpatients a total of 19,622 patient days and 266,474 outpatient visits a total of 290,105 procedures. 395398 0 131147 Patient and family support programs, general and other: During 2016 Union Hospital provided 52,149 meals for residents who were unable to prepare meals for themselves due to medical limitations. These meals are provided at cost and are delivered by a volunteer group, Mobile Meals. The Hospital had 138 volunteers donate 21,976 hours toward the common purpose of serving the health care needs of the community. The value of these hours is $230,748 which is returned to the community through lower cost of patient services. The Hospital co sponsors annual events that provides laboratory tests and blood pressure checks for the residents of the community; these services are provided at or below cost. Medicare and Medicaid made up 55% of patient care provided. The Hospital also participates in a local program called Rainbow Connection, a non profit charity that is dedicated to emitting the needs of disadvantaged and disabled resident of Tuscarawas County; we write off 50% of all charges for those patients while the program pays the remaining 50%. We also provided to the local Hospice agency a writ e off specified charges for individuals under this program (42 patients, $51,998). We sponsor a Helpline program that enabled 750 elderly and disabled consumers the opportunity to remain in their homes and feel safe in that setting. Since the Hospital does not provide mental health services as part of its normal operations, we lease building space to Community Professional Services, a mental health non profit organization at $2.04 per square foot, well below the average rate of $11.75 per square foot. Thus the rental rate and related in kind support provided by the Hospital are justified as a continuance of our mission. We operate a 35ft mobile medical vehicle that provides screenings to the areas that would have been underserved. An outreach sports medicine program provides training to various school to promote healthy athletes and physicals at a fraction of the cost. The Hospital supports and hosts various groups such as Down Syndrome, RSD, pain management, cancer supports,etc. We also provide babysitting and AARP driving courses to the community and sent out 55,000 biannual healthy newsletters to the community. 0 0 0 70158298 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 150 0 1208 1 1 1 0 0 0 0 0 X 17 13 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OH X Eugene A Thorn III 3303640805 659 Boulevard Dover OH 44622 John R Herzig Board Member 4 0 X 0 0 0 James J Pringle Board Member 4 0 X 0 0 0 Anne E Geib Board Member 4 0 X 0 0 0 Agnes Swigart Board Member 4 0 X 0 0 0 Robert Horn Chairman 4 0 X 0 0 0 Craig Laughlin Treasurer 4 0 X 0 0 0 Lois E Andreas Board Member 4 0 X 0 0 0 C Jason Deeds Board Member 4 0 X 0 0 0 John E Dooling Board Member 4 0 X 0 0 0 Perry L Hershberger Board Member 4 0 X 0 0 0 James E Knisely Board Member 4 0 X 0 0 0 Kevin Gray Board Member 4 0 X 0 0 0 Pat Warther Board Member 4 0 X 0 0 0 Mark Kubina Medical Staff 4 0 X 0 0 0 William V Swoger Medical Staff President 4 0 X 0 0 0 R Bruce James President and CEO 40 0 X X 414945 0 27806 Joseph N Zemis Medical Staff Vice President 40 0 X X 1054336 0 34358 Jody Stoldt Executive Director 40 0 X 219452 0 8749 Chris Beck Vice President 40 0 X 118074 0 20976 Eugene A Thorn III Vice President and CFO 40 0 X 236376 0 25783 Darwin K Smith Vice President 40 0 X 160569 0 19871 Diana L Boyd Vice President 40 0 X 169050 0 15310 Todd A Meyerhoefer Vice President 40 0 X 292701 0 34357 Robert Craig Vice President 40 0 X 178698 0 20748 Alok Bhagat Physician 40 0 X 558880 0 21062 Lindsay Moore Physician 40 0 X 625136 0 31717 William Burgette Physician 40 0 X 650000 0 31717 Robert Levitt Physician 40 0 X 775506 0 31718 5453723 0 324172 70 0 1 0 Emergimed Inc 659 Boulevard Dover OH 44622 Emergency services 6138335 Stryker Orthopaedics PO BOX 93213 Chicago IL 60673 Seller of medical equipment 1712036 Cardinal Health 5490 Collections Center Drive Chicago IL 60693 Seller of medical drugs 5813709 Anesthesia Care of Union Hospital 659 Boulevard Dover OH 44622 Anesthesia and pain care associates 2185062 Hammond Construction 1278 PARK AVE SW CANTON OH 44706 Construction contractor 4908774 84 0 0 0 0 0 361033 0 361033 Net patient revenue 622000 86195304 86195304 0 0 Laboratory services 621500 91046 0 91046 0 0 0 0 0 86286350 3969039 3969039 0 0 0 0 0 0 0 0 0 0 946441 0 532793 0 413648 0 413648 0 0 413648 0 -1709 0 0 0 -1709 -1709 0 0 -1709 0 23698443 11394193 12304250 12304250 0 0 Health promotion 900099 66763 66763 0 0 Helpline program 900099 129003 129003 0 0 Athletic training 900099 126191 126191 0 0 4421688 4421688 0 0 4743645 108076256 107212238 91046 411939 X 0 0 0 0 0 0 0 0 1789865 0 1789865 0 0 0 0 0 44606638 35517567 8986019 103052 2555037 0 2555037 0 5163065 0 5163065 0 3549279 2570400 970605 8274 0 0 0 0 116759 27655 89104 0 50986 0 50986 0 0 0 0 0 0 0 0 0 0 0 17395799 13866010 3528131 1658 366136 346854 19282 0 12039268 7607560 4431306 402 1661070 0 1661070 0 0 0 0 0 7021137 6256975 764162 0 172519 85170 87349 0 0 0 0 0 29602 29602 0 0 1390944 832898 555535 2511 0 0 0 0 5089207 2845228 2243979 0 635260 0 635260 0 Physician related expenses 734851 0 734851 0 Dues 184567 13223 170833 511 Meals 58810 43924 14886 0 Education Expense 61961 0 61961 0 639006 115232 523774 0 105311766 70158298 35037060 116408 4033248 3064182 0 0 14969842 15838590 0 0 0 0 0 2144871 1992949 1396162 1671130 155543855 94266689 59884975 61277166 43968882 40955920 1659735 2000271 769511 769511 67006816 66319867 195834042 193889586 9784464 4893228 45060000 45060000 1976016 634355 7426999 8968305 64247479 59555888 X 118767503 122105094 1026963 335314 11792097 11893290 131586563 134333698 195834042 193889586 X 2764490 0 0 0 0 -17355 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1105252 1105252 0 72433151 29166167 43266984 0 2644151 2433264 210887 0 79361301 62667258 16694043 0 0 0 0 61277166 Asset whose use is limited by donor specification 54988 Assets held by trustees under bond indenture 3463306 Trust agreements 11893290 Other receivable 49148248 Interest in TVRCC 1479710 Contribution receivable 280325 66319867 Interest Payable 54893 Workers compensation payable 204442 Interest rate swap agreements 3867071 Accrued payroll withholdings 4449329 Other Payables 392570 8968305 X Schedule D, Part X, Line 2 The Hospital is a not for profit corporation exempt form federal income taxes under Section 501c3 of the Internal Revenue Code; therefore no provision has been made for federal income taxes in the accompanying financial statements. In addition, the IRS has determined that the Hospital is not a "private foundation" within the meaning of section 509a of the code. 1 1 X 1 X 1 X 1 1 1 0 1 1 1587716 0 1587716 0.08 17315430 7212231 10103199 0.9 0 0 18903146 7212231 11690915 0.98 0 0 388498 131147 257351 0.02 0 0 6900 0 6900 0 0 0 395398 131147 264251 0.02 0 0 19298544 7343378 11955166 1.00 1 5618396 24721 31870552 25734525 6136027 X 1 1 Tuscarawas Ambulatory Surgery Center ambulatory surgery center 0.7 0 0.3 1 1 The Union Hospital Association 659 Boulevard Dover OH 44622 www.unionhospital.org X X X The Union Hospital Association 1 0 0 1 X X X X X X X X 15 1 1 1 1 X www.unionhospital.org X www.healthytusc.org X 1 16 1 www.unionhospital.org 0 0 1 X 100 300 X 1 1 X X 1 X 1 0 X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-The Union Hospital Association The Hospital's panel includes medical leaders and physicians encompassing all aspects of healthcare from mental health to dental care. They ranged from family doctors to drug and alcohol counselors. The information obtained was used to discover and address the community's health needs. Schedule H, Part V, Section B, Line 6a-The Union Hospital Association Trinity Twin City Hospital Schedule H, Part V, Section B, Line 6b-The Union Hospital Association Healthy Tusc, Tuscarawas County Health Dept., New Philadelphia Health Dept.,ADAMHS Board, Tuscarawas County Senior Center, United Way of Tuscarawas County Schedule H, Part V, Section B, Line 11-The Union Hospital Association The Hospital and surrounding community activists have taken all of the risks and needs into consideration and have focused on the items that could be successfully impacted. Schedule H, Part V, Section B, Line 13h-The Union Hospital Association The policy lists criteria for charges 6 Tuscarawas Ambulatory Surgery Center 320 Oxford Street Dover OH 44622 Ambulatory surgery center Tuscarawas Valley Regional Cancer Center 659 Boulevard Dover OH 44622 Physician oncology center Union Physician Services LLC 300 Medical Park Drive Suite 101 C Dover OH 44622 Physician offices DASCO UH Home Medical Equipment LLC 375 North West Street Westerville OH 43082 Home medical equipment sales UHMS LLC 659 Boulevard Dover OH 44622 Physician offices Union Pharmacy Care 659 Boulevard Dover OH 44622 Pharmaceutical Schedule H, Part I, Line 7 Used the ratio of patient cost to charge from Worksheet 2 to calculate charity care. Schedule H, Part III, Section A, Line 4 Patient accounts are due in full when billed. Accounts are considered delinquent and subsequently written off as bad debt based on individual credit evaluation and circumstances of the account. Line 2 represents 2.3% of gross patient revenue as seen as being uncollectible by self pay patients based on historical trending. A bad debt expense foot note is not presented in the notes to the financial statements. Schedule H, Part III, Section B, Line 8 Amounts are generated by the Medicare cost report which utilizes department cost to charge methodology. Schedule H, Part III, Section C, Line 9b The Hospital will refund any monies paid on an account deemed charity or that qualifies for financial assistance once that assessment has been determined. The account is then written off to such classification and any or all collections will cease after the determination has been made. Schedule H, Part VI, Line 2 Our community wellness department is committed to addressing the health assessments and concerns of our community. The department compiled the data by utilizing secondary sources such as the CDC and Ohio obesity prevention. We have identified Obesity (adult and youth), mental health and bullying (adult and youth), youth substance abuse, and access to dental care. Schedule H, Part VI, Line 3 Patients are given an informational booklet that contains patient accounts contact information, accepted insurances and other payment options for the insured and underinsured upon admission. The Hospital also employs a financial specialist who meets with the patient and or family to discuss factors of qualifying information. Financial assistance is provided with the first billing. Schedule H, Part VI, Line 4 Tuscarawas county is one of 88 counties in the state of Ohio. The county's population is approximately 91,000 with 24% under the age of 18 and 18% is over the age of 62. It is predominately Caucasian with 6% having a foreign language as their first language,. The county is a rural setting with 13% living in poverty and 9% without health insurance. Schedule H, Part VI, Line 5 We provide low cost clinics for blood pressure, cholesterol screenings, cancer screenings and diabetes clinics to the population served to help the community stay healthy and prevent diseases. We offer health fairs and promote health speakers on various topics ranging from breast cancer to teen self esteem issues at no cost. Schedule H, Part VI, Line 7 none X X 0 0 0 0 0 0 0 0 0 Jody Stoldt Executive Director 197758 0 21694 0 0 0 7378 0 1371 0 228201 0 0 0 R Bruce James President and CEO 348006 0 66939 0 0 0 15000 0 12806 0 442751 0 0 0 Chris Beck Vice President 113223 0 4851 0 0 0 2069 0 18907 0 139050 0 0 0 Eugene A Thorn III Vice President and CFO 210483 0 25893 0 0 0 12629 0 13154 0 262159 0 0 0 Darwin K Smith Vice President 145109 0 15460 0 0 0 8707 0 11164 0 180440 0 0 0 Diana L Boyd Vice President 150138 0 18912 0 0 0 8655 0 6655 0 184360 0 0 0 Todd A Meyerhoefer Vice President 257961 0 34740 0 0 0 15000 0 19357 0 327058 0 0 0 Robert Craig Vice President 158574 0 20124 0 0 0 9515 0 11233 0 199446 0 0 0 Alok Bhagat Physician 558880 0 0 0 0 0 15000 0 6062 0 579942 0 0 0 Lindsay Moore Physician 500011 0 125125 0 0 0 15000 0 16717 0 656853 0 0 0 William Burgette Physician 650000 0 0 0 0 0 15000 0 16717 0 681717 0 0 0 Robert Levitt Physician 775506 0 0 0 0 0 15000 0 16718 0 807224 0 0 0 Joseph N Zemis Medical Staff Vice President 842019 0 212317 0 0 0 15000 0 19358 0 1088694 0 0 0 A Tuscarawas County Ohio 346002853 2014-09-24 45060000 ED project and refinancing arrangements 0 1 0 A 0 25707957 45060000 0 950217 0 0 0 250153 0 0 0 2014 0 1 1 1 A 0 0 0 0 0 0 0 0 0 1 A 1 1 1 RBS Citizens NA 32 0 0 0 0 1 Jim Pringle Board member 48007 Attorney fees 0 Form 990, Part VI, Section A, Line 6 The Association has a 17 member board of trustees who oversee the management of the Hospital. All monthly financial reporting is presented to the board of trustees. The trustees also oversee the hiring of any upper management and the approval of all operating and capital budgets. Form 990, Part VI, Section A, Line 7a Board members have the opportunity to elect other members. Form 990, Part VI, Section B, Line 11b The 990 is prepared internally by the Manager of Accounting, the general ledger is reconciled to the appropriate schedules on the return and to the audited financial statements. It is then forwarded to the Chief Financial Officer who reviews it for completeness and accuracy, after his review it is then submitted to the board of trustees for review. The 990 is also reviewed by the Association's independent accounting firm. Form 990, Part VI, Section B, Line 12c Members of the board and officers are required annually to review the conflict of interest policy and make any known conflicts that may have or have arose or any other event that may require disclosure. If any notable event is disclosed it is reported to the Hospital CEO and Chairman of the board. Additionally all financial transactions are reviewed through the Hospital's accounting systems. Form 990, Part VI, Section B, Line 15 Compensation is established and based on appropriate healthcare industry standards and related surveys. Compensation amounts for key management positions are reviewed by the Executive Committee of the Board. Form 990, Part VI, Section C, Line 19 The public at anytime during normal business office hours may inquire at the administrative offices of the Association and ask for a copy of the 990 The public may view the annual report and community benefit report on the Hospital's website. Form 990, Part IX, Line 11g purchased maintenance agreements, contract labor, outside technical services Form 990, Part XI, Line 9 -17346 reclassification of net assets 9 rounding. Union Hospital Medical Services 659 Boulevard Dover OH 44622 270273520 Physician offices OH -404958 117100 N/A Union Physician Services 659 Boulevard Dover OH 44622 264215547 Physician office OH -6397890 3373781 N/A Tuscarawas Valley Regional Cancer Center 659 Boulevard Dover OH 44622 340000100 Physician and Hospital Organization OH 501c3 3 N/A 0 Union Hospital Auxillary 659 Boulevard Dover OH 44622 341204928 Fundraising for the Hospital OH 501c3 11-III-FI N/A 0 Tuscarawas Ambulatory Surgery Center 320 Oxford St Dover OH 44622 311525875 Ambulatory surgery center OH N/A Related 719535 1645857 0 0 0 0.7 Dasco Union Hospital Home Medical Equipment LLC 375 N West St Westerville OH 43082 270495743 Durable medical equipment sales OH N/A Unrelated -34677 306491 0 0 0.5 Valley Healthcare Inc 659 Boulevard Dover OH 44622 341654921 Inactive OH N/A C 0 0 1 Union Care Corporation 659 Boulevard Dover OH 44622 341556177 Inactive OH N/A C 0 0 1 Union Pharmaceutical Care 659 Boulevard Dover OH 44622 043588229 Retail pharmacy sales OH N/A C 2728 31400 1 0 1 0 1 0 0 1 0 0 0 1 0 0 0 0 0 0 1 0 0 Tuscarawas Valley Regional Cancer Center f 850000 Distribution from TVRCC Union Hospital Auxillary c 203000 Annual donation Tuscarawas Ambulatory Surgery Center a-iv 400505 Rent Received from TASC Tuscarawas Ambulatory Surgery Center j 400505 Leased building from UH Dasco Union Hospital Home Medical Equipment LLC a-iv 13600 REnt Obtained an extension to file an accurate report.