2016-11-15T14:17:26-07:00 2015-12-31 990 2015-01-01 340714771 THE UNION HOSPITAL ASSOCIATION UNIO 3303433311 659 Boulevard Dover OH 44622 Eugene A Thorn III CFO 3303640805 2016-08-10 2015 2017-02-10 21:41:12Z Union Hospital Eugene A Thorn III 659 Boulevard Dover OH 44622 117745493 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 16 1208 135 232069 2 218286 725360 89078567 89472612 2686500 2430690 13644317 13272858 105627670 105901520 0 0 0 0 54506895 55673832 0 0 119092 42835671 44871229 97342566 100545061 8285104 5356459 190897665 195834042 63285352 64247479 127612313 131586563 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 66705009 0 102640404 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 18,802 patient days and 261,397 outpatient visits a total of 296,709 procedures. 311947 0 55021 Patient and family support programs, general and other: During 2015 Union Hospital provided 54,519 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 134 volunteers donate 20,713 hours toward the common purpose of serving the health care needs of the community. The value of these hours is $196,774 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 write off specified charges for individuals under this program (75 patients, $94,509). 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 67016956 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 0 0 0 0 0 1 1 0 0 0 1 101 0 1208 1 1 1 0 0 0 0 0 X 17 16 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 Vice 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 Chairman 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 Joseph N Zemis Medical Staff Vice President 40 0 X X 0 0 0 R Bruce James President and CEO 40 0 X X 417948 0 27726 Jody Stoldt Executive Director 40 0 X 151276 0 16258 Eugene A Thorn III Vice President and CFO 40 0 X 229963 0 34277 Darwin K Smith Vice President 40 0 X 159647 0 20948 Diana L Boyd Vice President 40 0 X 171675 0 17135 Todd A Meyerhoefer Vice President 40 0 X 295693 0 34277 Robert Craig Vice President 40 0 X 186083 0 22528 Robert Levitt Physician 40 0 X 837039 0 28000 James E McQuillan Physician 40 0 X 717911 0 28121 Thomas L Teater Physician 40 0 X 638315 0 28001 Darrin Kuczynski Physician 40 0 X 607688 0 26416 4413238 0 283687 73 0 1 0 Emergimed Inc 659 Boulevard Dover OH 44622 Emergency services 5720413 Stryker Orthopaedics PO BOX 93213 Chicago IL 60673 Seller of medical equipment 1092250 Cardinal Health 5490 Collections Center Drive Chicago IL 60693 Seller of medical drugs 5333530 Anesthesia Care of Union Hospital 659 Boulevard Dover OH 44622 Anesthesia and pain care associates 2184794 Hammond Construction 1278 PARK AVE SW CANTON OH 44706 Construction contractor 9752113 93 0 0 0 0 0 725360 0 725360 Net patient revenue 622000 89392283 89392283 0 0 Laboratory services 621500 80329 0 80329 0 0 0 0 0 89472612 2543283 2391543 151740 0 0 0 0 0 0 0 0 0 917142 0 488044 0 429098 0 429098 0 0 429098 0 -112593 0 0 0 -112593 -112593 0 0 -112593 0 22222888 11355929 10866959 10866959 0 0 Health promotion 900099 74201 74201 0 0 Helpline program 900099 131029 131029 0 0 Athletic training 900099 107484 107484 0 0 1664087 1664087 0 0 1976801 105901520 104627586 232069 316505 X 0 0 0 0 0 0 0 0 1611692 0 1611692 0 0 0 0 0 43295846 34738776 8454847 102223 2430031 0 2430031 0 4460854 0 4460854 0 3875409 3123618 743661 8130 0 0 0 0 65357 47094 18263 0 78987 78987 0 0 0 0 0 0 0 0 0 0 0 0 21554376 15636955 5914788 2633 488758 66158 421667 933 9964628 8294058 1669894 676 1706339 0 1706339 0 0 0 0 0 1994855 902102 1092753 0 228061 98278 129698 85 0 0 0 0 56250 14195 42055 0 1434982 859267 575715 0 0 0 0 0 4978499 2596959 2378208 3332 751554 0 751554 0 Dues 184556 165800 17680 1076 Meals 52445 30872 21569 4 Education expense 468993 363837 105156 0 862589 0 862589 0 100545061 67016956 33409013 119092 6660440 4033248 0 0 13255729 14969842 0 0 0 0 2257544 2144871 1507979 1396162 149614635 89729660 47979528 59884975 49306250 43968882 1457386 1659735 769511 769511 67703298 67006816 190897665 195834042 8665394 9784464 45060000 45060000 2370000 1976016 7189958 7426999 63285352 64247479 X 113542503 118767503 1515397 1026963 12554413 11792097 127612313 131586563 190897665 195834042 X 5356459 -1006535 0 0 -49843 -325831 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1105252 1105252 0 56176403 27717821 28458582 0 2644152 2362801 281351 0 75530969 59649038 15881931 0 14157859 0 14157859 59884975 Asset whose use is limited by donor specification 63486 Assets held by trustees under bond indenture 9102301 Trust agreements 11792097 Other receivable 42947177 Interest in TVRCC 1771595 Contribution receivable 928447 Deferred financing costs 401713 67006816 0 Interest payable 45288 Workers compensation payable 188734 Interest rate swap agreements 4648779 Accrued payroll withholdings 2112481 Other payables 431717 7426999 X Schedule D, Part X, Line 2 The Hospital is a not for profit corporation exempt from federal income taxes under Section 501c3 of Internal Revenue Code; therefore no revision 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 1292637 0 1292637 15086544 7463048 7623496 0 0 16379181 7463048 8916133 0 305647 55021 250626 6300 0 6300 0 0 311947 55021 256926 0 0 0 16691128 7518069 9173059 0 1 5642252 22550 28791594 21612663 7178931 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 X 15 1 0 0 1 X www.unionhospital.org 1 13 1 www.unionhospital.org 0 0 1 X 100 300 X 1 1 X X 1 X 1 X X 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 included medical leaders and physicians that encompassed all aspects of healthcare from mental health, senior care and dental care. They ranged from emergency room physicians to family care doctors and drug and alcohol counselors. The information obtained was used to address and discover the community's health needs. Schedule H, Part V, Section B, Line 11-The Union Hospital Association The Hospital has taken all the needs that were brought up into consideration and then analyzed the ones that the Hospital could have the most significant impact on. A committee was organized to determine which ones. 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 two 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 3% of gross patient revenue as seen as being uncollectible by self pay patients based on historical trending valuations. 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 areas that are a high concern in our area; health care access, cardiovascular health, cancer, diabetes, arthritis, and obesity. The Hospital offers many low cost or free screenings for cholesterol, blood sugars, vascular and cancers and blood pressure checks. We maintain a walking trail and sponsor many walking programs. Schedule H, Part VI, Line 3 Patients are given an informational booklet upon admission to the Hospital, this booklet contains information regarding contact with patient account representatives, accepted insurances and other payment options for the insured and underinsured. The Hospital also employs a patient 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 the 88 counties in the state of Ohio. The county's population is approximately 91,000 with 25% under the age of 25 and 25% between 45-62. It is predominately Caucasian and is set in a rural setting with 7% being below the poverty level. 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 health 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 R Bruce James President and CEO 351009 0 66939 0 0 0 15000 0 12726 0 445674 0 0 0 Darwin K Smith Vice President 144188 0 15460 0 0 0 9579 0 11369 0 180596 0 0 0 Diana L Boyd Vice President 152762 0 18912 0 0 0 10300 0 6834 0 188808 0 0 0 Robert Craig Vice President 165959 0 20124 0 0 0 11158 0 11370 0 208611 0 0 0 Eugene A Thorn III Vice President and CFO 203332 0 25893 0 0 0 13753 0 13073 0 256051 0 0 0 Todd A Meyerhoefer Vice President 261963 0 34740 0 0 0 15000 0 19278 0 330981 0 0 0 Jody Stoldt Executive Director 129581 0 21695 0 0 0 9077 0 7182 0 167535 0 0 0 Darrin Kuczynski Physician 607688 0 0 0 0 0 15000 0 11416 0 634104 0 0 0 James E McQuillan Physician 717911 0 0 0 0 0 15000 0 13121 0 746032 0 0 0 Robert Levitt Physician 751165 0 85874 0 0 0 15000 0 13001 0 865040 0 0 0 Thomas L Teater Physician 638315 0 0 0 0 0 15000 0 13001 0 666316 0 0 0 Joseph N Zemis Medical Staff Vice President 1269923 0 0 0 0 0 15000 0 13000 0 1297923 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 A 1 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 capital and operating budgets. 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 form 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 their review. The return is also reviewed by an independent accounting firm. Form 990, Part VI, Section B, Line 12c Officers and members 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 the 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 Compensations are 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 of Trustees. Form 990, Part VI, Section C, Line 19 The public at anytime during normal business office hours may inquire at the administrative offices in the main campus and ask for a copy of the Form 990. The public may view the annual report and community benefit report on the Hospital's website. Form 990, Part IX, Line 11g Professional fees (health care related), contract labor and purchase maintenance agreements. Form 990, Part XI, Line 9 swap valuation Union Hospital Medical Services 659 Boulevard Dover OH 44622 270273520 Physician offices OH -507646 191265 N/A Union Physician Services 659 Boulevard Dover OH 44622 264215547 Physician office OH -8053634 3022557 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 565348 1452645 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 151740 342713 0 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 14952 37008 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 250000 receives distributions from TVRCC Union Hospital Auxillary c 200000 annual donation Tuscarawas Ambulatory Surgery Center a-iv 400505 lease payments received Tuscarawas Ambulatory Surgery Center j 400505 Lease building to TASC Dasco Union Hospital Home Medical Equipment LLC a-iv 13600 rent file an accurate return