2015-05-15T10:40:08-05:00 2014-06-30 381357951 PLANTE & MORAN PLLC 65 EAST STATE STREET SUITE 600 COLUMBUS OH 43215 990 2013-07-01 311156690 HOLZER HEALTH SYSTEM HOLZ 7404465060 100 JACKSON PIKE GALLIPOLIS OH 45631 DAN JANICAK CFO 7404465060 2015-05-14 1 BERNIE OSTROWSKI P00366367 6148493000 2013 2016-03-07 17:11:31Z HOLZER CONSOLIDATED HEALTH SYSTEM WAYNE MUNRO 100 JACKSON PIKE GALLIPOLIS OH 45631 149561003 0 X WWW.HOLZER.ORG X 1985 OH THE PRIMARY EXEMPT PURPOSE OF HOLZER HEALTH SYSTEM IS TO ACT AS THE MANAGING PARENT, SOLE VOTING MEMBER OF THE FOLLOWING 501(C)(3) ENTITIES, WHOSE PRIMARY PURPOSES ARE TO MEET THE HEALTHCARE NEEDS OF THEIR COMMUNITIES: HOLZER HOSPITAL FOUNDATION, HOLZER MEDICAL CENTER-JACKSON, HOLZER SENIOR CARE CENTER, HOLZER ASSISTED LIVING-GALLIPOLIS, HOLZER ASSISTED LIVING-JACKSON, HOLZER FOUNDATION AND HOLZER VANGUARD, A FOR-PROFIT SUBSIDIARY (COLLECTIVELY REFERRED TO AS CONSOLIDATED). 25 1 1389 5 0 0 0 0 173734837 148060356 49685 10314 2136041 1490333 175920563 149561003 0 0 0 0 111915666 105697172 0 0 0 81477018 81526060 193392684 187223232 -17472121 -37662229 186461553 176843446 179797525 174662045 6664028 2181401 TO ADVANCE THE HEALTH AND WELL BEING OF THOSE WE SERVE 0 0 28529425 0 11811834 HOLZER HEALTH SYSTEM PROVIDED MANAGEMENT SERVICES TO ITS SUBSIDIARIES WHOSE EXEMPT PURPOSES ARE TO MEET THE HEALTHCARE NEEDS OF THEIR COMMUNITIES. 990107 0 1062072 HOLZER DENTAL CLINIC-JACKSON STRIVES TO IMPROVE THE DENTAL HEALTH STATUS OF THE PEOPLE AND COMMUNITIES WE SERVE. 99603436 0 135408450 HOLZER CLINIC, LLC IS A MULTIPLE DISCIPLINE HEALTH CARE SYSTEM OF OVER 140 BOARD CERTIFIED PHYSICIANS PROVIDING CARE IN MORE THAN THIRTY AREAS OF EXPERTISE. 129122968 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 92 0 1 1389 1 0 0 0 0 0 0 0 0 0 0 X 25 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X DAN JANICAK CFO 7404465060 100 JACKSON PIKE GALLIPOLIS OH 45631 BRENT SAUNDERS CHAIRMAN 1.00 39.00 X X 187231 239077 40567 LOIS BOSLEY TRUSTEE 40.00 0.00 X 155776 0 0 STEVE CHAPMANCPA TRUSTEE 1.00 3.00 X 18000 0 0 RENUKA KANDULA MD TRUSTEE 38.00 2.00 X 416570 0 0 BOB GRILLO TRUSTEE 1.00 2.00 X 18000 0 0 DANNY HOLSCHUH TRUSTEE 1.00 2.00 X 18000 0 0 LARRY KIDD TRUSTEE 1.00 3.00 X 18000 0 0 CHRISTOPHER MEYER MD TRUSTEE 38.00 2.00 X 442488 0 0 BRAD MUNN TRUSTEE 1.00 2.00 X 18000 0 0 WAYNE MUNRO MD CEO- HHS 1.00 39.00 X X 609876 0 0 RODNEY STOUT MD TRUSTEE 38.00 2.00 X 189948 0 0 PAUL REED TRUSTEE 1.00 3.00 X 18000 0 0 GARY ROACH TRUSTEE 1.00 3.00 X 18000 0 0 ALAN STOCKMEISTER TRUSTEE 1.00 3.00 X 18000 0 0 DR JON SULLIVAN TRUSTEE 38.00 2.00 X 306986 0 0 KENNETH G PAYNE CFO- HHS 7/1/13-3/31/14 1.00 39.00 X X 167192 167706 37712 ARTURO ROA TRUSTEE 39.00 1.00 X 938047 0 0 PATRICK CONNERS TRUSTEE 36.00 4.00 X 345991 0 0 JOHN CUNNINGHAM TRUSTEE 36.00 4.00 X 295572 0 0 GREG MICKUNAS TRUSTEE 38.00 2.00 X 383105 0 0 JARED SHEETS TRUSTEE 38.00 2.00 X 265616 0 0 DAN JANICAK CFO 4/1/14-CURRENT 36.00 4.00 X X 0 0 0 BARBARA CAMPFIELD TRUSTEE 36.00 4.00 X 0 0 0 JIM PHILLIPPE TRUSTEE 1.00 39.00 X 144462 169057 31300 RYAN SMITH TRUSTEE 1.00 2.00 X 0 0 0 ELLEN GARLING CHIEF LEGAL COUNSEL 40.00 0.00 X 275782 0 0 DONALD MICHAEL ROACH MANAGER ANESTHESIA 40.00 0.00 X 256832 0 0 ROBERT TOWNSEND CRNA 40.00 0.00 X 241304 0 0 CLIFFORD QUEEN CRNA 40.00 0.00 X 234268 0 0 VERNON ROUSH CRNA 40.00 0.00 X 233630 0 0 6234676 575840 109579 193 0 1 0 BERKELEY RESEARCH GROUP LLC 2200 POWELL ST SUITE 2200 EMERYVILLE CA 94608 CONSULTING SERVICES 2231593 PLANTE AND MORAN PLLC 16060 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 FINANCIAL SERVICES 459559 NUANCE COMMUNICATIONS DEPT AT 952896 ATLANTA GA 311922896 TRANSCRIPTION SERVICES 434335 ACCENTURE LLP PO BOX 70629 CHICAGO IL 606730629 CONSULTING SERVICES 295060 DELTA LOCUM TENENS LLC PO BOX 202940 DALLAS TX 753202056 LOCUM SERVICES 241961 14 NET PATIENT SERVICE REVENUE 621110 136473390 136473390 AMBULATORY SURGERY CENTER REVENUE 621110 5668028 5668028 RENTAL INCOME 531120 5284652 5284652 REVENUE FROM CHEMO SERVICES 621110 575328 575328 MANAGEMENT FEES 561000 58958 58958 148060356 10314 10314 78794 0 78794 78794 78794 MEANINGFUL USE 900099 1325000 1325000 REBATES, REIMBURSEMENTS, REWARDS 900099 163000 163000 RESEARCH STUDY REIMBURSEMENT 900099 113000 113000 -189461 109000 -298461 1411539 149561003 148282356 0 557861 2121931 2121931 84412751 65841946 18570805 5030977 3924162 1106815 10264782 8006530 2258252 3866731 3016050 850681 192000 192000 453440 453440 1333217 1333217 18607128 3163212 15443916 1247305 1247305 11588401 5018249 6570152 4306971 732185 3574786 2521493 1966765 554728 758093 128876 629217 11583470 9035107 2548363 6129600 4781088 1348512 2469315 1926066 543249 BAD DEBT EXPENSE 11030251 11030251 MEDICAL SUPPLIES 8823184 8823184 RECRUITMENT 254252 254252 BOND EXPENSES 8280 8280 219660 219460 200 187223232 129122968 58100264 0 25863378 13396120 2478521 0 25043711 20356451 382420 0 3228144 0 1044502 686227 95859823 10739740 97224616 85120083 5026352 5654444 625582 2847609 3904000 3904000 18812055 18812055 2828272 26066457 186461553 176843446 48276168 37318760 1419196 0 117598471 129138446 7628201 4618664 4875489 3586175 179797525 174662045 X 6664028 2181401 6664028 2181401 186461553 176843446 X -37662229 210 33179392 X X 0 1 X 1 0 X X X 0 0 0 HOLZER HOSPITAL FOUNDATION 314379491 3 1 1 1 0 HOLZER MEDICAL CENTER-JACKSON 311724085 3 1 1 1 0 HOLZER SENIOR CARE CENTER 311534051 9 1 1 1 0 HOLZER FOUNDATION 310927482 7 1 1 1 0 4 0 SCHEDULE A, PART I, LINE 11 HOLZER HEALTH SYSTEM PROVIDES ADMINISTRATIVE SUPPORT SERVICES TO RELATED ORGANIZATIONS. 6962336 6962336 85136549 9846479 75290070 3620903 893261 2727642 140035 140035 85120083 RELATED PARTY RECEIVABLES 8439993 ASSETS LIMITED TO USE 17626464 26066457 RELATED PARTY PAYABLES 3586175 3586175 X PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE SYSTEM AND RECOGNIZE A TAX LIABILITY IF THE SYSTEM HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED TAX POSITIONS TAKEN BY THE SYSTEM AND HAS CONCLUDED THAT AS OF JUNE 30, 2014, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE SYSTEM IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE SYSTEM FILES FEDERAL AND STATE TAX RETURNS AND BELIEVES IT IS NO LONGER SUBJECT TO FEDERAL, STATE, OR LOCAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE FISCAL YEAR 2011. X X X 0 0 0 0 0 0 0 0 0 BRENT SAUNDERS CHAIRMAN 187231 239077 0 0 0 0 18723 21844 0 0 205954 260921 0 0 LOIS BOSLEY TRUSTEE 155776 0 0 0 0 0 0 0 0 0 155776 0 0 0 RENUKA KANDULA MD TRUSTEE 416570 0 0 0 0 0 0 0 0 0 416570 0 0 0 CHRISTOPHER MEYER MD TRUSTEE 442488 0 0 0 0 0 0 0 0 0 442488 0 0 0 WAYNE MUNRO MD CEO- HHS 609876 0 0 0 0 0 0 0 0 0 609876 0 0 0 RODNEY STOUT MD TRUSTEE 189948 0 0 0 0 0 0 0 0 0 189948 0 0 0 DR JON SULLIVAN TRUSTEE 306986 0 0 0 0 0 0 0 0 0 306986 0 0 0 KENNETH G PAYNE CFO- HHS 7/1/13-3/31/14 167192 167706 0 0 0 0 16719 16719 4274 0 188185 184425 0 0 ARTURO ROA TRUSTEE 938047 0 0 0 0 0 0 0 0 0 938047 0 0 0 PATRICK CONNERS TRUSTEE 345991 0 0 0 0 0 0 0 0 0 345991 0 0 0 JOHN CUNNINGHAM TRUSTEE 295572 0 0 0 0 0 0 0 0 0 295572 0 0 0 GREG MICKUNAS TRUSTEE 383105 0 0 0 0 0 0 0 0 0 383105 0 0 0 JARED SHEETS TRUSTEE 265616 0 0 0 0 0 0 0 0 0 265616 0 0 0 JIM PHILLIPPE TRUSTEE 144462 169057 0 0 0 0 14446 16854 0 0 158908 185911 0 0 ELLEN GARLING CHIEF LEGAL COUNSEL 275782 0 0 0 0 0 0 0 0 0 275782 0 0 0 DONALD MICHAEL ROACH MANAGER ANESTHESIA 256832 0 0 0 0 0 0 0 0 0 256832 0 0 0 ROBERT TOWNSEND CRNA 241304 0 0 0 0 0 0 0 0 0 241304 0 0 0 CLIFFORD QUEEN CRNA 234268 0 0 0 0 0 0 0 0 0 234268 0 0 0 VERNON ROUSH CRNA 233630 0 0 0 0 0 0 0 0 0 233630 0 0 0 A COUNTY OF GALLIA OHIO- BONDS SERIES 2012 A20 316400068 36381PAP2 2012-03-27 155315000 SEE SCHEDULE O 0 0 0 A 155315478 10998893 3087477 106281906 3817000 519735 2012 1 0 0 1 A 0 0 1 0 0 0 0 0 0 A 1 FORM 990, PART VI, SECTION A, LINE 3 HOLZER HEALTH SYSTEM PAYS BERKELEY RESEARCH GROUP, LLC FOR CFO SERVICES BY DAN JANICAK. THE CONTRACT WITH THE MANAGEMENT COMPANY IS $35,000 PER MONTH STARTING MAY 2014. THE SAME MANAGEMENT COMPANY IS USED FOR EMPLOYING THE EXECUTIVE V.P. FOR INTERIM CHIEF NURSING OFFICER, BARBARA CAMPFIELD (SERVES ON THE BOARD). THE CONTRACT WITH THE MANAGEMENT COMPANCY IS $35,000 STARTING IN MAY 2014. FORM 990, PART VI, SECTION B, LINE 11 THE CONTROLLER AND THE CFO REVIEW FORM 990 AND A COPY WILL BE PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION FOLLOWS THE ADOPTED POLICIES OF HOLZER MEDICAL CENTER- JACKSON AND HOLZER HOSPITAL FOUNDATION, RELATED TAX-EXEMPT ORGANIZATIONS. CONFLICT OF INTEREST STATEMENTS ARE COMPLETED ANNUALLY BY ALL BOARD MEMBERS AND OFFICERS, AND ARE REVIEWED BY THE CONFLICT OF INTEREST REVIEW COMMITTEE. MEMBERS OF THE BOARD ARE AWARE THAT THEY SHOULD DISCLOSE CONFLICTS WHEN THEY ARISE, AND MEMBERS ABSTAIN FROM PARTICIPATING IN DISCUSSIONS OR VOTING ON MATTERS WHERE A CONFLICT IS PRESENT. FORM 990, PART VI, SECTION B, LINE 15 HE HOLZER HEALTH SYSTEM BOARD APPROVES COMPENSATION OF THE CEO AND OTHER OFFICERS. THE BOARD UTILIZES WAGE RECOMMENDATIONS FROM AN UNRELATED CONSULTANT TO DETERMINE THE COMPENSATION. THE CEO MAY BE INVOLVED IN DETERMINING OTHER OFFICERS' COMPENSATION, HOWEVER THE ULTIMATE DECISION RESTS WITH THE BOARD. THE PROCESS WAS LAST UNDERTAKEN DURING MARCH 2014. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION DOES NOT HAVE ITS OWN CONFLICT OF INTEREST POLICY. FORM 990, PART XI, LINE 9: TRANSFERS TO/FROM AFFILIATES 33,179,392. FORM 990, PART XI, LINE 2C THE AUDIT OVERSIGHT PROCESS AND THE PROCESS OF SELECTION OF AN INDEPENDENT ACCOUNTANT HAVE NOT CHANGED FROM THE PRIOR YEAR. SCHEDULE K, PART I DESCRIPTION OF PURPOSE: (A) CURRENTLY REFUNDED THE ENTITY'S (I) SERIES 1998 BONDS ISSUED ON OCTOBER 1, 1998; (II) SERIES 2009 BONDS, ISSUED ON NOVEMBER 3, 2009, WHICH WERE A REISSUANCE OF THE SERIES 2005 BONDS ISSUES ON MARCH 10, 2005; AND (III) VARIOUS TAXABLE OBLIGATIONS; AND (B) ACQUISITION OF HOSPITAL FACILITIES INCLUDING A CLINIC AND FUTURE CAPITAL EQUIPMENT ACQUISITIONS AND FACILITY RENOVATIONS; AND CANCER CENTER PROJECT. FORM 990, PART VI, LINE 16 THE ORGANIZATION DOES NOT HAVE IN PLACE A WRITTEN POLICY TO EVALUATE ITS PARTICIPATION IN JOINT VENTURES, HOWEVER IT MAKES SURE TO TAKE THE NECESSARY PRECAUTIONS TO SAFEGUARD ITS TAX-EXEMPT STATUS. IN ADDITION, LEGAL COUNSEL IS CONSULTED BEFORE CONSIDERING A NEW JOINT VENTURE. HOLZER DENTAL CLINIC JACKSON 100 JACKSON PIKE GALLIPOLIS OH 45631 275346256 HEALTHCARE OH 1018798 1930742 HOLZER HEALTH SYSTEM HOLZER CLINIC LLC 90 JACKSON PIKE GALLIPOLIS OH 45631 310917085 PHYSICIAN PRACTICES OH 132214873 33638376 HOLZER HEALTH SYSTEM HOLZER FOUNDATION 100 JACKSON PIKE GALLIPOLIS OH 45631 310927482 CONTINUING ADVANCEMENT OF HEALTH AND MEDICAL CARE OH 501(C)(3) LINE 7 HOLZER HEALTH SYSTEM 1 HOLZER MEDICAL CENTER - JACKSON 100 JACKSON PIKE GALLIPOLIS OH 45631 311724085 HEALTH CARE OH 501(C)(3) LINE 3 HOLZER HEALTH SYSTEM 1 HOLZER SENIOR CARE CENTER 380 COLONIAL DRIVE BIDWELL OH 45614 311534051 SKILLED NURSING FACILITY OH 501(C)(3) LINE 9 HOLZER HEALTH SYSTEM 1 HOLZER HOSPITAL FOUNDATION 100 JACKSON PIKE GALLIPOLIS OH 45631 314379491 HEALTH CARE OH 501(C)(3) LINE 3 HOLZER HEALTH SYSTEM 1 HOLZER VANGUARD INC 100 JACKSON PIKE GALLIPOLIS OH 45631 311192567 STOCK HOLDING COMPANY OH HOLZER HEALTH SYSTEM C 3193271 3888877 1.00000 1 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 1 HOLZER HOSPITAL FOUNDATION K 108176 ACCRUAL TRANSACTION HOLZER HOSPITAL FOUNDATION J 6655400 ACCRUAL TRANSACTION HOLZER HOSPITAL FOUNDATION M 40630125 ACCRUAL TRANSACTION HOLZER HOSPITAL FOUNDATION N 3256609 ACCRUAL TRANSACTION HOLZER HOSPITAL FOUNDATION Q 532989 ACCRUAL TRANSACTION HOLZER HOSPITAL FOUNDATION P 1737640 ACCRUAL TRANSACTION HOLZER HOSPITAL FOUNDATION S 131746 ACCRUAL TRANSACTION HOLZER MEDICAL CENTER - JACKSON L 1294000 ACCRUAL TRANSACTION HOLZER SENIOR CARE CENTER A 11333 ACCRUAL TRANSACTION HOLZER HOSPITAL FOUNDATION A 427312 ACCRUAL TRANSACTION