UNIVERSITY HOSPITALS HEALTH SYSTEM INC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- UNIVERSITY HOSPITALS HEALTH SYSTEM INC (EIN 34-0714535)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-11-12
- IRS object ID
- 201503169349302500
- Schema version
- 2014v5.0
- 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 C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-11-12T11:18:42-06:00 | ReturnTs |
| Tax Period End | 2014-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 381357951 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 65 EAST STATE STREET | AddressLine1Txt |
| City | COLUMBUS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43215 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 340714535 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN REGIONAL HEALTH SYSTEM | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SAMA | BusinessNameControlTxt |
| Phone | 4192890491 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1025 CENTER STREET | AddressLine1Txt |
| City | ASHLAND | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44805 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DANNY L BOGGS | PersonNm |
| Person Title | PRESIDENT & CEO | PersonTitleTxt |
| Phone | 4192890491 | PhoneNum |
| Signature | 2015-11-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | BERNIE OSTROWSKI | PreparerPersonNm |
| PTIN | P00366367 | PTIN |
| Phone | 6148493000 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEE SCHEDULE O | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DANNY L BOGGS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1025 CENTER STREET | AddressLine1Txt |
| City | ASHLAND | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44805 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $82,938,137 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SAMARITANHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1910 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | SAMARITAN REGIONAL HEALTH SYSTEM PROVIDES QUALITY MEDICAL HEALTHCARE SERVICES AND EDUCATION REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. THE HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. SERVICES PROVIDED TO MEDICARE AND MEDICAID PATIENTS ARE SOMETIMES PROVIDED BELOW COST. TO THE EXTENT REIMBURSEMENT IS BELOW COST, THE HOSPITAL RECOGNIZES THESE AMOUNTS AS CHARITY CARE. CHARITY CARE IS ALSO PROVIDED THROUGHOUT THE YEAR BASED UPON ACTIVITIES AND SERVICES WHICH THE HOSPITAL BELIEVES WILL SERVE A BONA FIDE COMMUNITY HEALTH NEED. CHARITY CARE FOR 2014 WAS VALUED AT $2,083,763. DURING 2014, THE HOSPITAL ALSO PROVIDED NUMEROUS OUTREACH PROGRAMS WHICH SERVE AND EDUCATE THE COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 652 | TotalEmployeeCnt |
| Total Volunteers | 175 | TotalVolunteersCnt |
| Total Gross UBI | $2,855,092 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$512,891 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $831,596 | PYContributionsGrantsAmt |
| CY Contributions Grants | $813,301 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $73,670,305 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $76,725,961 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$327,702 | PYInvestmentIncomeAmt |
| CY Investment Income | $135,883 | CYInvestmentIncomeAmt |
| PY Other Revenue | $5,252,637 | PYOtherRevenueAmt |
| CY Other Revenue | $4,866,146 | CYOtherRevenueAmt |
| PY Total Revenue | $79,426,836 | PYTotalRevenueAmt |
| CY Total Revenue | $82,541,291 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $39,650 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $99,739 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $33,447,735 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $32,600,104 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $42,738,788 | PYOtherExpensesAmt |
| CY Other Expenses | $41,719,996 | CYOtherExpensesAmt |
| PY Total Expenses | $76,226,173 | PYTotalExpensesAmt |
| CY Total Expenses | $74,419,839 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,200,663 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $8,121,452 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $73,083,240 | TotalAssetsBOYAmt |
| Total Assets EOY | $76,259,954 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $27,976,873 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $26,047,142 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $45,106,367 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $50,212,812 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF SAMARITAN REGIONAL HEALTH SYSTEM IS TO TAKE THE LEAD IN PROMOTING THE HEALTH AND WELLNESS OF PEOPLE IN THE COMMUNITIES WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $49,153,133 | ExpenseAmt |
| Grant | $99,739 | GrantAmt |
| Revenue | $77,505,677 | RevenueAmt |
| Desc | SAMARITAN REGIONAL HEALTH SYSTEM PROVIDES QUALITY MEDICAL HEALTHCARE SERVICES AND EDUCATION REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. THE HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. SERVICES PROVIDED TO MEDICARE AND MEDICAID PATIENTS ARE SOMETIMES PROVIDED BELOW COST. TO THE EXTENT REIMBURSEMENT IS BELOW COST, THE HOSPITAL RECOGNIZES THESE AMOUNTS AS CHARITY CARE. CHARITY CARE IS ALSO PROVIDED THROUGHOUT THE YEAR BASED UPON ACTIVITIES AND SERVICES WHICH THE HOSPITAL BELIEVES WILL SERVE A BONA FIDE COMMUNITY HEALTH NEED.DURING 2014, THE HOSPITAL PROVIDED NUMEROUS OUTREACH PROGRAMS WHICH SERVE AND EDUCATE THE COMMUNITY. THESE INCLUDED:COMMUNITY HEALTH IMPROVEMENT SERVICES: $50,827 SERVING 2,159 PEOPLEHEALTH PROFESSIONS EDUCATION: $98SUBSIDIZED HEALTH SERVICES: $5,674,019 SERVING THE COMMUNITYFINANCIAL AND IN-KIND CONTRIBUTIONS: $22,684 SERVING 1,048 PEOPLECOMMUNITY BUILDING ACTIVITIES: $18,643 SERVING 18 PEOPLECOMMUNITY BENEFIT OPERATIONS: $12,547 SERVING THE COMMUNITY | Desc |
| Total Program Service Expenses | $49,153,133 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | 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 | Yes (1) | 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 | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | 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 | 53 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 652 | 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 | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | 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 | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARY GRIEST CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4192077837 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 663 EAST MAIN STREET | AddressLine1Txt |
| City | ASHLAND | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44805 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 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 |
|---|---|---|---|---|---|---|---|---|
| DANNY BOGGS | ||||||||
| PRESIDENT/CEO | 35.00 | 11.00 | Yes (X) | Yes (X) | $283,744 | $0 | $37,232 | |
| STEPHEN STUART PHD | ||||||||
| CHAIR (END 4/22/14) | 2.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| HAROLD KEENER PHD | ||||||||
| CHAIR | 2.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ANNE BEER | ||||||||
| SECRETARY | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| TIM COWEN | ||||||||
| VICE CHIAR | 2.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MATTHEW BERNHARD | ||||||||
| MEDICAL STAFF VP (1/1/14-8/26/14) | 2.00 | 0.00 | Yes (X) | $68,106 | $0 | $0 | ||
| MICHAEL MARTIN MD | ||||||||
| MEDICAL STAFF PRESIDENT | 2.00 | 0.00 | Yes (X) | $11,000 | $0 | $0 | ||
| PAUL MYERS | ||||||||
| BOARD MEMBER | 2.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL STENCEL MD | ||||||||
| BOARD MEMBER | 2.00 | 0.00 | Yes (X) | $8,250 | $63,625 | $3,700 | ||
| ROGER KRAMER CPA | ||||||||
| BOARD MEMBER (END 4/22/14) | 2.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| POLLY CHANDLER | ||||||||
| BOARD MEMBER | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| RALPH KELSEY | ||||||||
| BOARD MEMBER | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| TOM MCGEE | ||||||||
| BOARD MEMBER | 2.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ANNETTE SHAW | ||||||||
| BOARD MEMBER | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL J KELLY SR | ||||||||
| BOARD MEMBER (START 5/1/14) | 2.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| THOMAS GILMAN | ||||||||
| BOARD MEMBER (START 5/1/14) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| PARTICIA DAWSON | ||||||||
| BOARD MEMBER (START 6/24/14) | 2.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JOYCE HUNT | ||||||||
| BOARD MEMBER (START 6/24/14) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MARY GRIEST | ||||||||
| VP FINANCE/CFO | 40.00 | 5.00 | Yes (X) | $156,735 | $0 | $23,538 | ||
| CHRISTOPHER HUNT | ||||||||
| VP CLINICAL SERVICES | 40.00 | 0.00 | $127,724 | $0 | $14,048 | Yes (X) | ||
| ALYCE LEGG | ||||||||
| VP RESOURCE DEVELOPMENT | 40.00 | 0.00 | $131,039 | $0 | $18,214 | Yes (X) | ||
| PHILIP MYERS MD | ||||||||
| VP MEDICAL AFFAIRS | 30.00 | 1.00 | $121,936 | $0 | $21,038 | Yes (X) | ||
| RONALD MANCHESTER | ||||||||
| VP SUPPORT SERVICES | 40.00 | 0.00 | $127,122 | $0 | $17,793 | Yes (X) | ||
| KARIN SCHWAN | ||||||||
| CNO/VP PATIENT CARE | 40.00 | 0.00 | $124,763 | $0 | $17,480 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,160,419 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $63,625 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $153,043 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 13 | 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 |
|---|---|---|---|---|---|
| ASHLAND ANESTHESIA | |||||
| 1 RIVERFRONT PLACE6TH FLOOR | NEWPORT | KY | 41071 | MEDICAL SERVICES AND NON EMPL COMP | $917,260 |
| SAMARITAN EMERGENCY PHYSICIANS LLP | |||||
| PO BOX 674579 | DETROIT | MI | 48267 | NONEMPL COMP | $869,750 |
| AMERICAN KIDNEY STONE MANAGEMENT | |||||
| 100 WEST THIRD ST STE 350 | COLUMBUS | OH | 43201 | RENT, MEDICAL SVCS | $667,808 |
| LABORATORY COPORATION OF AMERICA | |||||
| PO BOX 12140 | BURLINGTON | NC | 27216 | MEDICAL SVCS | $514,491 |
| SLEEP MED INC | |||||
| 200 CORPORATE PL STE 5-B | PEABODY | MA | 01960 | MEDICAL SVCS | $350,844 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 13 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $728,546 | RelatedOrganizationsAmt |
| All Other Contributions | $84,755 | AllOtherContributionsAmt |
| Noncash Contributions | $178,430 | NoncashContributionsAmt |
| Total Contributions | $813,301 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICES | 621110 | $76,555,423 | $76,555,423 |
| RENTS FROM AFFILIATE | 900099 | $170,538 | $170,538 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $76,725,961 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $174,731 | TotalRevenueColumnAmt |
| Exclusion | $174,731 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $329,389 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $357,998 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$28,609 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$28,609 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$28,609 | RelatedOrExemptFuncIncomeAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $38,848 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$38,848 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$38,848 | TotalRevenueColumnAmt |
| Exclusion | -$38,848 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| PHARMACY RETAIL | 446110 | $2,370,801 | $2,370,801 | |
| AARA INCENTIVE PAYMENTS | 621110 | $805,969 | $805,969 | |
| AIMS REVENUE | 621110 | $467,752 | $467,752 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,250,233 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $16,539 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,233,694 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $4,894,755 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $82,541,291 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $77,503,321 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $2,855,092 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,369,577 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $77,851 | TotalAmt |
| Program Services | $77,851 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,888 | TotalAmt |
| Program Services | $21,888 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $588,605 | TotalAmt |
| Program Services | $148,127 | ProgramServicesAmt |
| Management And General | $440,478 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,314,888 | TotalAmt |
| Program Services | $16,073,830 | ProgramServicesAmt |
| Management And General | $8,241,058 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,828,423 | TotalAmt |
| Program Services | $1,014,769 | ProgramServicesAmt |
| Management And General | $813,654 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,071,373 | TotalAmt |
| Program Services | $2,300,454 | ProgramServicesAmt |
| Management And General | $1,770,919 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,796,815 | TotalAmt |
| Program Services | $1,017,694 | ProgramServicesAmt |
| Management And General | $779,121 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $403,466 | TotalAmt |
| Program Services | $346,666 | ProgramServicesAmt |
| Management And General | $56,800 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $255,222 | TotalAmt |
| Management And General | $255,222 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $269,221 | TotalAmt |
| Management And General | $269,221 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,457,371 | TotalAmt |
| Program Services | $5,636,614 | ProgramServicesAmt |
| Management And General | $5,820,757 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $77,587 | TotalAmt |
| Management And General | $77,587 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,398,126 | TotalAmt |
| Program Services | $1,193,299 | ProgramServicesAmt |
| Management And General | $1,204,827 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $147,647 | TotalAmt |
| Management And General | $147,647 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,633,025 | TotalAmt |
| Program Services | $892,507 | ProgramServicesAmt |
| Management And General | $740,518 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $150,962 | TotalAmt |
| Program Services | $92,419 | ProgramServicesAmt |
| Management And General | $58,543 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $399,860 | TotalAmt |
| Program Services | $225,454 | ProgramServicesAmt |
| Management And General | $174,406 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,575,982 | TotalAmt |
| Program Services | $2,434,166 | ProgramServicesAmt |
| Management And General | $3,141,816 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $808,801 | TotalAmt |
| Program Services | $350,870 | ProgramServicesAmt |
| Management And General | $457,931 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $12,738,485 | $12,738,485 | |
| PROVISION FOR BAD DEBTS | $4,011,181 | $4,011,181 | |
| FACILITIES ENGINEERING | $142,134 | $142,134 | |
| SAMARITAN ON MAIN | $99,496 | $99,496 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,151,430 | TotalAmt |
| Program Services | $576,859 | ProgramServicesAmt |
| Management And General | $574,571 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,419,839 | TotalAmt |
| Program Services | $49,153,133 | ProgramServicesAmt |
| Management And General | $25,266,706 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,996,271 | BOYAmt |
| EOY | $16,571,895 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,734,252 | BOYAmt |
| EOY | $6,592,106 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,649,655 | BOYAmt |
| EOY | $4,341,652 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,600,291 | BOYAmt |
| EOY | $1,524,227 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,910,621 | BOYAmt |
| EOY | $1,934,262 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $108,523,008 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $70,545,175 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,781,255 | BOYAmt |
| EOY | $37,977,833 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,488 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,377,407 | BOYAmt |
| EOY | $7,317,979 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $73,083,240 | BOYAmt |
| EOY | $76,259,954 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,106,103 | BOYAmt |
| EOY | $7,988,774 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $475,535 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,223,367 | BOYAmt |
| EOY | $13,783,224 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $566,101 | BOYAmt |
| EOY | $444,290 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,081,302 | BOYAmt |
| EOY | $3,355,319 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,976,873 | BOYAmt |
| EOY | $26,047,142 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,022,476 | BOYAmt |
| EOY | $50,142,683 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $83,891 | BOYAmt |
| EOY | $70,129 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,106,367 | BOYAmt |
| EOY | $50,212,812 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $73,083,240 | BOYAmt |
| EOY | $76,259,954 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $8,121,452 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $196,376 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$3,211,383 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $5,752 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $5,752 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | MEMBERSHIP DUES IN THE AMOUNT OF $20,940 AND $28,779 WERE PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND THE OHIO HOSPITAL ASSOCIATION, RESPECTIVELY. $4,774 AND $978 OF THE DUES PAYMENTS WERE FOR LOBBYING EXPENSES. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $401,415 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $20,071 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $20,071 | GrantsOrScholarshipsAmt |
| End Year Balance | $401,415 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $476,415 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$75,000 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $401,415 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $476,415 | BeginningYearBalanceAmt |
| End Year Balance | $476,415 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $476,415 | BeginningYearBalanceAmt |
| End Year Balance | $476,415 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $476,415 | BeginningYearBalanceAmt |
| End Year Balance | $476,415 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,346,208 | OtherCostOrOtherBasisAmt |
| Book Value | $2,346,208 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,169,160 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,849,116 | DepreciationAmt |
| Book Value | $8,320,044 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,321,822 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,751,151 | DepreciationAmt |
| Book Value | $570,671 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $39,777,064 | OtherCostOrOtherBasisAmt |
| Depreciation | $32,441,889 | DepreciationAmt |
| Book Value | $7,335,175 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $46,908,754 | OtherCostOrOtherBasisAmt |
| Depreciation | $27,503,019 | DepreciationAmt |
| Book Value | $19,405,735 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $37,977,833 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| BOND ISSUE COSTS | $24,048 |
| ACCRUED INTEREST INCOME | $2,249,943 |
| INVESTMENT IN PAIN MANAGEMENT | $143,988 |
| INTEREST IN MIFFLIN MEDICAL OFFICE BUILDING | $4,900,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $7,317,979 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| COST REPORT SETTLEMENT PAYABLE | $3,172,746 |
| INTEREST RATE SWAP | $182,573 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,355,319 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE INTENDED USE OF ENDOWMENT ASSETS INCLUDES FUTURE CAPITAL IMPROVEMENTS, SCHOLARSHIPS, AND OTHER SUCH PURPOSES AT THE DISCRETION OF THE BOARD OF DIRECTORS. |
| 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 IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE SYSTEM AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2014, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILTIY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE SYSTEM FILES FEDERAL AND STATE TAX RETURNS AND IS NO LONGER SUBJECT TO FEDERAL, STATE, OR LOCAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE FISCAL YEAR 2011. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| 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 | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,083,763 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,640,250 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $443,513 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00630 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,576,169 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,597,878 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,978,291 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05650 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,659,932 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,238,128 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,421,804 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06280 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2159 | PersonsServedCnt |
| Total Community Benefit Expns | $63,374 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,381 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $56,993 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $98 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $98 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1048 | PersonsServedCnt |
| Total Community Benefit Expns | $22,684 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $22,684 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 3207 | PersonsServedCnt |
| Total Community Benefit Expns | $86,156 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,381 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $79,775 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 3207 | PersonsServedCnt |
| Total Community Benefit Expns | $10,746,088 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,244,509 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,501,579 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06390 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,640 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,640 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,115 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,115 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,420 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,420 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,468 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $13,468 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,643 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $18,643 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $4,011,181 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $10,265 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $10,805,938 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $12,627,287 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,821,349 | 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 | SAMARITAN HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1025 CENTER STREET | AddressLine1Txt |
| City | ASHLAND | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44805 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | SAMARITAN REGIONAL HEALTH SYSTEM | 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 |
| CHNA Conducted | 13 | 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 | HTTP://WWW.SAMARITANHOSPITAL.ORG | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTP://WWW.SAMARITANHOSPITAL.ORG | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| 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 |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SAMARITAN REGIONAL HEALTH SYSTEM | PART V, SECTION B, LINE 5: THE FIRST SECTION OF THE CHNA IS A COMMUNITY HEALTH SURVEY OF ASHLAND COUNTY RESIDENTS. THE SURVEY CONSISTED OF FILL-IN-THE-BLANK QUESTIONS DESIGNED TO ELICIT RESPONSES FROM ASHLAND COUNTY RESIDENTS' OPINION OF HEALTHCARE NEEDS IN THE COUNTY. THE SECOND SECTION OF THE CHNA PRESENTS A FOCUS GROUP ASSESSMENT OF STAKEHOLDERS' OPINIONS OF HEALTHCARE NEEDS IN THE COUNTY. THE THREE FOCUS GROUPS INCLUDE MEMBERS OF REPRESENTING BUSINESS AND COMMUNITY LEADERS, MEDICAL PROFESSIONALS AND END USERS- PATIENTS. THE SURVEY AND FOCUS GROUP ASSESSMENTS WERE PERFORMED UNDER THE GUIDANCE AND COLLABORATION OF OSCAR MCKNIGHT, PH.D., A PROFESSOR AT ASHLAND UNIVERSITY AND STATISTICAL CONTRACTOR FOR BUSINESS IN OHIO AND SURROUNDING STATES. DR. MCKNIGHT WAS ALSO THE MODERATOR FOR THE FOCUS GROUPS. |
| SAMARITAN REGIONAL HEALTH SYSTEM | PART V, SECTION B, LINE 11: BOTH THE FOCUS GROUPS AND THE COMMUNITY SURVEYS RESULTS WERE THAT MORE HEALTHCARE SERVICES ARE NOT NECESSARY FOR ASHLAND COUNTY. HOWEVER, BOTH RESEARCH GROUPS DID OFFER SERVICES TO CONSIDER: WELLNESS, ELDERCARE, AND MENTAL HEALTH. COMMUNITY WELLNESS: EXTENDED THE QCARE PROGRAM FROM MON-THURS 11AM-6:30PM TO MON-FRI 11AM-6:30PM. A WIDE VARIETY OF EDUCATION CLASSES ARE OFFERED ON A MONTHLY BASIS. THESE INCLUDE : CHILDBIRTH, BREAST-FEEDING, FREEDOM FROM SMOKING, PRE-OP EDUCATION CLASSES FROM KNEE AND HIP REPLACEMENT PATIENTS, COMMUNITY EDUCATION SERIES (PHYSICIANS AND OTHER HEALTHCARE PROFESSIONALS PRESENT ONE-HOUR TALKS ON THE HOT TOPICS CURRENTLY IN HEALTHCARE AS WELL AS TOPICS SUGGESTED BY THE PUBLIC). SRHS IS WORKING CLOSELY WITH LOCAL MENTAL HEALTH PROFESSIONALS TO STRENGTHEN THE SERVICES AND CREATE NEW OPPORTUNITIES TO EDUCATE EMPLOYEES AND THE COMMUNITY ABOUT MENTAL HEALTH ISSUES. THE VP OF CLINICAL SERVICES NOW SITS ON THE APPLESEED COMMUNITY MENTAL HEALTH BOARD AND IS COORDINATING MEETINGS BETWEEN PHYSICIAN OFFICES AND MENTAL HEALTH PROVIDERS.TWO NEEDS IDENTIFIED BY BOTH THE COMMUNITY SURVEY AND THE FOCUS GROUPS THAT ARE NOT BEING ADDRESSED IN THE FORM OF PRIMARY CARE BY SRHS IS ELDERCARE AND MENTAL HEALTH SERVICES. WHILE THESE ARE NOT PRIMARY SERVICE AREAS OFFERED BY THE HOSPITAL FOR STRATEGIC PLANNING AND OPERATIONS PURPOSES, AS WELL AS BECAUSE OF LIMITED RESOURCES, THEY ARE BOTH SUPPORTED BY THIS ORGANIZATION IN MANY WAYS. THE HOSPITAL PARTICIPATES IN SEVERAL COMMITTEES INVOLVING THE ELDER AND MENTAL HEALTH COMMUNITIES. MANY MENTAL HEALTH AND ELDERCARE EDUCATIONAL AND WELLNESS OPPORTUNITIES ARE OFFERED BY THE HOSPITAL THROUGHOUT THE YEAR. THE VP OF CLINICAL SERVICES SERVES ON THE APPLESEED COMMUNITY MENTAL HEALTH AND RECOVERY BOARD AND THE SOCIAL SERVICES DEPARTMENT IS INSTRUMENTAL IN ADDRESSING ELDERCARE NEEDS AS PATIENT ADVOCATES. SRHS IS ALSO EXPLORING THE POSSIBILITY OF ADDING A PSYCHIATRIST TO STAFF. |
| SAMARITAN REGIONAL HEALTH SYSTEM | PART V, SECTION B, LINE 13H: FOR DISCOUNTED CARE THE FOLLOWING CRITERIA IS USED: MONTHLY EXPENSES, AND BANK STATEMENTS. DISCOUNT IS DETERMINED BY THE % OVER THE 200% FPL AND IS DECREASING THE GREATER THE VARIANCE IS. FOR 100% DISCOUNT, THE CRITERIA IS LESS THAN 100% OF THE FEDERAL POVERTY LEVEL. |
| SAMARITAN REGIONAL HEALTH SYSTEM | PART V, SECTION B, LINE 15E: A COMPLETED APPLICATION IS SUBMITTED TO PATIENT ACCOUNTING. THE DOCUMENTATION REQUIRED IS PROOF OF INCOME, WHICH MAY INCLUDE W2S AND/OR TAX RETURNS. |
| SAMARITAN REGIONAL HEALTH SYSTEM | PART V, SECTION B, LINE 16I: THE HOSPITAL USES BROCHURES, THIER WEBSITE, STATEMENTS, AND PHONE CALLS AS OTHER MEANS TO PUBLICIZE ITS FINANCIAL ASSISTANCE POLICY. |
| SAMARITAN REGIONAL HEALTH SYSTEM | PART V, SECTION B, LINE 22D: IF QUALIFIED BASED ON POLICY, 100% IS DISCOUNTED. |
| PART V, SECTION B, LINE 16 | FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY |
| SAMARITAN REGIONAL HEALTH SYSTEM PART V, SECTION B, LINE 16B WEBSITE: | HTTP://WWW.SAMARITANHOSPITAL.ORG |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 7 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| SAMARITAN HEALTH & REHAB CENTER | ||||
| 2163 CLAREMONT AVENUE | ASHLAND | OH | 44805 | OUTPATIENT PHYS, OCC, SPEECH REHAB |
| KETTERING SAMARITAN HEALTH CENTER | ||||
| 546 NORTH UNION STREET | ASHLAND | OH | 44842 | OUTPATIENT ANCILLARY SVC |
| SAMARITAN PROFESSIONAL PARK | ||||
| 2212 MIFFLIN AVENUE | ASHLAND | OH | 44805 | OUTPATIENT ENDOSCOPY |
| SAMARITAN PROFESSIONAL PARK | ||||
| 2212 MIFFLIN AVENUE | ASHLAND | OH | 44805 | WOMEN'S HEALTH, OCC MEDICINE |
| SAMARITAN PROFESSIONAL PARK | ||||
| 2212 MIFFLIN AVENUE | ASHLAND | OH | 44805 | SLEEP LAB, PHYSICIAN OFFICES |
| SAMARITAN BANEY RD OUTPATIENT FACILITY | ||||
| 1941 BANEY ROAD | ASHLAND | OH | 44805 | OUTPATIENT ANCILLARY SVCS |
| SAMARITAN ADMINISTRATIVE BUILDING | ||||
| 663 EAST MAIN STREET | ASHLAND | OH | 44805 | ADMINISTRATIVE OFFICES |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | SAMARITAN'S POLICY INCLUDES FEDERAL POVERTY GUIDELINES ALONG WITH EVALUATION OF MONTHLY EXPENSES AND BANK STATEMENTS TO DETERMINE ELIGIBILITY FOR CHARITY CARE. IN SOME CIRCUMSTANCES WHEN A PATIENT DOES NOT MEET THE CRITERIA, FURTHER DOCUMENTATION MAY BE REQUESTED (RELATED TO INCOME AND EXPENSES), AND THE CFO MAY GRANT A DISCOUNT AS A SPECIAL CIRCUMSTANCE. |
| PART I, LINE 7: | CHARITY CARE AND MEDICAID COSTS WERE CALCULATED USING A COST TO CHARGE RATIO USING THE WORKSHEET 2 METHOD TO CALCULATE THE COST TO CHARGE RATIO. |
| PART I, LINE 7G: | NOT APPLICABLE |
| PART I, LN 7 COL(F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN, IS $4,011,181. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | SAMARITAN REGIONAL HEALTH SYSTEM'S MISSION IS TO "TAKE THE LEAD IN PROMOTING THE HEALTH AND WELLNESS OF PEOPLE IN THE COMMUNITIES WE SERVE." AT THE FOREFRONT OF THESE EFFORTS IS SRHS'S FREE COMMUNITY EDUCATION CLASSES THAT ARE OFFERED SEVERAL TIMES A MONTH, SEPTEMBER-MAY. PHYSICIANS, PROVIDERS, NURSES AND CLINICAL EXPERTS SHARE THEIR KNOWLEDGE ON A VARIETY OF TOPICS. IN ADDITION, SEVERAL SAMARITAN NURSES SERVE AS COORDINATORS OF SUPPORT GROUPS, HOSTING REGULAR MEETINGS FOR PATIENTS AND FAMILIES DEALING WITH CARDIAC DISEASE OR DIABETES. SRHS IS ACTIVELY INVOLVED IN SERVICE CLUB ORGANIZATIONS AND SOCIAL SERVICE BOARDS, AND ROUTINELY PARTICIPATES IN HEALTH FAIRS. SRHS IS A STRONG SUPPORTER OF THE UNITED WAY OF ASHLAND COUNTY. |
| PART III, LINE 3: | MATCHED BAD DEBT REVERSALS ACCOUNTS DATE OF SERVICE 2013 TO CHARITY WRITE OFFS DATE OF SERVICE 2013 BOTH LIST POSTED DATE 2014. THIS AMOUNT AS A PERCENTAGE OF TOTAL BAD DEBT DATE OF SERVICE 2013. THIS PERCENTAGE IS USED AGAINST TOTAL BAD DEBT DATE OF SERVICE 2014 POSTED IN 2014. |
| PART III, LINE 4: | FINANCIAL STATEMENT FOOTNOTE: AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE SYSTEM'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE.THE BAD DEBT ESTIMATE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY WAS DETERMINED BY USING THE PERCENTAGE OF ACCOUNTS WRITTEN OFF TO BAD DEBT AND LATER REVERSED FROM BAD DEBT TO WRITE OFF AS A CHARITY ACCOUNT. THIS PERCENTAGE WAS APPLIED TO ALL BAD DEBT WRITE OFFS, THEN THE COST TO CHARGE RATIO APPLIED. |
| PART III, LINE 8: | MEDICARE REVENUE WAS 46.4% OF TOTAL REVENUE FOR SAMARITAN FOR 2014. BASED ON A COST TO CHARGE RATIO, THE COST OF PROVIDING CARE TO THE MEDICARE POPULATION IN 2014 WAS $12,627,287. THE PAYMENTS RELATED TO THESE SERVICES TOTALED $10,925,014. THIS LEAVES A MEDICARE SHORTFALL OF $1,702,273 FOR THE YEAR. THIS IS CONSIDERED A COMMUNITY BENEFIT BASED ON THE ELDERLY POPULATION. |
| PART III, LINE 9B: | PATIENTS RECEIVE 3 STATEMENTS FOR SELF PAY BALANCES. FOR BALANCES GREATER THAN $200, ONE ATTEMPT IS MADE TO CALL THE PATIENT TO MAKE PAYMENT ARRANGEMENTS. |
| PART VI, LINE 2: | FOCUS GROUPS FROM A CROSS SECTION OF COMMUNITY MEMBERS AND KEY STAKEHOLDERS WERE SURVEYED FOR THEIR INPUT. WE ALSO COLLABORATED WITH OTHER NON-PROFIT AGENCIES WHO CONDUCTED SIMILAR STUDIES AND VIEWED THEIR FINDINGS USEFUL AND PRACTICAL. OUR OCCUPATIONAL MEDICINE PROGRAM SERVES INDUSTRY AND FUNCTIONS AS A "LISTENING POST" TO GATHER INPUT FROM OUR BUSINESS COMMUNITY. |
| PART VI, LINE 3: | INFORMATION RELATED TO THE CHARITY PROGRAM AT SAMARITAN IS PROVIDED IN A NUMBER OF WAYS. BROCHURES ARE PROVIDED AT EACH POINT OF ADMISSION ALONG WITH THE PUBLICLY POSTED INFORMATION NOTICES. EACH STATEMENT SENT LISTS THE FEDERAL POVERTY GUIDELINES AND WHAT INFORMATION IS NEEDED TO QUALIFY. AN APPLICATION FOR FREE CARE IS ON THE BACK OF EACH STATEMENT SENT TO PATIENTS. |
| PART VI, LINE 4: | SAMARITAN REGIONAL HEALTH SYSTEM DEFINES ASHLAND COUNTY AND THE 10 ZIP CODES THAT COMPRISE IT AS OUR PRIMARY SERVICE AREA (PSA). FURTHER, WE INCLUDE AT LEAST ONE ZIP CODE FROM EACH OF THE 5 CONTIGUOUS COUNTIES WITHIN OUR PSA. OUR PSA IS PRIMARILY RURAL WITH GREATER THAN 50% OF THE POPULATION LIVING IN THE 44805 ZIP CODE AREA. AS A COMMUNITY HOSPITAL WE MEET A BROAD RANGE OF NEEDS FOR A COMMUNITY THAT IS DIVERSE IN AGE AND SOCIO ECONOMIC MAKE-UP. OUR COMMUNITY INCLUDES A LARGE AMISH POPULATION AND A DEMOGRAPHIC THAT HAS BEEN SEVERLY IMPACTED BY THE ECONOMIC DOWNTURN DUE TO THE DECLINE IN MANUFACTURING BASE OVER THE PAST SEVERAL YEARS. |
| PART VI, LINE 5: | SAMARITAN REGIONAL HEALTH SYSTEM IS VIEWED AS THE LEADER IN THE COMMUNITY FOR PROVIDING INFORMATION THAT LEADS TO EARLY TREATMENT AND BETTER OUTCOMES WITH LOWER ASSOCIATED COSTS. SAMARITAN HAS AN EFFECTIVE EDUCATIONAL PROGRAM (FREE OF CHARGE) THAT GATHERS DIRECT INPUT AS TO THE NEEDS AND CONCERNS OF THE COMMUNITY. |
| PART VI, LINE 6: | SAMARITAN REGIONAL HEALTH SYSTEM IS A GENERAL ACUTE-CARE FACILITY LOCATED IN ASHLAND, OHIO WHERE IT OPERATES FOUR MEDICAL OFFICE BUILDINGS, AN OUTPATIENT CLINIC, AN OFFSITE REHAB FACILITY, AND AN ADMINISTRATIVE OFFICE BUILDING. SRHS IS THE PARENT ORGANIZATION OF SAMARITAN PROFESSIONAL CORPORATION AND THE SOLE BENEFICIARY OF SAMARITAN HOSPITAL FOUNDATION.SAMARITAN PROFESSIONAL CORPORATION CONTINUED ITS MISSION TO RETAIN QUALITY PHYSICIANS AND EXPAND SERVICES IN THE COMMUNITY. THE STRUCTURE OF THE ORGANIZATION ENABLED THE PHYSICIANS TO CONTINUE THEIR OPERATIONS AND TO ENHANCE SERVICES PROVIDED BY THE LOCAL HEALTHCARE NETWORK.SAMARITAN HOSPITAL FOUNDATION PROVIDES A PROVISION OF FUNDRAISING AND ASSET MANAGEMENT IN SUPPORT OF SAMARITAN REGIONAL HEALTH SYSTEM. |
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 | UNITED WAY | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 132 W MAIN ST LOWER LEVEL | AddressLine1Txt |
| City | ASHLAND | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44805 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 346004364 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $26,673 | CashGrantAmt |
| Purpose Of Grant | TO MATCH THE EMPLOYEE CONTRIBUTIONS TO THE UNITED WAY OF ASHLAND COUNTY OHIO INC. | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | MEDICAL FINANCIAL ASSISTANCE | GrantTypeTxt |
| Recipient | 8 | RecipientCnt |
| Cash Grant | $21,888 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | SAMARITAN REGIONAL HEALTH SYSTEM MAKES CONTRIBUTIONS IN SUPPORT OF ITS RELATED PARTIES AS WELL AS ORGANIZATIONS WITHIN THE COMMUNITY. WHEN A PATIENT APPLIES FOR FINANCIAL ASSISTANCE, THE FINANCIAL COUNSELOR FOLLOWS THE FINANCIAL ASSISTANCE POLICY. IF THE PATIENT IS OVER INCOME GUIDELINES AND MAY NOT BE ABLE TO RETURN TO WORK DUE TO THE ILLNESS, THE FINANCIAL COUNSELOR WRITES AN EXCEPTION LETTER EXPLAINING THE PATIENT'S CIRCUMSTANCES. THIS LETTER IS ATTACHED TO THE SUPPORTING PAPERWORK AND FORWARDED TO THE CFO FOR APPROVAL. AN E-MAIL IS SENT TO THE FOUNDATION OFFICE EXPLAINING THE PATIENT'S CIRCUMSTANCES WITHOUT GIVING PERSONAL INFORMATION. THE OFFICE MAINTAINS A LOG OF ACCOUNTS WRITTEN OFF USING FOUNDATION FUNDS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| 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 (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DANNY BOGGS | ||||||||||||||
| PRESIDENT/CEO | $281,764 | $0 | $0 | $0 | $1,980 | $0 | $30,000 | $0 | $7,232 | $0 | $320,976 | $0 | $0 | $0 |
| MARY GRIEST | ||||||||||||||
| VP FINANCE/CFO | $154,755 | $0 | $0 | $0 | $1,980 | $0 | $18,034 | $0 | $5,504 | $0 | $180,273 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 1A | FormAndLineReferenceDesc |
| Explanation | THE PRESIDENT/CEO RECEIVES HEALTH/SOCIAL CLUB DUES WHICH ARE NON TAXABLE. THE HOSPITAL IS REIMBURSED FOR ANY PERSONAL USE. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (3 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|
| COUNTY OF ASHLAND OHIO | |||||||
| A | 346000122 | 2008-12-19 | $9,500,000 | ED & OB BUILDING & STRUCTURE RENOVATION & IMPROVEMENTS; EQUIPMENT | Yes (1) | 0 | 0 |
| COUNTY OF ASHLAND OHIO | |||||||
| B | 346000122 | 2009-01-09 | $4,495,023 | REFUND PRIOR ISSUE | Yes (1) | 0 | 0 |
| COUNTY OF ASHLAND OHIO | |||||||
| C | 346000122 | 2009-01-27 | $6,004,977 | BUILDING & STRUCTURE RENOVATION; EQUIPMENT | Yes (1) | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (3 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Working Capital ExpendituresWorkingCapitalExpendituresAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | Refunding EscrowRefundingEscrowAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| A | $2,083,155 | $9,665,616 | $119,942 | $1,744 | $9,543,930 | 2010 | 0 | 0 | Yes (1) | Yes (1) | |
| B | $1,371,923 | $4,495,023 | $4,495,023 | 2006 | Yes (1) | 0 | Yes (1) | Yes (1) | $4,495,023 | ||
| C | $1,321,555 | $6,208,273 | $41,424 | $57 | $6,166,792 | 2011 | 0 | 0 | Yes (1) | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (3 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Private Bus Concerning UBIPrivateBusConcerningUBIPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
| B | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
| C | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (3 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Term Of HedgeTermOfHedgePct | Superintegrated HedgeSuperintegratedHedgeInd | Hedge TerminatedHedgeTerminatedInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| FIFTH THIRD BANK | ||||||||||||
| A | 0 | 0 | 0 | Yes (1) | Yes (1) | Yes (1) | 6.900000000000 | 0 | 0 | 0 | 0 | 0 |
| FIFTH THIRD BANK | ||||||||||||
| B | 0 | 0 | Yes (1) | Yes (1) | Yes (1) | Yes (1) | 6.900000000000 | 0 | 0 | 0 | 0 | 0 |
| FIFTH THIRD BANK | ||||||||||||
| C | 0 | 0 | 0 | Yes (1) | Yes (1) | Yes (1) | 6.900000000000 | 0 | 0 | 0 | 0 | 0 |
Procedures Corrective Action ProceduresCorrectiveActionGrp (3 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | 0 |
| B | 0 |
| C | 0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | DATE REBATE COMPUTATION PERFORMED | FormAndLineReferenceDesc |
| Explanation | ISSUER NAME: COUNTY OF ASHLAND, OHIO DATE THE REBATE COMPUTATION WAS PERFORMED: 04/14/2014 ISSUER NAME: COUNTY OF ASHLAND, OHIO DATE THE REBATE COMPUTATION WAS PERFORMED: 04/14/2014 ISSUER NAME: COUNTY OF ASHLAND, OHIO DATE THE REBATE COMPUTATION WAS PERFORMED: 04/14/2014 | ExplanationTxt |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | EQUIPMENT | Desc |
| Contribution | 17 | ContributionCnt |
| Noncash Contributions Rpt F990 | $178,430 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | COST OF THE EQUIPMEN | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE CFO REVIEWS THE 990 PRIOR TO FILING. THE 990 IS REVIEWED AT THE BOARD OF DIRECTORS MEETING WITH SUFFICIENT TIME TO MAKE ANY AND ALL INQUIRIES REGARDING THE INFORMATION CONTAINED THEREIN. A COPY OF THE FORM 990 IS AVAILABLE TO EACH BOARD MEMBER BEFORE IT IS FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERS AND KEY EMPLOYEES ARE REQUIRED TO SIGN A DISCLOSURE OF POTENTIAL CONFLICT OF INTEREST AND CONFIDENTIALITY OF INFORMATION AGREEMENT ANNUALLY OR WHEN THEY FIRST JOIN. THE FORMS ARE SENT FROM THE CEO'S OFFICE AND ARE MAINTAINED THERE UPON COMPLETION. SHOULD A CONFLICT OF INTEREST ARISE, A BOARD MEMBER MAY RESIGN FROM THE BOARD DEPENDING ON THE LEVEL OF CONFLICT. IN ADDITION, THE BOARD MEMBER WILL ABSTAIN FROM VOTING AND IF APPROPRIATE WILL BE EXCUSED FROM THE BOARD MEETING DURING THE DISCUSSION REGARDING A POTENTIAL CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15 | EVERY TWO YEARS, SINCE 2004, AN INDEPENDENT CONSULTANT PERFORMS A MARKET ANALYSIS OF THE SENIOR LEADERSHIP POSITIONS USING THE RESULTS OF AT LEAST THREE INDEPENDENT WAGE SURVEYS. THEIR REPORT IS USED TO DEVELOP/REVISE WAGE RANGES FOR ALL LEADERSHIP POSITIONS. THE INFORMATION IS THEN PRESENTED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS FOR THEIR APPROVAL. DECISIONS REGARDING THE CEO'S COMPENSATION ARE DOCUMENTED IN THE BOARD OF DIRECTOR MINUTES WHEN IT IS APPROVED AS WELL AS A NOTIFICATION THAT IS KEPT IN THE CEO'S FILE. THE INDEPENDENT REVIEW PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO AND OFFICERS WAS LAST UNDERTAKEN DURING 2014. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | CONTRACT SERVICES- MEDICAL: PROGRAM SERVICE EXPENSES 2,745,937. MANAGEMENT AND GENERAL EXPENSES 1,036,225. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,782,162. CONTRACT SERVICES- NON PATIENT: PROGRAM SERVICE EXPENSES 1,614,704. MANAGEMENT AND GENERAL EXPENSES 3,656,599. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,271,303. MAINTENANCE: PROGRAM SERVICE EXPENSES 1,275,973. MANAGEMENT AND GENERAL EXPENSES 720,948. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,996,921. COLLECTION FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 358,468. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 358,468. COMMUNITY RELATIONS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 34,648. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 34,648. OTHER FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 13,869. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,869. |
| FORM 990, PART XI, LINE 9: | TRANSFER TO SAMARITAN PROFESSIONAL CORPORATION -3,211,383. |
| FORM 990, PAGE 12, PART XII, LINE 2C | THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
| FORM 990, PAGE 1, PART I, LINE C | DOING BUSINESS AS: SAMARITAN HOSPITAL PEOPLES HOSPITAL |
| FORM 990, PAGE 6, PART VI, LINE 16 | THERE IS A PROCEDURE IN PLACE THAT INVOLVED ATTORNEYS IN REVIEWING THE JOINT VENTURE ARRANGEMENT TO ENSURE TAX EXEMPT PROTECTION. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| SAMARITAN PROFESSIONAL CORPORATION | ||||||||||
| 1025 CENTER STREET | ASHLAND | OH | 44805 | 341856531 | PHYSICIAN BASED HEALTH SERVICES | OH | 501(C)(3) | 3 | SAMARITAN REGIONAL HEALTH SYSTEM | Yes (1) |
| SAMARITAN HOSPITAL FOUNDATION | ||||||||||
| 663 EAST MAIN STREET | ASHLAND | OH | 44805 | 341783215 | FUNDRAISING AND ASSET MANAGEMENT | OH | 501(C)(3) | 11A | SAMARITAN REGIONAL HEALTH SYSTEM | Yes (1) |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN REGIONAL PAIN MANAGEMENT LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1025 CENTER STREET | AddressLine1Txt |
| City | ASHLAND | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44805 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 462286785 | EIN |
| Primary Activities | HOSPITAL SUPPORT-MEDICAL SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN REGIONAL HEALTH SYSTEM | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | RELATED | PredominantIncomeTypeTxt |
| Share Of Total Income | $187,427 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $219,232 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | Yes (1) | GeneralOrManagingPartnerInd |
| Ownership | 0.51000 | OwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | 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 | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | 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 | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (6 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| SAMARITAN PROFESSIONAL CORP | ||
| A | $369,758 | ACTUAL RENT RECORDED |
| SAMARITAN PROFESSIONAL CORP | ||
| R | $3,211,383 | CASH VALUE |
| SAMARITAN HOSPITAL FOUNDATION | ||
| C | $704,414 | ACTUAL CONTRIBUTIONS RECEIVED |
| SAMARITAN HOSPITAL FOUNDATION | ||
| K | $228,500 | ACTUAL LEASE PAYMENT |
| SAMARITAN PROFESSIONAL CORP | ||
| L | $384,230 | ACTUAL PAYROLL EXPENSE |
| SAMARITAN PROFESSIONAL CORP | ||
| O | $121,108 | PAYROLL |
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