HOLZER HEALTH SYSTEM: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- HOLZER HEALTH SYSTEM (EIN 31-1156690)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-15
- IRS object ID
- 201401359349305485
- Schema version
- 2012v2.1
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-15T12:50:30-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 381357951 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 65 EAST STATE STREET SUITE 600 | AddressLine1 |
| City | COLUMBUS | City |
| State | OH | State |
| ZIP Code | 43215 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311156690 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOLZER HEALTH SYSTEM | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | HOLZ | NameControl |
| Phone | 7404465060 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 JACKSON PIKE | AddressLine1 |
| City | GALLIPOLIS | City |
| State | OH | State |
| ZIP Code | 45631 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DAN JANICAK | Name |
| Title | INTERIM CFO | Title |
| Phone | 7404465060 | Phone |
| Date Signed | 2014-05-15 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BERNIE OSTROWSKI | Name |
| PTIN | P00366367 | PTIN |
| Phone | 6148493000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOLZER CONSOLIDATED HEALTH SYSTEMS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | WAYNE MUNRO | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 JACKSON PIKE | AddressLine1 |
| City | GALLIPOLIS | City |
| State | OH | State |
| ZIP Code | 45631 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 175921163 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.HOLZER.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1985 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | THE PRIMARY EXEMPT PURPOSE OF HOLZER CONSOLIDATED HEALTH SYSTEMS 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). | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 0 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1318 | TotalNbrEmployees |
| Total Nbr Volunteers | 2 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 48918677 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 173734837 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 113757 | InvestmentIncomePriorYear |
| Investment Income Current Year | 49685 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 4440886 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2136041 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 53473320 | TotalRevenuePriorYear |
| Total Revenue Current Year | 175920563 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 140 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 28913340 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 111915666 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 24684982 | OtherExpensePriorYear |
| Other Expenses Current Year | 81477018 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 53598462 | TotalExpensesPriorYear |
| Total Expenses Current Year | 193392684 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -125142 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -17472121 | RevenuesLessExpensesCY |
| Total Assets BOY | 195941419 | TotalAssetsBOY |
| Total Assets EOY | 186461553 | TotalAssetsEOY |
| Total Liabilities BOY | 174983305 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 179797525 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 20958114 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 6664028 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO ADVANCE THE HEALTH AND WELL BEING OF THOSE WE SERVE | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 14076369 | Expense |
| Grants | 0 | Grants |
| Revenue | 127400624 | Revenue |
| Description | HOLZER HEALTH SYSTEM PROVIDED MANAGEMENT SERVICES TO ITS SUBSIDIARIES WHOSE EXEMPT PURPOSES ARE TO MEET THE HEALTHCARE NEEDS OF THEIR COMMUNITIES. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 967678 | Expense |
| Grants | 0 | Grants |
| Revenue | 1048252 | Revenue |
| Description | HOLZER DENTAL CLINIC-JACKSON STRIVES TO IMPROVE THE DENTAL HEALTH STATUS OF THE PEOPLE AND COMMUNITIES WE SERVE. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 122509547 | Expense |
| Grants | 0 | Grants |
| Revenue | 45286856 | Revenue |
| Description | 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. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 137553594 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 1 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 74 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1318 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 0 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | OH | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAN JANICAK INTERIM CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7404465060 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 JACKSON PIKE | AddressLine1 |
| City | GALLIPOLIS | City |
| State | OH | State |
| ZIP Code | 45631 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (24 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|---|
| BRENT SAUNDERS | |||||||||
| CHAIRMAN | 1.00 | 39.00 | X | X | 0 | 449307 | 24624 | ||
| LOIS BOSLEY | |||||||||
| TRUSTEE | 1.00 | 0.00 | X | 0 | 0 | 0 | |||
| STEVE CHAPMAN | |||||||||
| TRUSTEE | 1.00 | 3.00 | X | 0 | 0 | 0 | |||
| RENUKA KANDULA MD | |||||||||
| TRUSTEE | 1.00 | 0.00 | X | 0 | 0 | 0 | |||
| JUDGE ROBERT GRILLO | |||||||||
| TRUSTEE | 1.00 | 0.00 | X | 0 | 0 | 0 | |||
| DANNY HOLSCHUH | |||||||||
| TRUSTEE | 1.00 | 2.00 | X | 0 | 0 | 0 | |||
| LARRY KIDD | |||||||||
| TRUSTEE | 1.00 | 3.00 | X | 0 | 0 | 0 | |||
| CHRISTOPHER MEYER MD | |||||||||
| TRUSTEE | 1.00 | 0.00 | X | 0 | 0 | 0 | |||
| BRAD MUNN | |||||||||
| TRUSTEE | 1.00 | 0.00 | X | 0 | 0 | 0 | |||
| WAYNE MUNRO MD | |||||||||
| CEO- HHS | 1.00 | 39.00 | X | X | 650407 | 0 | 6560 | ||
| RODNEY STOUT MD | |||||||||
| TRUSTEE | 1.00 | 0.00 | X | 24000 | 0 | 0 | |||
| PAUL M REED | |||||||||
| TRUSTEE | 1.00 | 3.00 | X | 24000 | 0 | 0 | |||
| GARY ROACH | |||||||||
| TRUSTEE | 1.00 | 3.00 | X | 24000 | 0 | 0 | |||
| ALAN STOCKMEISTER | |||||||||
| TRUSTEE | 1.00 | 3.00 | X | 24000 | 0 | 0 | |||
| DR JON SULLIVAN | |||||||||
| TRUSTEE | 1.00 | 0.00 | X | 24000 | 0 | 0 | |||
| KENNETH G PAYNE | |||||||||
| CFO- HHS | 1.00 | 39.00 | X | 0 | 333236 | 33188 | |||
| PATRICK CONNERS | |||||||||
| EXEC VP/COO | 36.00 | 4.00 | 360192 | 0 | 0 | X | |||
| JOHN CUNNINGHAM | |||||||||
| EXEC VP/CAO | 36.00 | 4.00 | 334686 | 0 | 0 | X | |||
| ELLEN GARLING | |||||||||
| CHIEF LEGAL OFFICER/VP | 36.00 | 4.00 | 285447 | 0 | 0 | X | |||
| R ROA | |||||||||
| PHYSICIAN | 40.00 | 0.00 | 918224 | 0 | 8735 | X | |||
| WAYNE AMENDT | |||||||||
| PHYSICIAN | 40.00 | 0.00 | 925166 | 0 | 7850 | X | |||
| CHOUDHARY RAYANI | |||||||||
| PHYSICIAN | 40.00 | 0.00 | 918224 | 0 | 7262 | X | |||
| DEAN SICILIANO | |||||||||
| PHYSICIAN | 40.00 | 0.00 | 879460 | 0 | 6975 | X | |||
| BRUCE HAUPT | |||||||||
| PHYSICIAN | 40.00 | 0.00 | 813909 | 0 | 11904 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 6205715 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 782543 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 107098 | TotalOtherCompensation |
| Number Individuals GT100 K | 173 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| DELTA LOCUM TENENSLLC | |||||
| PO BOX 202940 | DALLAS | TX | 753202056 | PHYSICIAN SERVICES | 941261 |
| SCIOTO CLEANING LLC | |||||
| BIN 88604 | MILWAUKEE | WI | 532880604 | CLEANING SERVICES | 727009 |
| MEDICUS RADIOLOGY SERVICES | |||||
| 22 ROULSTON ROAD | WINDHAM | NH | 03087 | PHYSICIAN SERVICES | 594774 |
| WEATHERBY LOCUMS | |||||
| PO BOX 972633 | DALLAS | TX | 753972633 | PHYSICIAN SERVICES | 592831 |
| KYLE MCCAUSLAND MD | |||||
| 35674 KANAWHA VALLEY RD | PLINY | WV | 25082 | PHYSICIAN SERVICES | 558520 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 33 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PHYSICIAN SERVICES | 621110 | 165612499 | 165612499 |
| RENTAL INCOME | 531120 | 6294777 | 6294777 |
| OUTPATIENT REVENUE | 621400 | 1048252 | 1048252 |
| MANAGEMENT FEES | 561000 | 779309 | 779309 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 173734837 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 44958 | TotalRevenueColumn |
| Exclusion | $44,958 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 18352 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 600 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 17752 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 17752 | TotalRevenueColumn |
| Exclusion | $17,752 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 4727 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 4727 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4727 | TotalRevenueColumn |
| Exclusion | $4,727 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| INSURANCE SETTLEMENT | 900099 | 2043317 | $2,043,317 | |
| CREDIT CARD REBATE | 900099 | 74077 | $74,077 | |
| RECOVERY OF BAD DEBT | 561000 | 895 | 895 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 2118289 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 175920563 | TotalRevenueColumn |
| Related Or Exempt Function Income | 173735732 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $2,184,831 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 216000 | Total |
| Management And General | 216000 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 89254432 | Total |
| Program Services | 69618457 | ProgramServices |
| Management And General | 19635975 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5570204 | Total |
| Program Services | 4344759 | ProgramServices |
| Management And General | 1225445 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12310739 | Total |
| Program Services | 9602376 | ProgramServices |
| Management And General | 2708363 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4564291 | Total |
| Program Services | 3560147 | ProgramServices |
| Management And General | 1004144 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 168743 | Total |
| Management And General | 168743 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 498325 | Total |
| Management And General | 498325 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15246242 | Total |
| Program Services | 2591861 | ProgramServices |
| Management And General | 12654381 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1969373 | Total |
| Program Services | 1969373 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9240573 | Total |
| Program Services | 4001544 | ProgramServices |
| Management And General | 5239029 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5441402 | Total |
| Program Services | 925038 | ProgramServices |
| Management And General | 4516364 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10166796 | Total |
| Program Services | 7930101 | ProgramServices |
| Management And General | 2236695 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 896899 | Total |
| Program Services | 152473 | ProgramServices |
| Management And General | 744426 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11760535 | Total |
| Program Services | 9173217 | ProgramServices |
| Management And General | 2587318 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7971462 | Total |
| Program Services | 6228399 | ProgramServices |
| Management And General | 1743063 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2475603 | Total |
| Program Services | 1930970 | ProgramServices |
| Management And General | 544633 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 8040096 | 8040096 | |
| MEDICAL SUPPLIES | 7039038 | 7039038 | |
| RECRUITMENT | 351376 | 351376 | |
| TAXES-OTHER | 116186 | 116186 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 94369 | Total |
| Program Services | 94369 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 193392684 | Total |
| Program Services | 137553594 | ProgramServices |
| Management And General | 55839090 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26047227 | BOY |
| EOY | 25863378 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2563291 | BOY |
| EOY | 2478521 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22409376 | BOY |
| EOY | 25043711 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 761517 | BOY |
| EOY | 382420 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2583518 | BOY |
| EOY | 3228144 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1368239 | BOY |
| EOY | 1044502 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 105765658 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 8541042 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 105406092 | BOY |
| EOY | 97224616 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5021611 | BOY |
| EOY | 5026352 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3904000 | BOY |
| EOY | 3904000 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 625575 | BOY |
| EOY | 625582 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17942470 | BOY |
| EOY | 18812055 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7308503 | BOY |
| EOY | 2828272 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 195941419 | BOY |
| EOY | 186461553 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 41471141 | BOY |
| EOY | 48276168 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 1419196 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 117824181 | BOY |
| EOY | 117598471 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9395816 | BOY |
| EOY | 7628201 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6292167 | BOY |
| EOY | 4875489 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 174983305 | BOY |
| EOY | 179797525 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20958114 | BOY |
| EOY | 6664028 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20958114 | BOY |
| EOY | 6664028 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 195941419 | BOY |
| EOY | 186461553 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -17472121 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 675 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 3177360 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type3 Func Int | X | SupportingOrg509a3Type3FuncInt |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation (4 entries)
| EINEIN | Type Of OrganizationTypeOfOrganization | Listed In Governing DocListedInGoverningDoc | Supported Organization NotifiedSupportedOrganizationNotified | Organized In USOrganizedInUS | AmountAmount |
|---|---|---|---|---|---|
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 4 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 0 | SumOfAmounts |
| General Explanation | SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: PART I, LINE 11E, COLUMN (VII): THE ORGANIZATION PROVIDED MANAGEMENT AND SUPPORT SERVICES TO HOLZER HOSPITAL FOUNDATION IN THE AMOUNT OF $500,000 AND USE OF FACILITIES IN THE AMOUNT OF $362,677. THE ORGANIZATION PROVIDED MANAGEMENT AND SUPPORT SERVICES TO HOLZER MEDICAL CENTER - JACKSON IN THE AMOUNT OF $180,000. | GeneralExplanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4875879 | OtherCostOrOtherBasis |
| Book Value | 4875879 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 84242015 | OtherCostOrOtherBasis |
| Depreciation | 6802529 | Depreciation |
| Book Value | 77439486 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3163711 | OtherCostOrOtherBasis |
| Depreciation | 91383 | Depreciation |
| Book Value | 3072328 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11258917 | OtherCostOrOtherBasis |
| Depreciation | 996180 | Depreciation |
| Book Value | 10262737 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2225136 | OtherCostOrOtherBasis |
| Depreciation | 650950 | Depreciation |
| Book Value | 1574186 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 97224616 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | RELATED PARTY PAYABLES | Description |
| Amount | $4,875,489 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 4875489 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X, LINE 2: | ReturnReference |
| Explanation | 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, 2013, 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 2010. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BRENT SAUNDERS | ||||||||||||||
| CHAIRMAN | 0 | 401833 | 0 | 47474 | 0 | 0 | 0 | 19626 | 0 | 4998 | 0 | 473931 | 0 | 0 |
| WAYNE MUNRO MD | ||||||||||||||
| CEO- HHS | 631333 | 0 | 19074 | 0 | 0 | 0 | 4066 | 0 | 2494 | 0 | 656967 | 0 | 0 | 0 |
| KENNETH G PAYNE | ||||||||||||||
| CFO- HHS | 0 | 306796 | 0 | 26440 | 0 | 0 | 0 | 18549 | 0 | 14639 | 0 | 366424 | 0 | 0 |
| PATRICK CONNERS | ||||||||||||||
| EXEC VP/COO | 360192 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 360192 | 0 | 0 | 0 |
| JOHN CUNNINGHAM | ||||||||||||||
| EXEC VP/CAO | 334686 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 334686 | 0 | 0 | 0 |
| ELLEN GARLING | ||||||||||||||
| CHIEF LEGAL OFFICER/VP | 285447 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 285447 | 0 | 0 | 0 |
| R ROA | ||||||||||||||
| PHYSICIAN | 821084 | 0 | 0 | 0 | 97140 | 0 | 6254 | 0 | 2481 | 0 | 926959 | 0 | 0 | 0 |
| WAYNE AMENDT | ||||||||||||||
| PHYSICIAN | 855465 | 0 | 0 | 0 | 69701 | 0 | 5369 | 0 | 2481 | 0 | 933016 | 0 | 0 | 0 |
| CHOUDHARY RAYANI | ||||||||||||||
| PHYSICIAN | 821084 | 0 | 0 | 0 | 97140 | 0 | 4765 | 0 | 2497 | 0 | 925486 | 0 | 0 | 0 |
| DEAN SICILIANO | ||||||||||||||
| PHYSICIAN | 876702 | 0 | 0 | 0 | 2758 | 0 | 4476 | 0 | 2499 | 0 | 886435 | 0 | 0 | 0 |
| BRUCE HAUPT | ||||||||||||||
| PHYSICIAN | 766142 | 0 | 0 | 0 | 47767 | 0 | 9423 | 0 | 2481 | 0 | 825813 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 4B | ReturnReference |
| Explanation | 457(F)- SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE BRENT SAUNDERS $49,510 | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COUNTY OF GALLIA OHIO- BONDS SERIES 2012 A20 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 316400068 | IssuerEIN |
| CUSIP Number | 36381PAP2 | CUSIPNumber |
| Date Issued | 2012-03-27 | DateIssued |
| Issue Price | 155315000 | IssuePrice |
| Description Of Purpose | SEE SCHEDULE O | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | 155315478 | TotalProceeds |
| Amount In Reserve Fund | 10989520 | AmountInReserveFund |
| Issuance Costs From Proceeds | 3087477 | IssuanceCostsFromProceeds |
| Capital Expenditures | 106281906 | CapitalExpenditures |
| Other Spent Proceeds | 3817000 | OtherSpentProceeds |
| Amount Unspent | 519735 | AmountUnspent |
| Year Of Subst Completion | 2012 | YearOfSubstCompletion |
| Current Refunding | 1 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 0 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Bond Iss Meet Prvt Security Pay Test | 0 | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedProp |
| Non Qualified Bond Remed Procdrs | 0 | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiled |
| Rebate Not Due Yet | 0 | RebateNotDueYet |
| Exception To Rebate | 1 | ExceptionToRebate |
| No Rebate Due | 0 | NoRebateDue |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqs |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Proc To Undertk Corrective Action | 1 | ProcToUndertkCorrectiveAction |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 C, LINE 18 | FORM 1023 AND 990 ARE AVAILABLE TO THE PUBLIC UPON REQUEST. | |
| 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 3,177,360. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| 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. | ||
| FORM 990, PART VI, SECTION B, LINES 12-15: THE ORGANIZATION DOES NOT HAVE EMPLOYEES, HOWEVER WHEN APPLICABLE WOULD FOLLOW THE POLICIES IN PLACE BY HOLZER MEDICAL CENTER-JACKSON AND HOLZER HOSPITAL FOUNDATION FOR CONFLICT OF INTEREST, WHISTLEBLOWER, DOCUMENT RETENTION & DESTRUCTION, AND COMPENSATION. | ||
| SCHEDULE K, PART I, DESCRIPTION OF PURPOSE: (A)CURRENTLY REFUND 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 ISSUED 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. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Total IncomeTotalIncome | EOY AssetsEOYAssets | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| HOLZER DENTAL CLINIC JACKSON | |||||||||
| 100 JACKSON PIKE | GALLIPOLIS | OH | 45631 | 275346256 | HEALTHCARE | OH | 1048252 | 930198 | HOLZER HEALTH SYSTEM |
| HOLZER CLINIC LLC | |||||||||
| 90 JACKSON PIKE | GALLIPOLIS | OH | 45631 | 310917085 | PHYSICIAN PRACTICES | OH | 167863374 | 47871938 | HOLZER HEALTH SYSTEM |
Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOLZER VANGUARD INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 JACKSON PIKE | AddressLine1 |
| City | GALLIPOLIS | City |
| State | OH | State |
| ZIP Code | 45631 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311192567 | EIN |
| Primary Activity | STOCK HOLDING COMPANY | PrimaryActivity |
| Legal Domicile State | OH | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOLZER HEALTH SYSTEM | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| Share Of Total Income | 707250 | ShareOfTotalIncome |
| Share Of EOY Assets | 3058615 | ShareOfEOYAssets |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 1 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| HOLZER HOSPITAL FOUNDATION | ||
| A | 363636 | ACCRUAL TRANSACTION |
| HOLZER HOSPITAL FOUNDATION | ||
| L | 4197738 | ACCRUAL TRANSACTION |
| HOLZER HOSPITAL FOUNDATION | ||
| J | 108176 | ACCRUAL TRANSACTION |
| HOLZER HOSPITAL FOUNDATION | ||
| Q | 3968885 | ACCRUAL TRANSACTION |
| HOLZER HOSPITAL FOUNDATION | ||
| R | 3170651 | ACCRUAL TRANSACTION |
Comments