2014-05-15T12:50:30-05:00 2013-06-30 381357951 PLANTE & MORAN PLLC 65 EAST STATE STREET SUITE 600 COLUMBUS OH 43215 990 2012-07-01 311156690 HOLZER HEALTH SYSTEM HOLZ 7404465060 100 JACKSON PIKE GALLIPOLIS OH 45631 DAN JANICAK 7404465060 2014-05-15 1 BERNIE OSTROWSKI P00366367 6148493000 2012 2015-11-30 17:44:51Z HOLZER CONSOLIDATED HEALTH SYSTEMS WAYNE MUNRO 100 JACKSON PIKE GALLIPOLIS OH 45631 175921163 0 X WWW.HOLZER.ORG X 1985 OH 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). 0 9 1318 2 0 0 0 0 48918677 173734837 113757 49685 4440886 2136041 53473320 175920563 140 0 0 0 28913340 111915666 0 0 0 24684982 81477018 53598462 193392684 -125142 -17472121 195941419 186461553 174983305 179797525 20958114 6664028 TO ADVANCE THE HEALTH AND WELL BEING OF THOSE WE SERVE 0 0 14076369 0 127400624 HOLZER HEALTH SYSTEM PROVIDED MANAGEMENT SERVICES TO ITS SUBSIDIARIES WHOSE EXEMPT PURPOSES ARE TO MEET THE HEALTHCARE NEEDS OF THEIR COMMUNITIES. 967678 0 1048252 HOLZER DENTAL CLINIC-JACKSON STRIVES TO IMPROVE THE DENTAL HEALTH STATUS OF THE PEOPLE AND COMMUNITIES WE SERVE. 122509547 0 45286856 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. 137553594 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 74 0 1 1318 1 0 0 0 0 0 0 0 0 0 0 X 0 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 1 0 OH X DAN JANICAK INTERIM CFO 7404465060 100 JACKSON PIKE GALLIPOLIS OH 45631 BRENT SAUNDERS 1.00 39.00 X X 0 449307 24624 LOIS BOSLEY 1.00 0.00 X 0 0 0 STEVE CHAPMAN 1.00 3.00 X 0 0 0 RENUKA KANDULA MD 1.00 0.00 X 0 0 0 JUDGE ROBERT GRILLO 1.00 0.00 X 0 0 0 DANNY HOLSCHUH 1.00 2.00 X 0 0 0 LARRY KIDD 1.00 3.00 X 0 0 0 CHRISTOPHER MEYER MD 1.00 0.00 X 0 0 0 BRAD MUNN 1.00 0.00 X 0 0 0 WAYNE MUNRO MD 1.00 39.00 X X 650407 0 6560 RODNEY STOUT MD 1.00 0.00 X 24000 0 0 PAUL M REED 1.00 3.00 X 24000 0 0 GARY ROACH 1.00 3.00 X 24000 0 0 ALAN STOCKMEISTER 1.00 3.00 X 24000 0 0 DR JON SULLIVAN 1.00 0.00 X 24000 0 0 KENNETH G PAYNE 1.00 39.00 X 0 333236 33188 PATRICK CONNERS 36.00 4.00 X 360192 0 0 JOHN CUNNINGHAM 36.00 4.00 X 334686 0 0 ELLEN GARLING 36.00 4.00 X 285447 0 0 R ROA 40.00 0.00 X 918224 0 8735 WAYNE AMENDT 40.00 0.00 X 925166 0 7850 CHOUDHARY RAYANI 40.00 0.00 X 918224 0 7262 DEAN SICILIANO 40.00 0.00 X 879460 0 6975 BRUCE HAUPT 40.00 0.00 X 813909 0 11904 6205715 782543 107098 173 0 1 0 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 33 PHYSICIAN SERVICES 621110 165612499 165612499 RENTAL INCOME 531120 6294777 6294777 OUTPATIENT REVENUE 621400 1048252 1048252 MANAGEMENT FEES 561000 779309 779309 173734837 44958 44958 18352 600 17752 17752 17752 4727 0 4727 4727 4727 INSURANCE SETTLEMENT 900099 2043317 2043317 CREDIT CARD REBATE 900099 74077 74077 RECOVERY OF BAD DEBT 561000 895 895 2118289 175920563 173735732 0 2184831 216000 216000 89254432 69618457 19635975 5570204 4344759 1225445 12310739 9602376 2708363 4564291 3560147 1004144 168743 168743 498325 498325 15246242 2591861 12654381 1969373 1969373 9240573 4001544 5239029 5441402 925038 4516364 10166796 7930101 2236695 896899 152473 744426 11760535 9173217 2587318 7971462 6228399 1743063 2475603 1930970 544633 BAD DEBT EXPENSE 8040096 8040096 MEDICAL SUPPLIES 7039038 7039038 RECRUITMENT 351376 351376 TAXES-OTHER 116186 116186 94369 94369 193392684 137553594 55839090 0 26047227 25863378 2563291 2478521 22409376 25043711 761517 382420 2583518 3228144 1368239 1044502 105765658 8541042 105406092 97224616 5021611 5026352 3904000 3904000 625575 625582 17942470 18812055 7308503 2828272 195941419 186461553 41471141 48276168 0 1419196 117824181 117598471 9395816 7628201 6292167 4875489 174983305 179797525 X 20958114 6664028 20958114 6664028 195941419 186461553 X -17472121 675 3177360 X X 0 1 X 1 0 X X X 0 0 0 HOLZER HOSPITAL FOUNDATION 314379491 3 1 1 1 0 HOLZER MEDICAL CENTER-JACKSON 311724085 3 1 1 1 0 HOLZER SENIOR CARE CENTER 311534051 9 1 1 1 0 HOLZER FOUNDATION 310927482 7 1 1 1 0 4 0 SCHEDULE A, PART 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. 4875879 4875879 84242015 6802529 77439486 3163711 91383 3072328 11258917 996180 10262737 2225136 650950 1574186 97224616 RELATED PARTY PAYABLES 4875489 4875489 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE SYSTEM AND RECOGNIZE A TAX LIABILITY IF THE SYSTEM HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED TAX POSITIONS TAKEN BY THE SYSTEM AND HAS CONCLUDED THAT AS OF JUNE 30, 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. X X X 0 1 0 0 0 0 0 0 0 BRENT SAUNDERS 0 401833 0 47474 0 0 0 19626 0 4998 0 473931 0 0 WAYNE MUNRO MD 631333 0 19074 0 0 0 4066 0 2494 0 656967 0 0 0 KENNETH G PAYNE 0 306796 0 26440 0 0 0 18549 0 14639 0 366424 0 0 PATRICK CONNERS 360192 0 0 0 0 0 0 0 0 0 360192 0 0 0 JOHN CUNNINGHAM 334686 0 0 0 0 0 0 0 0 0 334686 0 0 0 ELLEN GARLING 285447 0 0 0 0 0 0 0 0 0 285447 0 0 0 R ROA 821084 0 0 0 97140 0 6254 0 2481 0 926959 0 0 0 WAYNE AMENDT 855465 0 0 0 69701 0 5369 0 2481 0 933016 0 0 0 CHOUDHARY RAYANI 821084 0 0 0 97140 0 4765 0 2497 0 925486 0 0 0 DEAN SICILIANO 876702 0 0 0 2758 0 4476 0 2499 0 886435 0 0 0 BRUCE HAUPT 766142 0 0 0 47767 0 9423 0 2481 0 825813 0 0 0 PART I, LINE 4B 457(F)- SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE BRENT SAUNDERS $49,510 A COUNTY OF GALLIA OHIO- BONDS SERIES 2012 A20 316400068 36381PAP2 2012-03-27 155315000 SEE SCHEDULE O 0 0 0 A 155315478 10989520 3087477 106281906 3817000 519735 2012 1 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 0 0 0 0 0 A 1 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: TRANSFERS TO/FROM AFFILIATES 3,177,360. 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. 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 HOLZER FOUNDATION 100 JACKSON PIKE GALLIPOLIS OH 45631 310927482 CONTINUING ADVANCEMENT OF HEALTH AND MEDICAL CARE OH 501(C)(3) LINE 7 HOLZER HEALTH SYSTEM 1 HOLZER MEDICAL CENTER - JACKSON 100 JACKSON PIKE GALLIPOLIS OH 45631 311724085 HEALTH CARE OH 501(C)(3) LINE 3 HOLZER HEALTH SYSTEM 1 HOLZER SENIOR CARE CENTER 380 COLONIAL DRIVE BIDWELL OH 45614 311534051 SKILLED NURSING FACILITY OH 501(C)(3) LINE 9 HOLZER HEALTH SYSTEM 1 HOLZER HOSPITAL FOUNDATION 100 JACKSON PIKE GALLIPOLIS OH 45631 314379491 HEALTH CARE OH 501(C)(3) LINE 3 HOLZER HEALTH SYSTEM 1 HOLZER VANGUARD INC 100 JACKSON PIKE GALLIPOLIS OH 45631 311192567 STOCK HOLDING COMPANY OH HOLZER HEALTH SYSTEM C 707250 3058615 1.00000 0 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 1 1 0 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