2014-11-14T13:24:40-07:00 2013-12-31 990 2013-01-01 340714771 THE UNION HOSPITAL ASSOCIATION UNIO 3303433311 659 Boulevard Dover OH 44622 Eugene A Thorn III Vice President - Finance 3303640805 2014-05-31 2013 2015-11-30 17:44:51Z Union Hospital Eugene A Thorn 659 Boulevard Dover OH 44622 113969188 0 X www.unionhospital.org X 1906 OH To provide excellent quality health care to the community at a competitive price through highly competent people and an integrated provider network. 17 16 1163 132 155933 1 370098 79070 85720902 84113424 2948408 5060457 12510863 13569380 101550271 102822331 0 0 0 0 53903045 52654862 0 0 114764 44532220 42421668 98435265 95076530 3115006 7745801 155573487 163042892 44508157 41831406 111065330 121211486 Patient Care: The Union Hospital Association provides quality medical health care regardless of race, creed, sex, national origin, handicap, age or ability to pay. 0 0 65742389 0 84113424 The Union Hospital Association provided quality medical health care regardless of race, creed, age, sex, national origin, handicap, or the ability to pay. Hospital medical services provided 5,680 inpatients a total of 21,400 patient days and 253,000 outpatient visits a total of 338,000 procedures. 430559 0 49440 Patient and family support programs, general and other: During 2013 Union Hospital provided 52,631 meals for residents who were unable to prepare meals for themselves due to medical limitations. These meals are provided at cost and are delivered by a volunteer group, Mobile Meals. The Hospital had 132 volunteers donate 21,798 hours toward the common purpose of serving the health care needs of the community. The value of these hours is $207,081 which is returned to the community through lower cost of patient services. The Hospital co sponsors annual events that provides laboratory tests and blood pressure checks for the residents of the community; these services are provided at or below cost. Medicare and Medicaid made up 55% of patient care provided. The Hospital also participates in a local program called Rainbow Connection, a non profit charity that is dedicated to emitting the needs of disadvantaged and disabled resident of Tuscarawas County; we write off 50% of all charges for those patients while the program pays the remaining 50%. We also provided to the local Hospice agency a write off specified charges for individuals under this program (110 patients, $87,231). We sponsor a Helpline program that enabled 750 elderly and disabled consumers the opportunity to remain in their homes and feel safe in that setting. Since the Hospital does not provide mental health services as part of its normal operations, we lease building space to Community Professional Services, a mental health non profit organization at $2.04 per square foot, well below the average rate of $11.75 per square foot. Thus the rental rate and related in kind support provided by the Hospital are justified as a continuance of our mission. We operate a 35ft mobile medical vehicle that provides screenings to the areas that would have been underserved. An outreach sports medicine program provides training to various school to promote healthy athletes and physicals at a fraction of the cost. The Hospital supports and hosts various groups such as Down Syndrome, RSD, pain management, cancer supports,etc. We also provide babysitting and AARP driving courses to the community and sent out 55,000 biannual healthy newsletters to the community. 0 0 0 66172948 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 108 0 1 1163 1 1 1 0 0 0 0 0 X 17 16 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 0 1 1 1 1 1 X Eugene A Thorn III 3303640805 659 Boulevard Dover OH 44622 R Bruce James President and CEO 40 0 X X 359663 0 22951 John R Herzig Board Member 2 0 X 0 0 0 James J Pringle Board Member 3 0 X 0 0 0 Anne E Geib Board Member 2 X 0 0 0 Michael B Hovan Board Member 2 0 X 0 0 0 Agnes K Swigart Treasurer 3 0 X 0 0 0 Mark N Kubina Medical Staff President 2 0 X 0 0 0 Robert A Horn Board Member 2 0 X 0 0 0 Craig B Laughlin Board Member 2 0 X 0 0 0 Lois E Andreas Board Member 2 0 X 0 0 0 Robert E Moore Jr Board member 2 0 X 0 0 0 C Jason Deeds Chairman of the Board 3 0 X 0 0 0 John E Dooling Board Member 3 0 X 0 0 0 Perry L Hershberger Board Member 2 0 X 0 0 0 Andrew J Wherley Medical Staff Past President 2 0 X 0 0 0 James E Knisely Vice Chairman 3 0 X 0 0 0 William V Swoger Medical Staff Vice President 2 0 X 0 0 0 Darwin K Smith Vice President 40 0 X 142259 0 16180 Thomas J Kelly Jr Vice President 40 0 X 263424 0 29695 Eugene A Thorn III Vice President 40 0 X 204102 0 26680 Diana L Boyd Vice President 40 0 X 155813 0 14827 Robert J Craig Vice President 40 X 165574 0 25219 Darrin Kuczynski Physician 40 0 X 596373 0 31912 James McQuillan Physician 40 0 X 775694 0 33793 Scott Holder Physician 40 0 X 549069 0 31137 Thomas Teater Physician 40 0 X 579265 0 33189 Miguel Bravo Physician 40 0 X 475514 0 17895 Kevin Gray Board Member 2 0 X 0 0 0 Jody Stoldt Vice President 40 0 X 120368 0 23148 4387118 0 306626 11 0 1 0 Emergimed Inc 659 Boulevard Dover OH 44622 Emergency services 5179526 Seneca Medical PO BOX 712361 Cincinnati OH 45271 Seller of medical equipment 2720449 Cardinal Health 5490 Collections Center Drive Chicago IL 60693 Seller of medical drugs 5031133 Anesthesia Care of Union Hospital 659 Boulevard Dover OH 44622 Anesthesia and pain care associates 1407374 Milestone Healthcare L 3452 Columbus OH 43260 Management and subcontract labor 882340 83 0 0 0 0 0 79070 0 79070 Net patient revenue 622000 84019503 84019503 0 0 Laboratory services 621500 93921 0 93921 0 0 0 0 0 84113424 5057164 4995152 62012 0 0 0 0 0 0 0 0 0 908138 0 480566 0 427572 0 427572 0 0 427572 0 3293 0 0 0 3293 3293 0 0 3293 0 21150433 10666291 10484142 0 0 10484142 Health promotion 900099 59490 59490 0 0 Helpline program 900099 132223 132223 0 0 Athletic training 900099 80430 80430 0 0 2385523 2385523 0 0 2657666 102822331 91672321 155933 10915007 X 0 0 0 0 0 0 0 0 1411203 0 1411203 0 0 0 0 0 40281155 34535790 5659522 85843 2045450 0 2045450 0 5840192 103924 5736268 0 3076862 2499583 570880 6399 0 0 0 0 129150 0 129150 0 96205 0 96205 0 0 0 0 0 0 0 0 0 0 0 17946759 14271806 3664835 10118 450089 77616 367862 4611 9791238 8744226 1046100 912 1299632 0 1299632 0 0 0 0 0 2077011 1394617 681438 956 157310 82992 73924 394 0 0 0 0 58755 4595 53850 310 1321780 791482 530298 0 0 0 0 0 5403071 3381919 2017276 3876 897962 3833 894129 0 Miscellaneous 2488380 252473 2235447 460 Dues 188393 14987 172521 885 Meals 55852 2565 53287 0 Education expense 60081 10540 49541 0 95076530 66172948 28788818 114764 6997491 6277449 0 0 0 13092966 12523158 0 0 2361169 2274694 1303593 1448405 130608288 82269517 50286649 48338771 47442469 49841503 1913501 2057398 2009690 2009690 30165959 38271824 155573487 163042892 7630857 7979720 26180000 25685000 3034092 3247308 7663208 4919378 44508157 41831406 X 100193986 108244235 121127 399983 10750217 12567268 111065330 121211486 155573487 163042892 X 7745801 -603256 0 0 0 3003611 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1105252 1105252 0 56501481 25064292 31437189 0 2616769 2235339 381430 0 70052130 54969886 15082244 0 332656 0 332656 48338771 Assets whose use is limited by donor specification 315983 Assets whose use is limited by indenture agreement 588 Trust aggreements 12567268 Other receivables 23511221 Deferred financing costs 415588 Interest in TVRCC 1461176 38271824 0 Interest payable 119653 Workers compensation payable 207465 Interest rate swap agreement 1632964 Accrued payroll withholdings 2163597 Franchise Fee 384814 Other Payables 410885 4919378 X Schedule D, Part X, Line 2 The Hospital is a not for profit corporation exempt from federal income taxes under Section 501c3 of the Internal Revenue Code; therefore no provision has been made for federal income taxes in the accompanying financial statements. In addition the IRS has determined that the Hospital is not a "private foundation" within the meaning of section 509(a) of the code. 1 1 X 1 X 1 X 1 1 1 0 1 1 3513967 0 3513967 0.0332 12612446 5432030 7180416 0.0678 0 0 16126413 5432030 10694383 0.1010 50 54138 414354 49440 364914 0.0039 13 0 3425 0 3425 0 63 54138 417779 49440 368339 0.0039 63 54138 16544192 5481470 11062722 0.1049 1700 0 1700 11080 0 11080 0 0 12780 0 12780 0 1 5972243 19510 28248320 20743943 7504377 X 1 1 Tuscarawas Ambulatory Surgery Center ambulatory surgery center 0.7 0 0.3 1 1 The Union Hospital Association 659 Boulevard Dover OH 44622 X X X The Union Hospital Association 1 1 X X X X X X X X X 12 1 0 1 X www.unionhospital.org X X X X X X X 1 0 1 1 100 1 300 1 X 1 1 X X 1 X X X X 1 X X X X X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 3-The Union Hospital Association The Hospital interviewed a panel of persons who represent a variety of positions in the medical community. They ranged from ER physicians, physicians in practice in the community, managers and directors of the emergency room, members of the alcohol and drug addiction board. The Hospital used the information obtained from the panel to help identify the medical issues that the community needs to address and possible solutions. Schedule H, Part V, Section B, Line 12-The Union Hospital Association Charges are consistent with all payers. 6 Tuscarawas Ambulatory Surgery Center 320 Oxford Street Dover OH 44622 Ambulatory surgery center Tuscarawas Valley Regional Cancer Center 659 Boulevard Dover OH 44622 Physician oncology center Union Physician Services LLC 300 Medical Park Drive Suite 101 C Dover OH 44622 Physician offices DASCO UH Home Medical Equipment LLC 375 North West Street Westerville OH 43082 Home medical equipment sales UHMS LLC 659 Boulevard Dover OH 44622 Physician offices Union Pharmacy Care 659 Boulevard Dover OH 44622 Pharmaceutical Schedule H, Part I, Line 7 Used the ratio of patient cost to charge from Worksheet 2 to calculate the reported charity care. Schedule H, Part II The Hospital has numerous community building activities. The hopsital hosts Project Search a program that welcomes mentally handicapped youth into the workforce to give them the ability to learn workforce traites and be more socially interactive. The Hospital provides space and intership positions for this program. Numerous staff members sit on various agency boards to help promote health issue awareness. The Hospital also helps promote area agencies and organizations that support our community's health needs. Schedule H, Part III, Section A, Line 4 Patient accounts are due in full when billed. Accounts are considered delinquent and subsequently written off as bad debt based on individual credit evaluation and circumstances of the account. Line 2 represents 3% of gross patient revenue as seen as being uncollectible by self pay patients which is based upon historical trending valuations. A bad debt expense footnote is not presented in the notes to the financial statements. Schedule H, Part III, Section B, Line 8 Amounts are generated by the Medicare cost report which utilizes a department cost to charge methodology. Schedule H, Part III, Section C, Line 9b The Hospital will refund any monies paid on an account deemed charity or that qualifies for financial assistance once that assessment has been determined. The account is then written off to such classification and any or all collections will cease after determination has been made. Schedule H, Part VI, Line 2 Our Community Wellness department is committed to addressing the health assessments and concerns of our community. The deaprtment compiled data gathered by utilizing secondary sources such as the CDC and Ohio Obesity prevention. We have indentified six areas that are of high concern in our community; they are cancer, diabetes, heart disease and strokes, physical activity and fitness, tobacco use, and the overall education of the community on health issues. In response to the areas of concern, the Hospital offers blood pressure and cholesterol screenings, fasting blood sugar tests, vascular screenings at a reduced cost or free to members of the community. We also have cancer prevention day which includes pap smears, mammograms and skin cancer exams at no cost or reduced cost. In response to the obesity and physcial activity risks, the Hospital sponsors annual marathon training sessions, supports the youth fit iniative, and maintains a walking trail. For the general health of the community we also teach classes on bicycle safety, Senior driving safety, babysitting basics, CPR, and smoking cessation. Schedule H, Part VI, Line 3 Inpatients are given an informational booklet upon admission to the Hospital, this booklet contains information regarding contact with patient account representatives, accepted insurances and other payment options for insured, uninsured and underinsured. The Hospital also employees a patient financial specialist who meets with the patient and or family to discuss family size, income and other qualifying information for the various charity care programs. Financial assistance information is not provided at discharge but provided with the initial statement. The Hospital also discusses with the patients and family the availability of state and federal programs for medical care. Schedule H, Part VI, Line 4 Tuscarawas County is one of the 88 counties of the State of Ohio. The county has a population of approximately 91,000 residents with 25% under the age of 25 amd 25% between the ages of 45 and 62. It is predominately caucasion and is set in a rural setting with 7.2% of families being below the federal poverty level. 30% of adults smoke and 31% are obese or overweight; heart disease and strokes are the prevalent health issues. To help counteract these issues, the Hosptial provides numerous blood pressure, cholesterol and blood sugar screenings throughout the year. The Hospital also provides smoking cessation programs and sponsors youth and adult fitness initiatives to combat the obesity epidemic. Schedule H, Part VI, Line 5 The Hospital provides many low cost clinics for blood pressure, cholesterol screenings, cancer screenings, and diabetes clinics to the area to help the community stay healthy and prevent diseases. We offer health fairs and promote health speakers on various health and safety issues to the community at no cost to the person. The board is made up of individuals representing the community, there is an open medical staff and all surplus funds are used to make the Hospital a better organization for its community. Schedule H, Part VI, Line 7 Community benefit report is not filed with any state. X X 0 0 0 0 0 0 0 0 0 R Bruce James President and CEO 306921 0 52742 0 0 0 15000 0 7951 0 382614 0 0 0 Darwin K Smith Vice President 128618 0 13641 0 0 0 7718 0 8462 0 158439 0 0 0 Diana L Boyd Vice President 140653 0 15160 0 0 0 8261 0 6566 0 170640 0 0 0 Robert J Craig Vice President 149558 0 16016 0 0 0 8973 0 16245 0 190792 0 0 0 Eugene A Thorn III Vice President 184853 0 19249 0 0 0 10095 0 16465 0 230662 0 0 0 Thomas J Kelly Jr Vice President 238149 0 25275 0 0 0 14289 0 15406 0 293119 0 0 0 Jody Stoldt Vice President 118302 0 2066 0 0 0 7098 0 16050 0 143516 0 0 0 Darrin Kuczynski Physician 571736 0 24637 0 0 0 15000 0 16912 0 628285 0 0 0 James McQuillan Physician 669411 0 106283 0 0 0 15000 0 18793 0 809487 0 0 0 Scott Holder Physician 525273 0 23796 0 0 0 13939 0 17198 0 580206 0 0 0 Thomas Teater Physician 572640 0 6625 0 0 0 15000 0 18189 0 612454 0 0 0 Miguel Bravo Physician 475514 0 0 0 0 0 9456 0 8439 0 493409 0 0 0 A Tuscarawas County Ohio 346002853 90069baa2 2009-10-15 27515000 Re issue of 1993 and 2001 bonds 1 1 0 A 0 0 0 0 0 0 484184 0 0 2969070 0 0 2009 1 1 1 1 A 0 0 0 0 0 0 0 1 0 1 A 0 0 0 0 1 1 RBS Citizens NA 20.5 0 0 0 0 1 A 0 Form 990, Part VI, Section A, Line 6 The Hospital has a 17 member board of trustees who oversee the management of the Hospital. All monthly financial reporting is presented to the board of trustees. The trustees also oversee the hiring of any upper management and the approval of all capital and operating budgets. Form 990, Part VI, Section B, Line 11b The 990 is prepared internally by the Manager of Accounting. The general ledger is reconciled to the appropriate schedules on the form and to the audited financial statements. It is then forwarded to the Vice President of Finance who reviews it for completeness and accuracy. After his review it is then submitted to the Finance Committee made up of Board of Trustee members; after the committee reviews it it is then forwared to the Board of Trustees for review and approval. The return is also reviewed by an independent accounting firm. Form 990, Part VI, Section B, Line 12c Officers and members are required annually to review the conflict of interest policy and make known any conflicts that may have or have arose or any other discloseable event. If any notable event is disclosed it is reported to the Hospital CEO and Chairman of the Board of Trustees. Additionally, all financial transactions are reviewed through the Hospital's accounting systems. Form 990, Part VI, Section B, Line 15 Compensation amountsd are established based on the appropriate healthcare industry standards and related surveys. Compensation amounts for the key management is reviewed by the Executive Committee of the Board of Trustees. Form 990, Part VI, Section C, Line 19 The public can at anytime during normal business office hours inquire at the administrative office in the main building and ask for a copy of the Form 990. The public may view on the Hospital's website the annual report and community benefit report. Form 990, Part IX, Line 11g Represents uOutside technical vendors and purchased maintenance agreements. Form 990, Part XI, Line 9 Unrealized gain and loss in investments and swaps. Union Hospital Medical Services 659 Boulevard Dover OH 44622 270273520 Physician offices OH -96644 182526 N/A Union Physician Services 659 Boulevard Dover OH 44622 264215547 Physician office OH -6362529 2095419 N/A Tuscarawas Valley Regional Cancer Center 659 Boulevard Dover OH 44622 340000100 Physician and Hospital Organization OH 501c3 3 N/A 0 Union Hospital Auxillary 659 Boulevard Dover OH 44622 341204928 Fundraising for the Hospital OH 501c3 11-III-FI N/A 0 Tuscarawas Ambulatory Surgery Center 320 Oxford St Dover OH 44622 311525875 Ambulatory surgery center OH N/A Related 626455 1418239 0 0 0.7 Dasco Union Hospital Home Medical Equipment LLC 375 N West St Westerville OH 43082 270495743 Durable medical equipment sales OH N/A Unrelated 62334 110892 0 0 0 0.5 Valley Healthcare Inc 659 Boulevard Dover OH 44622 341654921 Inactive OH N/A C 0 0 1 Union Care Corporation 659 Boulevard Dover OH 44622 341556177 Inactive OH N/A C 0 0 1 Union Pharmaceutical Care 659 Boulevard Dover OH 44622 043588229 Retail pharmacy sales OH N/A C -1857 -110 1 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 1 0 0 Tuscarawas Valley Regional Cancer Center f 500000 The Hospital received $500,000 in distributions from TVRCC. Union Hospital Auxillary c 170000 Hospital receives an annual donation from the Auxillary Tuscarawas Ambulatory Surgery Center a-iv 400505 Lease payments received for space Tuscarawas Ambulatory Surgery Center j 400505 Lease payments paid for space rented Dasco Union Hospital Home Medical Equipment LLC a-iv 13600 Fair market of space rented. All applicable extensions have been filed.