OHIOHEALTH CORPORATION: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
OHIOHEALTH CORPORATION (EIN 31-1045101)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-08
IRS object ID
201311289349302021
Schema version
2011v1.5
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

FieldValueIRS element (for citing)
Timestamp2013-05-08T15:41:38-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN381357951EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PLANTE & MORAN PLLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line165 EAST STATE ST STE 600AddressLine1
CityCOLUMBUSCity
StateOHState
ZIP Code43215ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN311045101EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1APPALACHIAN COMMUNITY VISITING NURSEBusinessNameLine1
Business Name Line2ASSOCIATION HOSPICE AND HEALTH SERVICESBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlAPPANameControl
Phone7405935551Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line130 HERROLD AVENUEAddressLine1
CityATHENSCity
StateOHState
ZIP Code457012326ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDEHORAH SECHKARName
TitleCFOTitle
Phone7405935551Phone
Date Signed2013-05-02DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBERNIE OSTROWSKIName
PTINP00366367PTIN
Phone6148493000Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonTERRI MCKINLEYNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line130 HERROLD AVENUEAddressLine1
CityATHENSCity
StateOHState
ZIP Code457012326ZIPCode
FieldValueIRS element (for citing)
Gross Receipts3776326GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.ACVNA.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1982YearFormation
State Legal DomicileOHStateLegalDomicile
Activity Or Mission DescriptionWE ARE DEDICATED TO PROVIDING COST EFFECTIVE, HIGH QUALITY HOME HEALTH SERVICES TO THE PEOPLE IN OUR APPALACHIAN COMMUNITY. WE PROVIDE SERVICES TO MEDICAID CLIENTS THROUGH OHIO HOME CARE PROGRAMS AS WELL AS FOR CLIENTS WITH WORKERS' COMPENSATION, VETERAN'S ADMINISTRATION, MEDICARE AND OTHER PAYOR SOURCES.ActivityOrMissionDescription
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees114TotalNbrEmployees
Total Nbr Volunteers48TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year133112ContributionsGrantsPriorYear
Contributions Grants Current Year99056ContributionsGrantsCurrentYear
Program Service Revenue Prior Year3758424ProgramServiceRevenuePriorYear
Program Service Revenue CY3674576ProgramServiceRevenueCY
Investment Income Prior Year2286InvestmentIncomePriorYear
Investment Income Current Year2694InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year3893822TotalRevenuePriorYear
Total Revenue Current Year3776326TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year2404202SalariesEtcPriorYear
Salaries Etc Current Year2684107SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year1902TotalFundrsngExpCurrentYear
Other Expense Prior Year1237155OtherExpensePriorYear
Other Expenses Current Year1231929OtherExpensesCurrentYear
Total Expenses Prior Year3641357TotalExpensesPriorYear
Total Expenses Current Year3916036TotalExpensesCurrentYear
Revenues Less Expenses Prior Year252465RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-139710RevenuesLessExpensesCY
Total Assets BOY952589TotalAssetsBOY
Total Assets EOY950851TotalAssetsEOY
Total Liabilities BOY378372TotalLiabilitiesBOY
Total Liabilities EOY462839TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY574217NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY488012NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionWE ARE SOUTHEASTERN OHIO'S PRIMARY SOURCE FOR QUALITY HOME CARE, STRIVING TO IDENTIFY AND FULFILL THE HEALTHCARE NEEDS OF OUR APPALACHIAN COMMUNITY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense879593Expense
Grants0Grants
Revenue1543115Revenue
DescriptionTHE ORGANIZATION PROVIDES CARE TO HOME BOUND, INDIGENT, AND TERMINALLY-ILL PATIENTS IN THE COMMUNITY. TO ACCOMPLISH ITS CHARITABLE PURPOSE, THE ORGANIZATION PROVIDED 9,255 DAYS OF HOSPICE CARE. THE ORGANIZATION PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WHITOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense490500Expense
Grants0Grants
Revenue621990Revenue
DescriptionTHE ORGANIZATION PROVIDES CARE TO HOME BOUND, INDIGENT, AND TERMINALLY-ILL PATIENTS IN THE COMMUNITY. TO ACCOMPLISH ITS CHARITABLE PURPOSE, THE ORGANIZATION PROVIDED 28,669 HOURS OF HEALTH SERVICES. THE ORGANIZATION PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WHITOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense1058109Expense
Grants0Grants
Revenue1477128Revenue
DescriptionTHE ORGANIZATION PROVIDES CARE TO HOME BOUND, INDIGENT, AND TERMINALLY-ILL PATIENTS IN THE COMMUNITY. TO ACCOMPLISH ITS CHARITABLE PURPOSE, THE ORGANIZATION PROVIDED 13,659 HOME HEALTH VISITS. THE ORGANIZATION PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WHITOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense1086519Expense
Grants0Grants
Revenue32343Revenue
DescriptionOTHER- MAJORITY OF EXPENSE INCLUDES STAFF COSTS FOR MISCELLANEOUS SERVICESDescription
FieldValueIRS element (for citing)
Total Of Other Program Service Exp1086519TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev32343TotalOfOtherProgramServiceRev
Total Program Service Expense3514721TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10966NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees114NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledOHStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1KEN DICKENBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7405929298TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line155 HOSPITAL DRIVEAddressLine1
CityATHENSCity
StateOHState
ZIP Code45701ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (13 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
JAN HODSON
TRUSTEE1.00X000
SUSAN CYRAN
TRUSTEE1.00X000
RON STRICKMAKER
TRUSTEE1.00X000
DAVID STROH
CHAIR1.00X000X
MICHAEL TURNER
VICE CHAIR1.00X000X
KATHY TARANTELLI
TRUSTEE1.00X000
RUTH ANN ALTHAUS
SECRETARY1.00X000X
DOREEN IRETON
TRUSTEE1.00X000
SANDRA SHIREY
TRUSTEE1.00X000
RAY STEPHENS
TREASURER1.00X000X
CANDY KEMMERER
TRUSTEE1.00X000
DEBORAH SECHKAR
PRESIDENT/CEO40.008145501352X
THOMAS CAMPBELL
PHYSICAL THERAPIST40.00154079029X
FieldValueIRS element (for citing)
Total Reportable Comp From Org235534TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation1381TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Government Grants10132GovernmentGrants
All Other Contributions88924AllOtherContributions
Total Contributions99056TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT SERVICESDescription
Business Code621610BusinessCode
Total Revenue Column3674576TotalRevenueColumn
Related Or Exempt Function Income3674576RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue3674576TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column2694TotalRevenueColumn
Exclusion$2,694ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column3776326TotalRevenueColumn
Related Or Exempt Function Income3674576RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$2,694ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total87343Total
Program Services77517ProgramServices
Management And General9826ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total2205152Total
Program Services1957073ProgramServices
Management And General248079ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total210044Total
Program Services186414ProgramServices
Management And General23630ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total181568Total
Program Services161142ProgramServices
Management And General20426ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total350Total
Management And General350ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total98146Total
Program Services87104ProgramServices
Management And General11042ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total16774Total
Program Services14887ProgramServices
Management And General1887ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total389251Total
Program Services345460ProgramServices
Management And General43791ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total1258Total
Program Services1116ProgramServices
Management And General142ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total86603Total
Program Services76860ProgramServices
Management And General9743ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total216548Total
Program Services192187ProgramServices
Management And General24361ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total1130Total
Program Services1003ProgramServices
Management And General127ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total750Total
Management And General750ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2457Total
Program Services2181ProgramServices
Management And General276ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total31611Total
Program Services28055ProgramServices
Management And General3556ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
HOSPICE ROOM & BOARD267499267499
BAD DEBTS7482074820
EMERGENCY RESPONSE SYST2836028360
DUES AND SUBSCRIPTIONS89208061859

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total7452Total
Program Services4982ProgramServices
Management And General568ManagementAndGeneral
Fundraising1902Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total3916036Total
Program Services3514721ProgramServices
Management And General399413ManagementAndGeneral
Fundraising1902Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY212702BOY
EOY35094EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY70317BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY635151BOY
EOY712760EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY14048BOY
EOY11521EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY13656BOY
EOY29853EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis834548LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec830290LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY6715BOY
EOY4258EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY157365EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY952589BOY
EOY950851EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY378372BOY
EOY362839EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY100000EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY378372BOY
EOY462839EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY571963BOY
EOY331052EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2254BOY
EOY156960EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY574217BOY
EOY488012EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY952589BOY
EOY950851EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-139710ReconcilationRevenueExpenses
Reconcilation Other Changes53504ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years269104CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years153022CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years230286CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year133112CurrentTaxYearMinus1Year
Current Tax Year99056CurrentTaxYear
Total884580Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3468287CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3540437CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3901744CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3758424CurrentTaxYearMinus1Year
Current Tax Year3747453CurrentTaxYear
Total18416345Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3737391CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3693459CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4132030CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3891536CurrentTaxYearMinus1Year
Current Tax Year3846509CurrentTaxYear
Total19300925Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50919300925PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2180CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2425CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2100CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2286CurrentTaxYearMinus1Year
Current Tax Year2694CurrentTaxYear
Total11685Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2180CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2425CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2100CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2286CurrentTaxYearMinus1Year
Current Tax Year2694CurrentTaxYear
Total11685Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3739571CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3695884CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4134130CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3893822CurrentTaxYearMinus1Year
Current Tax Year3849203CurrentTaxYear
Total19312610Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99940PublicSupportPercentage509
Prior Year Support Percentage0.99830PriorYearSupportPercentage
Investment Income Percentage0.00060InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00060PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance2261BeginningOfYearBalance
Contributions156967Contributions
End Of Year Balance159228EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance2259BeginningOfYearBalance
Investment Earnings Or Losses2InvestmentEarningsOrLosses
End Of Year Balance2261EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance2257BeginningOfYearBalance
Investment Earnings Or Losses2InvestmentEarningsOrLosses
End Of Year Balance2259EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance2251BeginningOfYearBalance
Investment Earnings Or Losses6InvestmentEarningsOrLosses
End Of Year Balance2257EndOfYearBalance
FieldValueIRS element (for citing)
Term Endowment EOY Balance1.00000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs1EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis834548OtherCostOrOtherBasis
Depreciation830290Depreciation
Book Value4258BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings4258TotalOfBookValueLandBuildings

Other Securities OtherSecurities (2 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
BOARD DESIGNATED INVESTMENTS70259C
DONOR RESTRICTED INVESTMENTS87106C
FieldValueIRS element (for citing)
Total Of Book Value Securities157365TotalOfBookValueSecurities

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionSHELTERING ARMS HOSPITAL FOUNDATION LOAN PAYABLEDescription
Amount$100,000Amount
FieldValueIRS element (for citing)
Total Of Amounts100000TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:THE ENDOWMENTS ARE INTENDED FOR THE SUPPORT OF THE ORGANIZATION'S HEALTHCARE ACTIVITIES.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL 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 HOSPITAL AND HAS CONCLUDED THAT AS OF JUNE 30, 2012, 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 HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO JUNE 30, 2009.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonTHOMAS CAMPBELLNamePerson
Base Compensation Filing Org154079BaseCompensationFilingOrg
Comp Based On Related Orgs0CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org29NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs0NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org154108TotalCompensationFilingOrg
Total Compensation Related Orgs0TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 6SHELTERING ARMS HOSPITAL FOUNDATION, INC. D/B/A O'BLENESS MEMORIAL HOSPITAL IS THE SOLE MEMBER OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7ATHE SOLE MEMBER HAS THE RIGHT TO ELECT OR APPOINT MEMBERS OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION A, LINE 7BGOVERNANCE DECISIONS OF THE ORGANIZATION, SUCH AS APPROVAL OF THE ELECTION OR REMOVAL OF MEMBERS OF THE GOVERNING BODY AND DECISIONS TO DISSOLVE, ARE RESERVED FOR THE SOLE MEMBER.
FORM 990, PART VI, SECTION B, LINE 11THE CHIEF FINANCIAL OFFICER REVIEWS THE FORM 990 PRIOR TO SIGNING AND SUBMITTING TO THE IRS. THE ORGANIZATION IS CONTROLLED BY SHELTERING ARMS HOSPITAL FOUNDATION. WHILE THE BOARD DID NOT REVIEW THE FORM 990 FOR THIS FILING YEAR, THE ORGANIZATION, THROUGH SHELTERING ARMS HOSPITAL FOUNDATION, WILL BE IMPLEMENTING A BOARD REVIEW FOR NEXT YEAR'S FORM 990.
FORM 990, PART VI, SECTION B, LINE 12CANNUAL CONFLICTS OF INTEREST QUESTIONNAIRES ARE COMPLETED AND SIGNED BY BOARD MEMBERS. CONFLICTS THAT ARISE THROUGHOUT THE YEAR ARE TO BE DISCLOSED TO THE BOARD AND NECESSARY ACTION WILL BE DETERMINED BY THE BOARD. POSSIBLE RESOLUTION COULD INCLUDE RESTRICTIONS ON VOTING AND PARTICIPATION OF ORGANIZATION BUSINESS BEFORE THE BOARD.
FORM 990, PART VI, SECTION B, LINE 15ACOMPENSATION FOR THE PRESIDENT/CEO IS REVIEWED BY AN EVALUATION COMMITTEE APPOINTED BY THE BOARD AND IS NEGOTIATED DURING THIS REVIEW. THIS EVALUATION IS PERFORMED ANNUALLY. THE LAST EVALUATION WAS IN 2011. THERE ARE NO OTHER OFFICERS OR KEY EMPLOYEES THAT ARE COMPENSATED BY THE ORGANIZATION.
FORM 990, PART VI, SECTION C, LINE 18FORM 1023 AND 990 ARE AVAIABLE UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19IF REQUESTS ARE MADE FROM THE PUBLIC TO VIEW THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS, THE ORGANIZATION COMPLIES WITH THE IRS PUBLIC INSPECTION REQUIREMENTS FOR FORM 990. REQUESTS FROM THE PUBLIC FOR ANY OTHER DOCUMENTS MUST BE IN WRITING AND LEGAL COUNSEL ENSURES COMPLIANCE AS REQUIRED.
FORM 990, PART XI, LINE 5:NET UNREALIZED LOSSES ON INVESTMENTS: -6,595. NET ASSETS RELEASED FROM RESTRICTION -94,607. TEMPORARILY RESTRICTED NET ASSETS RECLASS FROM OPERATING CASH ACCOUNT 154,706. TOTAL TO FORM 990, PART XI, LINE 5: 53,504.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 2CTHE AUDIT IS OVERSEEN BY A COMMITTEE OF THE SHELTERING ARMS HOSPITAL FOUNDATION AND THIS HAS NOT CHANGED SINCE THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1SHELTERING ARMS HOSPITAL FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line155 HOSPITAL DRIVEAddressLine1
CityATHENSCity
StateOHState
ZIP Code45701ZIPCode
FieldValueIRS element (for citing)
EIN314446959EIN
Primary ActivitiesPATIENT CAREPrimaryActivities
Legal Domicile StateOHLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity StatusHOSPITALPublicCharityStatus
Direct Controlling Entity NAN/ADirectControllingEntityNA
Controlled Org0ControlledOrg

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNA
ATHENS SURGERY CENTER LTD
75 HOSPITAL DRIVEATHENSOH45701550840856OUTPATIENT SURGERYOHN/A
O'BLENESS MEMORIAL PAIN MANAGEMENT CLINIC LLC
55 HOSPITAL DRIVEATHENSOH45701454587317PAIN CLINICOHN/A

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1ATHENS MEDICAL LABORATORY ASSOCIATES INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1265 WEST UNION STREET SUITE BAddressLine1
CityATHENSCity
StateOHState
ZIP Code45701ZIPCode
FieldValueIRS element (for citing)
EIN311381808EIN
Primary ActivityMEDICAL LABORATORYPrimaryActivity
Legal Domicile StateOHLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntitySTypeOfEntity
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
SHELTERING ARMS HOSPITAL FOUNDATION
J67200LEASE AGREEMENT
SHELTERING ARMS HOSPITAL FOUNDATION
E100000LOAN AGREEMENT

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