ASHLAND COMMUNITY HEALTH SERVICES: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
ASHLAND COMMUNITY HEALTH SERVICES (EIN 93-1213059)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-02-07
IRS object ID
201330389349300928
Schema version
2011v1.2
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)
Timestamp2013-02-07T11:42:28-06:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN410746749EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line13000 NORTHUP WAY SUITE 200AddressLine1
CityBELLEVUECity
StateWAState
ZIP Code98004ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN931213059EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ASHLAND COMMUNITY HEALTHCARE SERVICESBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlASHLNameControl
Phone5412014000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1280 MAPLE STREETAddressLine1
CityASHLANDCity
StateORState
ZIP Code97520ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMARK MARCHETTIName
TitleCEOTitle
Phone5412014000Phone
Date Signed2013-02-07DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDANIEL M FREINName
PTINP01581995PTIN
Phone4252506100Phone
Date Prepared2013-02-07DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1ASHLAND COMMUNITY HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonMARK MARCHETTINameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1280 MAPLE STREETAddressLine1
CityASHLANDCity
StateORState
ZIP Code97520ZIPCode
FieldValueIRS element (for citing)
Gross Receipts50690794GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.ASHLANDHOSPITAL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1996YearFormation
State Legal DomicileORStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE HIGH QUALITY CARE THAT IMPROVES THE HEALTH OF PATIENTS, FAMILIES, AND THE COMMUNITY.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees458TotalNbrEmployees
Total Nbr Volunteers170TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year367088ContributionsGrantsPriorYear
Contributions Grants Current Year456062ContributionsGrantsCurrentYear
Program Service Revenue Prior Year50723766ProgramServiceRevenuePriorYear
Program Service Revenue CY49625110ProgramServiceRevenueCY
Investment Income Prior Year28940InvestmentIncomePriorYear
Investment Income Current Year18139InvestmentIncomeCurrentYear
Other Revenue Prior Year705474OtherRevenuePriorYear
Other Revenue Current Year591483OtherRevenueCurrentYear
Total Revenue Prior Year51825268TotalRevenuePriorYear
Total Revenue Current Year50690794TotalRevenueCurrentYear
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 Year26846653SalariesEtcPriorYear
Salaries Etc Current Year27489851SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year25304307OtherExpensePriorYear
Other Expenses Current Year26210626OtherExpensesCurrentYear
Total Expenses Prior Year52150960TotalExpensesPriorYear
Total Expenses Current Year53700477TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-325692RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-3009683RevenuesLessExpensesCY
Total Assets BOY41905474TotalAssetsBOY
Total Assets EOY38286714TotalAssetsEOY
Total Liabilities BOY16097882TotalLiabilitiesBOY
Total Liabilities EOY15494028TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY25807592NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY22792686NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE MISSION OF ASHLAND COMMUNITY HOSPITAL IS TO PROVIDE COMPASSIONATE, HIGH QUALITY CARE THAT IMPROVES THE OVERALL HEALTH OF OUR PATIENTS, THEIR FAMILIES AND THE COMMUNITY BY WORKING IN PARTNERSHIP WITH OUR PHYSICIANS AND OTHER REGIONAL HEALTHCARE PROVIDERS.MissionDescription
Significant New Program Services1SignificantNewProgramServices
Significant Change0SignificantChange
Expense39391217Expense
Grants0Grants
Revenue49625110Revenue
DescriptionPROVISION OF HEALTHCARE SERVICES TO RESIDENTS WITHIN OUR GEOGRAPHIC REGION, INCLUDING A SIGNIFICANT PORTION OF SERVICES TO MEDICARE/MEDICAID PATIENTS ($56 MILLION GROSS) AND CHARITY CARE ($1.4 MILLION GROSS).Description
Total Program Service Expense39391217TotalProgramServiceExpense
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 Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP1LoanToOfficerOrDQP
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 Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109694NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees458NumberOfEmployees
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 Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
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 Body1Form990ProvidedToGoverningBody
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 Venture1InvestmentInJointVenture
Written Policy Or Procedure0WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledORStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonCHRISTY NIKOLANamePerson
Telephone Number5412014000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1280 MAPLE STREETAddressLine1
CityASHLANDCity
StateORState
ZIP Code97520ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
DOUGLAS DIEL MD
CHAIR10.00XX000
DOUGLAS GENTRY
CHAIR-ELECT10.00XX000
ANNE GOLDEN
SECRETARY10.00XX000
MARIE DONOVAN
PAST CHAIR10.00XX000
ALAN DEBOER
MEMBER5.00X000
SAUNDRA THEIS
MEMBER5.00X000
CAROL CHRISTLIEB
MEMBER5.00X000
RICHARD MORRIS
MEMBER30.00X4020800
LINDA BUTLER
MEMBER5.00X000
STEVE MINER
MEMBER5.00X000
TOM REID
MEMBER5.00X000
MARK MARCHETTI
CEO40.00XX220617026990
AREBI GARSA
CFO40.00X000
AGNIESKA DOBIECKA
HOSPITALIST40.00209710026186X
BETH LEONE
HOSPITALIST40.00197314020706X
DAVID CANDELARIA
HOSPITALIST40.00200796022326X
PAM ATOR
HOSPITALIST40.0021545506221X
MOLLEY GRAMLEY
PHYSICIAN PROVIDER30.0018848005343X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1272580TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation107772TotalOtherCompensation
Number Individuals GT100 K30NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
BE SMITH INC
9777 RIDGE DRIVE SUITE 300LENESAKS66219TEMP STAFFING/RECRUITING887263
ASHLAND ANESTHESIA ASSOCIATES
638 NORTH MAIN STASHLANDOR97520ANESTHESIA PROVIDERS597032
GARSA AREBI
2071 EMERALD DRLONGMONTCO80504CONTRACT CFO473035
FAVORITE HEALTHARE STAFFING
825 NE MULTNOMAH SUITE 285PORTLANDOR97232TEMP STAFFING/RECRUITING458242
ASHLAND EMERGENCY ASSOCITATES PC
1370 LITHIA WAYTALENTOR97540ER PHYSICIANS428898
FieldValueIRS element (for citing)
Number Of Contractors GT100 K15NumberOfContractorsGT100K
Government Grants10714GovernmentGrants
All Other Contributions445348AllOtherContributions
Total Contributions456062TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
HOSPITAL SERVICES6219902612004726120047
MEDICARE/MEDICAID SERV6219902350506323505063
FieldValueIRS element (for citing)
Total Program Service Revenue49625110TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column18139TotalRevenueColumn
Exclusion$18,139ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real36376Real
Personal81462Personal

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real36376Real
Personal81462Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column117838TotalRevenueColumn
Exclusion$117,838ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
NONPATIENT FOOD SALES722210219589$219,589
OTHER REVENUE900099158982$158,982
PASSTHROUGH INCOME62199095074$95,074
FieldValueIRS element (for citing)
Total Other Revenue473645TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column50690794TotalRevenueColumn
Related Or Exempt Function Income49625110RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$609,622ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total271470Total
Management And General271470ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total21318574Total
Program Services16696285ProgramServices
Management And General4622289ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1403472Total
Program Services1091448ProgramServices
Management And General312024ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2873462Total
Program Services2243847ProgramServices
Management And General629615ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1622873Total
Program Services1256546ProgramServices
Management And General366327ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total225140Total
Management And General225140ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total63148Total
Management And General63148ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total8593051Total
Program Services5498298ProgramServices
Management And General3094753ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total152355Total
Program Services1334ProgramServices
Management And General151021ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total855058Total
Program Services319826ProgramServices
Management And General535232ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total937623Total
Program Services220918ProgramServices
Management And General716705ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1141571Total
Program Services244822ProgramServices
Management And General896749ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total131933Total
Program Services111609ProgramServices
Management And General20324ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total1993Total
Management And General1993ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total368277Total
Management And General368277ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2592110Total
Program Services1355302ProgramServices
Management And General1236808ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total209535Total
Management And General209535ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL SUPPLIES AND EQ51384505138450
OTHER EXPENSES26754912213780461711
BAD DEBT18603311860331
PHARMACEUTICAL DRUGS921816921816

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total342744Total
Program Services216605ProgramServices
Management And General126139ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total53700477Total
Program Services39391217ProgramServices
Management And General14309260ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2645088BOY
EOY603880EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY2589274BOY
EOY603529EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY7021382BOY
EOY8336474EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY120000EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY154751BOY
EOY135411EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1351882BOY
EOY1419732EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY506106BOY
EOY500145EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis49185586LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec25818757LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY24245705BOY
EOY23366829EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY212426BOY
EOY205310EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3178860BOY
EOY2995404EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY41905474BOY
EOY38286714EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY6760073BOY
EOY6468896EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY8724560BOY
EOY8438113EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY613249BOY
EOY587019EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY16097882BOY
EOY15494028EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY25528498BOY
EOY22570441EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY279094BOY
EOY222245EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY25807592BOY
EOY22792686EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY41905474BOY
EOY38286714EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-3009683ReconcilationRevenueExpenses
Reconcilation Other Changes-5223ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

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

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis306411OtherCostOrOtherBasis
Book Value306411BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis509382OtherCostOrOtherBasis
Depreciation276990Depreciation
Book Value232392BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis26779995OtherCostOrOtherBasis
Depreciation7697472Depreciation
Book Value19082523BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis19159793OtherCostOrOtherBasis
Depreciation15643110Depreciation
Book Value3516683BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2430005OtherCostOrOtherBasis
Depreciation2201185Depreciation
Book Value228820BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings23366829TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
RESTRICTED CASH2770372
INVESTMENT IN JOINT VENTURE224532
MISCELLANEOUS RECEIVABLES500
FieldValueIRS element (for citing)
Total Book Value Other Assets2995404TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
ESTIMATED MEDICAL MALPRACTICE LIABILITY$100,000
CAPITAL LEASE OBLIGATIONS$487,019
FieldValueIRS element (for citing)
Total Of Amounts587019TotalOfAmounts
Total Revenue50690794TotalRevenue
Total Expenses53700477TotalExpenses
Excess Or Deficit For Year-3009683ExcessOrDeficitForYear
Net Unrealized GL On Investments-5223NetUnrealizedGLOnInvestments
Total Adjustments-5223TotalAdjustments
Excess Or Deficit Per FS-3014906ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt48506733TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-5223NetUnrealizedGainsInvestments
Other Revenues-1860331OtherRevenues
Revenue Not Rptd F990-1865554RevenueNotRptdF990
Revenue Subtotal50372287RevenueSubtotal
Other Revenues Not Included318507OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt318507RevenueNotRptdOnFinStmt
Total Revenue Per Form99050690794TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt51840146TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal51840146ExpensesSubtotal
Other Expenses Not Included1860331OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt1860331ExpensesNotRptdOnFinStmt
Total Expenses Per Form99053700477TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:THE HOSPITAL HAS ADOPTED GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE STANDARD REQUIRES THE HOSPITAL TO DETERMINE WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION ON THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE HOSPITAL RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS AS A RESULT OF THE ADOPTION OF THE STANDARD.
PART XII, LINE 2D - OTHER ADJUSTMENTS:BAD DEBT EXPENSE NETTED WITH REVENUE ON FINANCIAL STATEMENTS -1,860,331.
PART XII, LINE 4B - OTHER ADJUSTMENTS:CAPITAL CONTRIBUTIONS AS NET ASSETS ON FINANCIAL STATEMENTS 318,507.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:BAD DEBT EXPENSE NETTED WITH REVENUE ON FINANCIAL STATEMENTS 1,860,331.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense773336TotalCommunityBenefitExpense
Net Community Benefit Expense773336NetCommunityBenefitExpense
Percent Of Total Expense0.01440PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense4536748TotalCommunityBenefitExpense
Direct Offsetting Revenue4100866DirectOffsettingRevenue
Net Community Benefit Expense435882NetCommunityBenefitExpense
Percent Of Total Expense0.00810PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense5310084TotalCommunityBenefitExpense
Direct Offsetting Revenue4100866DirectOffsettingRevenue
Net Community Benefit Expense1209218NetCommunityBenefitExpense
Percent Of Total Expense0.02250PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs12NumberOfActivitiesOrPrograms
Total Community Benefit Expense276739TotalCommunityBenefitExpense
Direct Offsetting Revenue82800DirectOffsettingRevenue
Net Community Benefit Expense193939NetCommunityBenefitExpense
Percent Of Total Expense0.00360PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs5NumberOfActivitiesOrPrograms
Total Community Benefit Expense2388TotalCommunityBenefitExpense
Net Community Benefit Expense2388NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs6NumberOfActivitiesOrPrograms
Total Community Benefit Expense13196303TotalCommunityBenefitExpense
Direct Offsetting Revenue10278696DirectOffsettingRevenue
Net Community Benefit Expense2917607NetCommunityBenefitExpense
Percent Of Total Expense0.05430PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs18NumberOfActivitiesOrPrograms
Total Community Benefit Expense21668TotalCommunityBenefitExpense
Net Community Benefit Expense21668NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs41NumberOfActivitiesOrPrograms
Total Community Benefit Expense13497098TotalCommunityBenefitExpense
Direct Offsetting Revenue10361496DirectOffsettingRevenue
Net Community Benefit Expense3135602NetCommunityBenefitExpense
Percent Of Total Expense0.05830PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs41NumberOfActivitiesOrPrograms
Total Community Benefit Expense18807182TotalCommunityBenefitExpense
Direct Offsetting Revenue14462362DirectOffsettingRevenue
Net Community Benefit Expense4344820NetCommunityBenefitExpense
Percent Of Total Expense0.08080PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense3174TotalCommunityBuildingExpense
Net Community Building Expense3174NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Total Community Building Expense3967TotalCommunityBuildingExpense
Net Community Building Expense3967NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Total Community Building Expense14817TotalCommunityBuildingExpense
Net Community Building Expense14817NetCommunityBuildingExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Other Other

FieldValueIRS element (for citing)
Total Community Building Expense25050TotalCommunityBuildingExpense
Net Community Building Expense25050NetCommunityBuildingExpense
Percent Of Total Expense0.00050PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense47008TotalCommunityBuildingExpense
Net Community Building Expense47008NetCommunityBuildingExpense
Percent Of Total Expense0.00100PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$1,860,331BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare11798442AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare17460783CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-5662341MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care0ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1ASHLAND COMMUNITY HEALTHCARE SERVICESBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1280 MAPLE STREETAddressLine1
CityASHLANDCity
StateORState
ZIP Code97520ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1ASHLAND COMMUNITY HEALTHCARE SERVICESBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent100.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent300.000000000000FPGDiscountPercent
Explains Basis0ExplainsBasis
Explains Application Method0ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities4NumberOfOtherFacilities

Other Facilities OtherFacilities (4 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
CENTER FOR INTERNAL MEDICINE
530 CATALINA STREETASHLANDOR97520INTERNAL MEDICINE CLINIC
CENTER FOR FAMILY MEDICINE
628 N MAIN STREETASHLANDOR97520FAMILY MEDICINE CLINIC
CENTER FOR FAMILY MEDICINE
49 TALENT AVETALENTOR97540FAMILY MEDICINE CLINIC
ACH AQUATIC THERAPY
540 YMCA WAYASHLANDOR97520THERAPY CENTER

Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)

ExplanationExplanationReturn ReferenceReturnReferenceIdentifierIdentifier
PART I, LINE 7: THE AMOUNTS REPORTED IN PART I, LINE 7 WERE COMPUTED USING A RATIO OF COST TO CHARGES THAT WAS DERIVED FROM USING WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS.
PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDE THE EMERGENCY ROOM, OBSTETRICS, HOME HEALTH, AND HOSPICE.
PART I, L7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A,) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $1,860,331.
ASHLAND COMMUNITY HOSPITAL PREPARES A COMMUNITY BENEFIT REPORT FOR THE STATE OF OREGON.PART 1, LINE 6A
PART II: IN LATE 2009, THE CITY OF ASHLAND CREATED AN ECONOMIC DEVELOPMENT COMMITTEE TO BRING TOGETHER BUSINESS LEADERS AND COMMUNITY REPRESENTATIVES FOR THE PURPOSE OF CREATING A COMPREHENSIVE ECONOMIC DEVELOPMENT STRATEGY FOR THE CITY. MEMBERS OF THE COMMITTEE WERE APPOINTED BY THE MAYOR. THE COMMITTEE IS CHAIRED BY A MEMBER OF ASHLAND CITY COUNCIL AND STAFF SUPPORT IS PROVIDED BY CITY PLANNING DEPARTMENT STAFF. THE CHARGE TO THE ECONOMIC DEVELOPMENT COMMITTEE INCLUDED:- REVIEW OF CURRENT COUNCIL GOALS RELATED TO ECONOMIC DEVELOPMENT- CONSIDERATION OF CITY GOVERNMENT'S ROLE IN ECONOMIC DEVELOPMENT- IDENTIFICATION OF OVERALL GOALS FOR ECONOMIC DEVELOPMENT- IDENTIFICATION OF SPECIFIC ACTIONS/TACTICS TO REACH IDENTIFIED GOALSTHE ECONOMY OF ASHLAND IS LARGELY DRIVEN BY TOURISM, BASED ON THE PRESENCE OF THE OREGON SHAKESPEARE FESTIVAL, AND TO A LESSER EXTENT BY THE AVAILABILITY OF A WIDE RANGE OF OUTDOOR ACTIVITIES SUCH AS SKIING, WHITE WATER RAFTING, AND FISHING. THESE ARE SEASONAL ACTIVITIES SUPPORTING RELATIVELY LOW-PAID, SEASONAL, SERVICE SECTOR JOBS. THE GOAL OF CITY ECONOMIC DEVELOPMENT EFFORTS IS TO DIVERSIFY THE ECONOMY, REDUCE SEASONAL FLUCTUATIONS IN ECONOMIC ACTIVITY, AND CREATE A STABLE BASE OF HIGHER-WAGE PROFESSIONAL AND TECHNICAL JOBS. ASHLAND COMMUNITY HOSPITAL IS THE CITY'S THIRD LARGEST EMPLOYER. THE HOSPITAL IS BOTH A SIGNIFICANT CONTRIBUTOR TO AND RELIANT ON THE CITY'S ECONOMIC WELL BEING. SINCE A HEALTHY AND SUSTAINABLE ECONOMY IS CRITICAL TO THE HEALTH AND WELL BEING OF ANY COMMUNITY, THE HOSPITAL CONTRIBUTES TO THE CITY'S COMMUNITY DEVELOPMENT EFFORTS AS PART OF ITS LARGER MISSION OF IMPROVING THE OVERALL HEALTH OF THE COMMUNITY.ASHLAND COMMUNITY HOSPITAL PROVIDES SEVERAL COMMUNITY HEALTH IMPROVEMENT ACTIVITIES THROUGHOUT THE YEAR INCLUDING CLASSES FOR NEW PARENTS AND SIBLINGS, CONSULTING WITH THE LOCAL SCHOOLS ON CARBOHYDRATES COUNTING, IN-SERVICES ON A MULTITUDE OF TOPICS AT THE ASSISTED LIVING CENTERS, PARTICIPATION AT LOCAL HEALTH FAIRS, AND GRIEF SUPPORT GROUPS. ALL OF THESE ACTIVES PROMOTE BETTER HEALTH HABITS, A BETTER UNDERSTANDING OF HEALTH RELATED ISSUES AND GUIDANCE ON HOW TO LIVE A HEALTHIER LIFE.ASHLAND COMMUNITY HOSPITAL ALSO PROVIDES SOME FINANCIAL SUPPORT FOR LIKE MINDED NON-PROFIT ORGANIZATIONS IN OUR AREA. THESE DONATIONS HELP TO SUPPORT A VARIETY OF ISSUES LIKE CHILD WELFARE, COMMUNITY OUTREACH PROGRAMS, SUPPORT FOR SEXUAL/PHYSICAL ABUSE VICTIMS, AND OTHER LOCAL HEALTHCARE PROVIDERS.ASHLAND COMMUNITY HOSPITAL ALSO PROVIDES MENTORING PROGRAMS IN THE MEDICAL/SURGICAL, EMERGENCY, SAME DAY SURGERY, RADIOLOGY, AND LABORATORY DEPARTMENTS. THIS EXPERIENCE PROVIDES REAL WORLD, HANDS ON EXPERIENCE FOR MEDICAL STUDENTS.
PART III, LINE 4: THE FOLLOWING IS FROM THE "PATIENT ACCOUNTS RECEIVABLES, NET" PARAGRAPH IN NOTE 1 OF THE HOSPITAL'S FINANCIAL STATEMENTS: "THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE SELF-PAY AND MISCELLANEOUS COMMERCIAL INSURANCE ACCOUNTS. PATIENTS ARE NOT REQUIRED TO PROVIDE COLLATERAL FOR SERVICES RENDERED. PAYMENT FOR SERVICES IS REQUIRED UPON RECEIPT OF AN INVOICE, AFTER PAYMENT BY INSURANCE, IF ANY. SELF-PAY ACCOUNTS ARE ANALYZED FOR COLLECTABILITY BASED ON THE MONTHS PAST DUE AND PAYMENT HISTORY. AN ALLOWANCE IS ESTIMATED FOR THESE ACCOUNTS BASED ON THE HISTORICAL EXPERIENCE OF THE HOSPITAL. ACCOUNTS THAT ARE DETERMINED TO BE UNCOLLECTIBLE ARE SENT TO A COLLECTION AGENCY AND WRITTEN OFF AT THAT TIME."THE AMOUNT OF BAD DEBT EXPENSE REPORTED IN PART III, LINE 2 IS CALCULATED AS FOLLOWS: PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES, AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD PARTY PAYORS.
PART III, LINE 8: OVER THE PAST 20 YEARS, THE POPULATION OF ASHLAND HAS AGED CONSIDERABLY AS THE CITY HAS GAINED THE REPUTATION AS A DESIRABLE "RETIREMENT" COMMUNITY. THIS IS EVIDENCED BY THE CLOSURE OF TWO OF THE CITY'S FIVE ELEMENTARY SCHOOLS WITHIN THE PAST TEN YEARS AND THE SIGNIFICANT INCREASE IN THE PERCENTAGE OF THE HOSPITALS REVENUE THROUGH THE MEDICARE PROGRAM FROM 40% IN 2003-2004 TO 51.5% TODAY. THIS SHIFT IN PAYOR MIX HAS HAD A SIGNIFICANT NEGATIVE IMPACT ON THE HOSPITAL'S FINANCIAL PERFORMANCE, RESULTING IN A NEGATIVE OPERATING MARGIN. WHILE THE INCREASED RELIANCE ON REIMBURSEMENT THROUGH THE MEDICARE PROGRAM HAS CREATED FINANCIAL STRESS FOR THE ORGANIZATION, THE HOSPITAL REMAINS COMMITTED TO ITS MISSION OF MEETING THE HEALTH CARE NEEDS OF ITS COMMUNITY. IN 2008, THE HOSPITAL CREATED THE ACH CENTER FOR INTERNAL MEDICINE, A PROVIDER-BASED INTERNAL MEDICINE CLINIC TO ADDRESS THE LACK OF ACCESS TO PRIMARY CARE FOR MEDICARE RECIPIENTS. DESPITE ENHANCED REIMBURSEMENT FROM MEDICARE AS A PROVIDER-BASED MODEL, THE CLINIC OPERATES AT A LOSS. IN 2011, THE HOSPITAL CREATED TWO FAMILY MEDICINE CLINICS, PROVIDER-BASED CLINICS TO ADDRESS THE LOSS OF FAMILY MEDICINE AVAILABILITY IN THE AREA. THESE CLINICS ALSO OPERATE AT A LOSS. SIMILARLY, THE HOSPITAL PROVIDES HOME HEALTH AND HOSPICE SERVICES, BOTH AT NEGATIVE MARGIN, YET BOTH VALUABLE SERVICES TO THE COMMUNITY. OTHER OF THE HOSPITAL'S SERVICES HEAVILY DEPENDENT ON REIMBURSEMENT THROUGH THE MEDICARE PROGRAM, SUCH AS ORTHOPEDIC JOINT REPLACEMENT AND RETINA SURGERY, RESULT IN NEGATIVE MARGINS BUT CONTINUE TO BE PROVIDED BY THE HOSPITAL BECAUSE THEY ARE CONSIDERED VITAL TO "THE OVERALL HEALTH OF PATIENTS, THEIR FAMILIES AND THE COMMUNITY" CONSISTENT WITH THE HOSPITAL'S MISSION.BY PROVIDING THESE SERVICES TO THE MEDICARE POPULATION AND IN COMES CASES EVEN TARGETING THE MEDICARE POPULATION FOR SERVICES, THE HOSPITAL ENSURES THAT WE ARE MEETING THE NEEDS OF OUR COMMUNITY. IF THE HOSPITAL WERE TO ELIMINATE OR REDUCES THESE SERVICES WE WOULD NOT SUSTAIN SUCH A SHORTFALL, BUT THE COMMUNITY WOULD SUFFER AT THE LOSS OF THESE SERVICES AND HAVE TO TRAVEL OUTSIDE ASHLAND TO TRY AND RECEIVE CARE.
PART III, LINE 9B: THE HOSPITAL HAS A WRITTEN DEBT COLLECTION POLICY. THE POLICY DOES NOT CONTAIN PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE.
PART V, SECTION B, LINE 18C: ASHLAND COMMUNITY HOSPITAL PROVIDES A FLAT 30% DISCOUNT TO INDIVIDUALS THAT DO NOT HAVE ANY INSURANCE COVERAGE. THIS IS AN AUTOMATIC DISCOUNT THAT DOES NOT NEED TO BE APPLIED FOR BY THE PATIENT. THE 30% WAS DETERMINED BY LOOKING AT OUR CONTRACTED RATES WITH OUR INSURANCE RATES, DETERMINING THE LOWEST NEGOTIATED RATE, THEN INCREASING SEVERAL PERCENTAGE POINTS TO ENSURE COMPLIANCE AND PROVIDING ADDITIONAL BENEFIT FOR PATIENTS.ASHLAND COMMUNITY HEALTHCARE SERVICES
PART VI, LINE 2: ASHLAND COMMUNITY HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES THROUGH ITS PLANNING PROCESSES, INCLUDING THE LONG-RANGE STRATEGIC PLAN, MEDICAL STAFF DEVELOPMENT PLAN, MARKETING PLAN, AND PROGRAM/BUSINESS PLANNING. PLANNING INPUTS INCLUDE: SERVICE AREA DEMOGRAPHICS INCLUDING POPULATION AND AGE PROJECTIONS; MEDICAL STAFF INTERVIEW FINDINGS; MEDICAL STAFF COMPOSITION, PRACTICE PATTERNS, AND AGE TO PROJECT PROVIDER NEEDS BY SPECIALTY; CURRENT AND HISTORIC SERVICE VOLUMES AND TRENDS; COMMUNITY PERCEPTION SURVEY DATA; MARKET SHARE ANALYSIS; COMPETITOR POSITIONS; PATIENT SURVEY DATA; COMMUNITY INPUT THROUGH THE BOARD OF DIRECTORS; AND FOCUS GROUPS OF FORMER PATIENTS AND COMMUNITY MEMBERS.
PART VI, LINE 3: ASHLAND COMMUNITY HOSPITAL EDUCATES PATIENTS WHO MIGHT BE ELIGIBLE FOR FINANCIAL ASSISTANCE IN A NUMBER OF WAYS. THERE ARE SIGNS POSTED IN ADMITTING AREAS THAT ADVISE PATIENTS OF OUR CHARITY CARE POLICY. OHP APPLICATIONS ARE GIVEN TO ANYONE UNDER THE AGE OF 18 THAT PROCESSES THROUGH THE E.R. STATEMENTS ADVISE PATIENTS THAT THEY MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE AND THE PHONE NUMBER TO CONTACT FOR FURTHER INFORMATION. MEETINGS ARE HELD AT LOCAL PHYSICIAN OFFICES TO INFORM THEM OF OUR FINANCIAL ASSISTANCE PROGRAMS SO THEY MAY PASS THE INFORMATION ALONG TO THEIR PATIENTS. PATIENTS ARE ALSO NOTIFIED OF FINANCIAL OPTIONS WHEN SPEAKING WITH OUR PATIENT ACCOUNTS OFFICE.
PART VI, LINE 4: ASHLAND COMMUNITY HOSPITAL IS A 49-BED ACUTE CARE COMMUNITY HOSPITAL LOCATED IN ASHLAND, OREGON, A COMMUNITY OF APPROXIMATELY 20,000 RESIDENTS LOCATED IN THE SOUTHERN-MOST PART OF THE STATE, APPROXIMATELY 15 MILES FROM THE CALIFORNIA BORDER. FOUNDED IN 1907, ASHLAND COMMUNITY HOSPITAL EXISTS TODAY AS A PRIVATE, NON-PROFIT 501-C-3 CORPORATION. GOVERNANCE OF THE ORGANIZATION IS PROVIDED BY A 12-MEMBER BOARD OF DIRECTORS, APPOINTED BY THE ASHLAND CITY COUNCIL, WHO VOLUNTEER THEIR TIME AND EXPERTISE ON BEHALF OF THE COMMUNITY. THE HOSPITAL IS ACCREDITED BY DNV HEALTHCARE INC AND IS CERTIFIED FOR PARTICIPATION IN THE MEDICARE PROGRAM.ASHLAND COMMUNITY HOSPITAL PROVIDES A WIDE RANGE OF HEALTH CARE AND RELATED SERVICES AS DEEMED APPROPRIATE IN ACCORDANCE WITH THE HOSPITAL'S MISSION, VISION AND STRATEGIC PLANS, AVAILABLE RESOURCES, COMMUNITY NEED, FEDERAL AND STATE LAW AND REGULATION AND PROFESSIONAL PRACTICE STANDARDS. THESE SERVICES INCLUDE INPATIENT AND OUTPATIENT CARE, EMERGENCY CARE, DIAGNOSTIC AND TREATMENT SERVICES, HOME HEALTH AND HOSPICE CARE, AND HEALTH OUTREACH SERVICES. ASHLAND COMMUNITY HOSPITAL DEFINES ITS PRIMARY SERVICES AREAS AS THE COMMUNITIES OF ASHLAND AND TALENT AND AREAS SOUTH TO THE CALIFORNIA BORDER, COMPRISED OF POSTAL ZIP CODES 97520 AND 97540, WITH A POPULATION OF APPROXIMATELY 35,000. THE SECONDARY SERVICE AREA INCLUDES THE COMMUNITIES OF PHOENIX AND MEDFORD NORTH OF ASHLAND, WITH POSTAL ZIP CODES 97504, 97501, AND 97535 AND A POPULATION OF APPROXIMATELY 92,000. THE HOSPITAL DRAWS FROM A BROADER GEOGRAPHIC AREA FOR CERTAIN SPECIALTY SERVICES NOT WIDELY AVAILABLE, INCLUDING COMPREHENSIVE WOUND CARE AND RETINA SURGERY.THE POPULATION OF THE HOSPITAL'S PRIMARY SERVICE IS PROJECTED TO INCREASE BY APPROXIMATELY 6.3% OVER THE FIVE YEAR PERIOD 2009-2014. SIMILARLY, THE POPULATION OF THE SECONDARY SERVICE AREA IS PROJECTED TO INCREASE BY 6.7% OVER THE SAME PERIOD. ALMOST 50% OF THE POPULATION GROWTH IN BOTH THE PRIMARY AND SECONDARY SERVICE AREAS IS PROJECTED TO OCCUR IN THE 65+ AGE COHORT. THE SIGNIFICANT INCREASE IN THE PORTION OF THE HOSPITAL'S TOTAL REVENUE DERIVING FROM THE MEDICARE PROGRAM, FROM APPROXIMATELY 40% OF GROSS REVENUE IN 2004 TO 52% IN 2012, SUPPORTS THESE PROJECTIONS.
PART VI, LINE 5: AS A NON-PROFIT, MISSION DRIVEN ORGANIZATION, ASHLAND COMMUNITY HOSPITAL IS COMMITTED TO THE PROVISION OF COMPASSIONATE, HIGH-QUALITY CARE THAT IMPROVES THE OVERALL HEALTH OF PATIENTS, THEIR FAMILIES AND THE COMMUNITY AND TO THE FURTHERANCE OF ITS EXEMPT PURPOSE. 1. THE HOSPITAL MAINTAINS A CURRENT STRATEGIC PLAN TO GUIDE THE LONG-TERM STRATEGIC DIRECTION OF THE HOSPITAL TO BEST MEET THE NEEDS OF THE COMMUNITY. 2. THE HOSPITAL'S MEDICAL STAFF IS OPEN TO ANY PHYSICIAN OR ALLIED HEALTH PROVIDER WHO IS LICENSED IN THE STATE OF OREGON AND ABLE TO DEMONSTRATE CURRENT COMPETENCE.3. THE HOSPITAL HAS CREATED A MEDICAL STAFF DEVELOPMENT PLAN TO DEFINE THE NUMBER AND TYPES OF PHYSICIANS NEEDED TO MEET COMMUNITY NEED. THE PLAN IS UPDATED ON A REGULAR BASIS. 4. THE HOSPITAL'S PHYSICIAN RECRUITMENT SUPPORT PROGRAM PROVIDES FINANCIAL ASSISTANCE FOR NEW PHYSICIANS ESTABLISHING PRACTICES WITHIN THE COMMUNITY, WITHIN THE CONSTRAINTS OF FEDERAL LAW AND REGULATION.5. IN 2008, THE HOSPITAL ESTABLISHED THE ASHLAND CENTER FOR INTERNAL MEDICINE TO ADDRESS ACCESS ISSUES FOR MEDICARE PATIENTS. IN 2011, THE HOSPITALIST ESTABLISHED THE ASHLAND AND TALENT CENTERS FOR FAMILY MEDICINE. 6. THE HOSPITAL MAINTAINS A PHYSICIAN HOSPITALIST PROGRAM TO SUPPORT THE AVAILABILITY OF IN-PATIENT CARE, AT A NET COST OF APPROXIMATELY $750,000 PER YEAR. 7. HOSPITAL GOVERNANCE IS PROVIDED BY A 13-MEMBER BOARD OF DIRECTORS, APPOINTED BY THE ASHLAND CITY COUNCIL. DIRECTORS OF ARE MEMBERS OF THE HOSPITAL'S SERVICE AREA AND RECEIVE NO COMPENSATION FOR THEIR SERVICES.8. THROUGH THE HOSPITAL AND ITS FOUNDATION, FUNDS ARE USED TO SUPPORT A VARIETY OF HEALTH AND RELATED COMMUNITY ORGANIZATIONS AND ACTIVITIES INCLUDING LA CLINICA DEL VALLE, COMMUNITY HEALTH CENTER, THE CHILDREN'S ADVOCACY CENTER, AND THE HEARTS AND VINES FOUNDATION.9. THE HOSPITAL OPERATES HEALTH CLINICS IN MIDDLE-SCHOOLS AND HIGH SCHOOLS IN ASHLAND AND TALENT.10. THROUGH FUNDING, IN KIND CONTRIBUTIONS, AND/OR STAFF PARTICIPATION THE HOSPITAL SUPPORTS A VARIETY OF COMMUNITY ACTIVITIES SUCH AS THE 4TH OF JULY CELEBRATION AND HOLIDAY FESTIVAL OF LIGHTS.11. THROUGH ITS EMPLOYEE VOLUNTEER RECOGNITION PROGRAM, THE HOSPITAL PROVIDES GRANTS TO NON-PROFIT ORGANIZATIONS WITH WHICH EMPLOYEES VOLUNTEER.12. THE HOSPITAL'S TUITION REIMBURSEMENT PROGRAM PROVIDES EMPLOYEES UP TO $2,500 PER SCHOOL YEAR FOR TUITION, BOOKS AND FEES THEREBY SUPPORTING THE DEVELOPMENT OF NEEDED HEALTH CARE PROFESSIONALS.13. THE HOSPITAL SUPPORTS A MONTHLY MEDICAL EDUCATION PROGRAM FOR MEMBERS OF THE MEDICAL STAFF.14. THE HOSPITAL'S CHARITY CARE PROGRAM PROVIDES FINANCIAL ASSISTANCE TO ASSIST WITH MEDICAL EXPENSES.15. THE HOSPITAL PARTICIPATES IN THE VOLPACT PROGRAM, A PATIENT FINANCIAL AIDE PROGRAM SPONSORED BY THE JACKSON COUNTY MEDICAL SOCIETY.
ORPART VI, LINE 7REPORTS FILED WITH STATES

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyXCompensationSurvey
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 (6 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
MARK MARCHETTI
2178580002759061230208670247607000
AGNIESKA DOBIECKA
2042780005432058940202920235896000
BETH LEONE
1912870006027059730147330218020000
DAVID CANDELARIA
1995280001268057830165430223122000
PAM ATOR
201768000136870595202690221676000
MOLLEY GRAMLEY
161334000271460514202010193823000

Schedule L IRS990ScheduleL

Loan Table LoanTable

FieldValueIRS element (for citing)
Name PersonMARK MARCHETTINamePerson
Purpose Of LoanHOUSE LOANPurposeOfLoan
Loan From OrganizationXLoanFromOrganization
Original Principal$120,000OriginalPrincipalAmount
Balance Due120000BalanceDue
Default0Default
Approved By Board1ApprovedByBoard
Written Agreement1WrittenAgreement
FieldValueIRS element (for citing)
Total Balance Due120000TotalBalanceDue

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
NEW PROGRAM SERVICESFORM 990, PART III, LINE 2ASHLAND COMMUNITY HEALTHCARE SERVICES ADDED TWO FAMILY PRACTICE CLINICS.
FORM 990, PART VI, SECTION A, LINE 1THE HOSPITAL HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE BOARD CHAIR, CHAIR ELECT, SECRETARY, TREASURER, IMMEDIATE PAST CHAIR AND THE CEO. THE COMMITTEE IS AUTHORIZED TO TRANSACT THE BUSINESS OF THE BOARD IN THE INTERIM BETWEEN MEETINGS OF THE FULL BOARD WHEN A MEETING OF THE FULL BOARD IS NOT FEASIBLE; ALSO TO ADVISE THE BOARD CHAIR AND CEO. THERE ARE, HOWEVER, POWERS SPECIFICALLY RESERVED TO THE FULL BOARD BY THE HOSPITAL'S BYLAWS INCLUDING: AUTHORIZATION OF DISTRIBUTIONS; RECOMMENDATION OR APPROVAL OF DISSOLUTION, MERGER, OR SALE; ELECTION, APPOINTMENT OR REMOVAL OF DIRECTORS; AND THE ADOPTION, AMENDMENT OR REPEAL OF ARTICLES OF INCORPORATION OR BYLAWS.
FORM 990, PART VI, SECTION A, LINE 6THE ORGANIZATION HAS ONE MEMBER, THE CITY OF ASHLAND.
FORM 990, PART VI, SECTION A, LINE 7ATHE ORGANIZATION'S MEMBER HAS THE AUTHORITY AND RESPONSIBILITY TO APPOINT, AND REMOVE FOR CAUSE, THE ORGANIZATION'S DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7BTHE ORGANIZATION'S MEMBER HAS THE AUTHORITY AND RESPONSIBILITY TO APPROVE OR DISAPPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION WHICH HAVE BEEN PROPOSED OR CONCURRED IN BY THE BOARD. THE MEMBER ALSO HAS THE AUTHORITY TO DISSOLVE THE CORPORATION IN THE EVENT OF AN UNCURED BREACH BY THE CORPORATION IN THE FACILITIES LEASE TO WHICH THE CITY AND THE CORPORATION ARE PARTIES.
FORM 990, PART VI, SECTION B, LINE 11THE FINANCE COMMITTEE REVIEWS FORM 990 AND A COPY IS SENT OUT TO THE FULL BOARD PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12CTHE ORGANIZATION ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY DOING AN ANNUAL REVIEW OF THE POLICY AND OBTAINING NEW ACKNOWLEDGEMENT SIGNATURES ON THE POLICY BY THE BOARD OF DIRECTORS. THE ORGANIZATION FOLLOWS UP ON ANY POTENTIAL CONFLICT AS NEEDED. WHENEVER ANY DIRECTOR FIRST BECOMES AWARE THAT HE OR SHE HAS OR MAY HAVE ANY CONFLICT OF INTEREST, THAT DIRECTOR MUST PROMPTLY DISCLOSE THE EXISTENCE OF THAT CONFLICT TO THE BOARD OF DIRECTORS. FULL DISCLOSURE OF ALL MATERIAL FACTS CONCERNING THE CONFLICT IS ENCOURAGED, AND DISCLOSURE WILL BE DULY RECORDED IN THE BOARD MINUTES. IF THE DIRECTOR MAKES FULL DISCLOSURE AS DESCRIBED ABOVE, THE DIRECTOR MAY THEREAFTER ENGAGE IN ANY DISCUSSION ON THE MATTER AND MAY VOTE, UNLESS THE BOARD OF DIRECTORS BELIEVES THAT THE NATURE AND EXTENT OF THE CONFLICT OF INTEREST WARRANTS THE DIRECTOR'S EXCLUSION FROM EITHER OR BOTH OF THE DISCUSSION AND VOTE. IF THE DIRECTOR DOES NOT MAKE FULL DISCLOSURE, HE OR SHE THEREAFTER MUST LEAVE THE MEETING ROOM DURING ANY DISCUSSION OR VOTE ON THE MATTER.
FORM 990, PART VI, SECTION B, LINE 15ATHE CEO'S COMPENSATION IS DETERMINED BY THE BOARD OF DIRECTORS. THE VP OF HUMAN RESOURCES GATHERS WAGE AND BENEFIT DATA FROM THE OREGON HOSPITAL ASSOCIATION SALARY SURVEY (WAGE WATCH) AND THE NORTHWEST HOSPITAL EXECUTIVE SURVEY CONDUCTED BY OLNEY ASSOCIATES, INC. THE DATA IS PROVIDED TO THE BOARD CHAIR AND REVIEWED BY THE EXECUTIVE COMMITTEE. THE BOARD THEN DETERMINES THE COMPENSATION FOR THE CEO. COMPENSATION FOR THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES IS BASED ON THE OREGON HOSPITAL ASSOCIATION SALARY SURVEY (WAGE WATCH) AND LOCAL SURVEYS. THE VP OF HUMAN RESOURCES MAKES A RECOMMENDATION TO THE CEO FOR ALL ADJUSTMENTS TO SALARY RANGES.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION'S FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. THE CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC.
CHANGES IN NET ASSETS OR FUND BALANCES:FORM 990, PART XI, LINE 5:NET UNREALIZED LOSSES ON INVESTMENTS: -5,223.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1ASHLAND COMMUNITY HOSPITAL FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1280 MAPLE STREETAddressLine1
CityASHLANDCity
StateORState
ZIP Code97520ZIPCode
FieldValueIRS element (for citing)
EIN930691238EIN
Primary ActivitiesSUPPORT ASHLAND COMMUNITY HOSPITALPrimaryActivities
Legal Domicile StateORLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity StatusLINE 7PublicCharityStatus
Controlled Org0ControlledOrg
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 Org0LoansOrGuaranteesFromOtherOrg
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 Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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