2013-09-30T09:49:35-07:00 2012-12-31 990 2012-01-01 341531817 ALLIANCE COMMUNITY HOSPITAL FOUNDATION ALLI 3305966000 200 E STATE ST ALLIANCE OH 44601 Dale Wells 3305967066 2013-09-30 2012 2016-02-25 16:41:14Z Dale W Wells 200 E State Street Alliance OH 44601 532246 0 X X 1986 OH The Alliance Community Hospital Foundation's mission is to contribute to hospital fundraising, maintain community involvement and healthcare awareness, and grow as a philanthropic spirit of Alliance Community Hospital. 4 3 0 128 0 0 225839 195797 0 0 77958 76159 0 564 303797 272520 34003 328114 0 0 0 0 0 0 0 17121 8419 51124 336533 252673 -64013 3040448 2999615 0 0 3040448 2999615 To assist Alliance Community Hospital financially in its mission of delivering quality health care in the community, maintain community involvement and health care awareness. The Foundation also provides support to other local non-profits. 0 0 322421 0 0 Alliance Community Hospital Foundation supports Alliance Community Hospital (ACH) for building and medical equipment expenses. Major purchases and improvements in 2012 included high-definition endoscopes costing $279,200, Cardio equipment of $15,000, Blanket warmers for ACH's Senior Care and Progressive Care Units totaling $10,000. ACH also received funds for mutliple smaller purchases, each less then $5,000, for building improvements including its fitness stairwell, patient supplies for the skilled nursing facility, and equipment for Cardiac Rehab Unit, Same Day and Inpatient Surgery, Post Anesthesia Care, Outpatient Therapy, and Outside Transport Department. 5693 0 0 The Foundation supports Alliance Community Hospital by providing funds for indigent patient care. In 2012 they provided prescription drug and medical expense assistance of $5,346, and noncash hospice patient assistance costing $347. 793 0 0 The Foundation provides information brochures and cards to Visiting Nurse and Hospice patients and their families. 0 0 0 328907 1 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 X 4 3 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X Dale W Wells 3305967066 200 E STATE ST ALLIANCE OH 44601 Mike Hoover 1 3 X X 0 0 0 Ron Lyons 1 3 X X 0 0 0 David Lundgren 1 2 X X 0 0 0 Dale Wells 2 44 X X 0 180812 18280 Stan Jonas 1 46 X 0 388324 19347 0 569136 37627 0 0 1 0 0 0 0 82160 31543 0 82094 752 195797 0 77659 0 0 77659 0 0 0 0 0 0 0 0 0 0 225000 0 226500 0 -1500 0 -1500 0 0 -1500 33790 82160 33226 564 0 564 0 272520 0 0 76723 322421 322421 5693 5693 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6300 0 6300 0 0 0 0 0 0 0 0 0 619 0 619 0 707 0 707 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Visiting Nurse & Hospice brochures&supplies 793 793 0 336533 328907 7626 0 32349 15476 3008099 2984139 3040448 2999615 0 0 X 888136 770459 1294616 1371410 857696 857746 3040448 2999615 3040448 2999615 -64013 23180 0 0 0 0 X 0 1 X 1 0 X X X 0 0 0 Alliance Community Hospital 340714581 Hospital, Line 3 1 328907 1 328907 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 857696 50 0 0 0 0 857746 857646 50 0 0 0 0 857696 493942 363704 0 0 0 0 857646 2666 491276 0 0 0 0 493942 10885 1412 0 0 9631 0 2666 0 1 0 0 0 Assets Limited As To Use: Internally Designated 24794 F Assets Limited As To Use: Externally Restricted 903911 F Long Term Investments 2055434 F 2984139 SchD_P05_S00_L04 Schedule D, Part V, Line 4 The intended use of the organization's endowment funds is to hold the principal in perpetuity and use the interest for the general operations of the organization. Hospice 5K 26493 14753 11740 700 1071 0 985 200 6170 Charity Ball 70163 51913 18250 0 2466 750 15481 2500 281 3 19294 15494 3800 500 0 0 400 1700 22 115950 82160 33790 1200 3537 750 16866 4400 6473 33226 564 1 Alliance Community Hospital 200 E State Street Alliance OH 44601 340714581 501(c)(3) 322421 0 Medical Equipment & building improvements 1 0 Indigent Patient Care 124 5346 347 Purchase price Air conditioner, voice monitors, door bells SchI_P01_S00_L02 Schedule I, Part I, Line 2 Alliance Community Hospital Foundation was created to benefit Alliance Community Hospital's (ACH) mission which is to provide care to all, regardless of ability to pay. Funds given to ACH are used to purchase medical equipment, contribute to hospital building improvements, and provide for patients needs. Alliance Community Hospital Foundation has not provided grants to organizations outside its control. It worked in conjunction with other community, non-profit organizations to raise funds on their behalf. As such, these organizations such as the local YMCA, Neighborhood Center, Stark County Homeless Council, and Alliance Area Development Foundation are fully engaged and a participant in the fund raising process. As such, ACHF relies on their participation and funding reports to verify use of the funds. Should ACHF provide grants outside those listed above, then ACHF will rely on the policy of lump sum funding preceeded by a grant application, approval from the Board, and then followed by a 6-month and annual evaluation of the project if needed and/or grant application funding based on reimbursement of actual expense(s) along with Board approval. 0 0 0 0 0 0 0 0 0 Stan Jonas 0 371324 0 0 0 17000 0 6964 0 14502 0 409790 0 0 Dale Wells 0 180812 0 0 0 0 0 4625 0 14792 0 200229 0 0 SchJ_P01_S00_L03 Schedule J, Part I, Line 3 Alliance Community Hospital Foundation's Schedule J lists Dale Wells and Stan Jonas, employees of Alliance Community Hospital, a related organization. Their compensation is determined using all six methods listed in Part I, line 3. F990_P06_S0A_L01a Form 990, Part VI, Section A, Line 1a The governing body of Alliance Community Hospital Foundation (per its Code of Regulations) has delegated authority to the Board of Alliance Citizens' Health Association (the Member), a related organization, as follows: 1.) Power to elect and remove members of the Board of Trustees and/or Officers of the corporation. 2.) Approve the annual operating budgets; capital expenditures budgets; capital expenditures or dispositions of capital assets with a value in excess of such limits as shall be set from time to time by the Member; any action which requires Certificate of Need approval from the State Health Planning Development Agency; and any purchase, sale, lease, disposition, or hypothecation of real property. 3.) The incurrence of any obligation(s), liability(ies), and/or debt(s) requiring a mortgage on or security interest in any part of the assets of the corporation. 4.) Power to determine, upon dissolution of the corporation, the organization or organizations to which its remaining assets will be distributed. F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 See Schedule O comment for Part VI line 1a. F990_P06_S0A_L07a Form 990, Part VI, Section A, Line 7a See Schedule O comment for Part VI question 1a. F990_P06_S0A_L07b Form 990, Part VI, Section A, Line 7b See Schedule O comment for Part VI question 1a. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b The Form 990 is reviewed by the CFO/COO of Alliance Community Hospital, a related organization. Prior to filing, the 990 is also distributed to the Board of Trustees for their review and comments. It is then discussed as part of the financial report at the next Board meeting where any questions/concerns can be addressed. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c Members of the Board of Trustees are required to annually review and sign a conflict of interest policy. Under that policy, the Board member (i) has a duty to disclose any conflict, and (ii) must recuse themselves from a vote and or decision when such conflict arises. If this policy is violated, then the Board shall take appropriate action which may include an investigation and disciplinary action. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 No compensation is paid directly by Alliance Community Hospital Foundation; however, certain officers and top officials of this organization are compensated by Alliance Community Hospital, a related organization. That compensation is determined by an independent (noncompensated) committee from the Board of Trustees. This committee annually reviews compensation by obtaining market surveys of the positions. F990_P06_S0C_L17 Form 990, Part VI, Section C, Line 17 Ohio does not require the Form 990 to be filed with the Ohio Attorney General's Office. Instead, a "Verification of Filing with the Internal Revenue Service" form is completed stating that we did file Form 990 by the required due date. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The organization makes its governing documents available to the public via the Ohio Secretary of State's website. Financial statements are available in the NRMSIR filing database at www.emma.msrb.org. The conflict of interest policy is available upon request. Alliance Citizens' Health Association 200 E State St Alliance OH 44601 341531815 Manage Health Facil OH 501(C)(3) Sch A, 11b, II N/A 0 Alliance Community Hospital 200 E State St Alliance OH 44601 340714581 Community Hospital OH 501(C)(3) Sch A, Ln 3 Alliance Citizens' Health Assn 0 Alliance Comm Hospital Auxiliary 200 E State St Alliance OH 44601 340777659 Volunteer Services OH 501(C)(3) Sch A, 11c, III-FI N/A 0 Alliance Health Institute 200 E State St Alliance OH 44601 341932972 Support ACH OH 501(C)(3) Sch A, 11a, I Alliance Citizens' Health Assn 0 Caring Hands 885 Sawburg Rd Alliance OH 44601 341505340 Private Duty Nursing OH 501(C)(3) Sch A, 11c, III-FI Alliance Citizens' Health Assn 0 Alliance Health Partners 200 E State St Alliance OH 44601 341884059 PHO OH N/A C 0 0 0 0 Alliance Hospitalist Group 200 E State St Alliance OH 44601 203188585 Dr Offices OH Alliance Comm Hospital C 0 0 1 0 Alliance Community Radiologists Inc 200 E State St Alliance OH 44601 205698786 Dr Offices OH Alliance Comm Hospital C 0 0 1 0 Alliance Medical Associates Inc 200 E State St Alliance OH 44601 911889215 Dr Offices OH Alliance Comm Hospital C 0 0 1 0 Alliance Pulmonary Associates Inc 200 E State St Alliance OH 44601 204083441 Dr Offices OH Alliance Comm Hospital C 0 0 1 0 Health Alliance Inc 200 E State St Alliance OH 44601 341531993 Dr Offices OH All Citizens Health Assn C 0 0 1 0 NEO Surgical Associates Inc 200 E State St Alliance OH 44601 200760723 Dr Offices OH Alliance Comm Hospital C 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 0 SchR_P04_S00_L00 Schedule R, Part IV Schedule R, Part IV - The 100% ownership in column (h) of Part IV is based on voting power, not total value of all outstanding shares; thus, columns (f) and (g) are 0.