LICKING MEMORIAL HOSPITAL: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- LICKING MEMORIAL HOSPITAL (EIN 31-4379519)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-07
- IRS object ID
- 201333119349302053
- Schema version
- 2012v2.1
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-07T14:20:27-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 271235638 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOUNTJOY CHILTON MEDLEY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 462 S FOURTH ST SUITE 2600 | AddressLine1 |
| City | LOUISVILLE | City |
| State | KY | State |
| ZIP Code | 402023445 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 314379519 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LICKING MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | LICK | NameControl |
| Phone | 7403484528 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1320 WEST MAIN STREET | AddressLine1 |
| City | NEWARK | City |
| State | OH | State |
| ZIP Code | 43055 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CYNTHIA L WEBSTER | Name |
| Title | V P OF FINANCIAL SERVICES | Title |
| Phone | 7403484528 | Phone |
| Date Signed | 2013-10-30 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | VICTORIA D BUSTER CPA | Name |
| PTIN | P00024054 | PTIN |
| Phone | 5027491900 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | ROBERT A MONTAGNESE | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1320 WEST MAIN STREET | AddressLine1 |
| City | NEWARK | City |
| State | OH | State |
| ZIP Code | 43055 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 180782733 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.LMHEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1898 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | TO IMPROVE THE HEALTH OF THE COMMUNITY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 13 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1474 | TotalNbrEmployees |
| Total Nbr Volunteers | 126 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 169149310 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 178311860 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 475778 | InvestmentIncomePriorYear |
| Investment Income Current Year | 320241 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1916078 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1445479 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 171541166 | TotalRevenuePriorYear |
| Total Revenue Current Year | 180077580 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 70764828 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 75274257 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 74057718 | OtherExpensePriorYear |
| Other Expenses Current Year | 74301388 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 144822546 | TotalExpensesPriorYear |
| Total Expenses Current Year | 149575645 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 26718620 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 30501935 | RevenuesLessExpensesCY |
| Total Assets BOY | 139138337 | TotalAssetsBOY |
| Total Assets EOY | 147845017 | TotalAssetsEOY |
| Total Liabilities BOY | 82385476 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 89448873 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 56752861 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 58396144 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | LICKING MEMORIAL HOSPITAL EXISTS TO IMPROVE THE HEALTH OF THE COMMUNITY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 130241867 | Expense |
| Revenue | 178567652 | Revenue |
| Description | LICKING MEMORIAL HOSPITAL (LMH) PROVIDES HEALTHCARE SERVICES WITHOUT REGARD TO A PATIENT'S RACE, CREED, GENDER, DISABILITY, ETHNICITY, AGE, RELIGION, CITIZENSHIP, NATIONAL ORIGIN OR SOURCES OF PAYMENT FOR CARE. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF LMH, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. FURTHER, WE BELIEVE OUR PURPOSE IS TO SERVE THE COMMUNITY BY PROVIDING HEALTHCARE SERVICES AND EDUCATION. THEREFORE, IN KEEPING WITH OUR COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, WE PROVIDE: - FREE CARE AND/OR SUBSIDIZED CARE - CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS BELOW COST - HEALTH ACTIVITIES AND PROGRAMS FREE-OF-CHARGE TO THE COMMUNITYTHE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, AND SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED AND MEDICALLY UNDER SERVED.LMH SERVED 8,103 INPATIENTS AND 1,084 NEWBORNS FOR A TOTAL OF 26,340 PATIENT DAYS, AND PROVIDED SERVICES TO 283,215 OUTPATIENTS IN 2012.ADDITIONALLY, LMH PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS, BELOW COST IN MANY CASES. TO THE EXTENT REIMBURSEMENT IS BELOW CHARGES, LMH CONSIDERS THESE AMOUNTS TO BE CONTRACTUAL ADJUSTMENTS, WHICH WILL NEVER BE COLLECTED. THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS AMOUNTED TO $142,640,000 IN 2012.UNCOMPENSATED CARE IS PROVIDED THROUGH MANY REDUCED PRICE SERVICES AND FREE PROGRAMS OFFERED THROUGHOUT THE YEAR BASED UPON ACTIVITIES AND SERVICES LMH BELIEVES WILL SERVE A BONA FIDE COMMUNITY HEALTH NEED. THE HOSPITAL ROUTINELY PROVIDES UNCOMPENSATED CARE TO PATIENTS WHO ARE UNWILLING OR UNABLE TO PAY THEIR HOSPITAL BILLS. IN 2012, LMH WROTE OFF CHARGES OF APPROXIMATELY $16,259,000 IN BAD DEBTS AND $19,745,000 IN CHARITY CARE. | Description |
| Total Program Service Expense | 130241867 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 379 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1474 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 13 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | OH | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAVID CLAYPOOL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7403484528 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1320 WEST MAIN STREET | AddressLine1 |
| City | NEWARK | City |
| State | OH | State |
| ZIP Code | 43055 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| LINDA K DALGARN | ||||||||
| CHAIRMAN | 1.30 | 1.30 | X | X | 0 | 0 | 0 | |
| KIM FLEMING | ||||||||
| TREASURER | 1.30 | X | X | 0 | 0 | 0 | ||
| PATRICK D GUANCIALE | ||||||||
| VICE CHAIRMAN | 1.30 | X | X | 0 | 0 | 0 | ||
| CRAIG R BALDWIN | ||||||||
| SECRETARY | 1.30 | X | X | 0 | 0 | 0 | ||
| MICHAEL D CANTLIN | ||||||||
| DIRECTOR | 1.30 | X | 0 | 0 | 0 | |||
| GENE BRANSTOOL | ||||||||
| DIRECTOR | 1.30 | X | 0 | 0 | 0 | |||
| NANCY G NEELY | ||||||||
| DIRECTOR | 1.30 | X | 0 | 0 | 0 | |||
| GUS A ANDREWS | ||||||||
| DIRECTOR | 1.30 | X | 0 | 0 | 0 | |||
| THOMAS MULLADY | ||||||||
| DIRECTOR | 1.30 | X | 0 | 0 | 0 | |||
| F JENNIFER UTREVIS | ||||||||
| DIRECTOR | 1.30 | X | 0 | 0 | 0 | |||
| BART M WEILER | ||||||||
| DIRECTOR | 1.30 | X | 0 | 0 | 0 | |||
| DEBORAH A KOHMAN | ||||||||
| DIRECTOR | 1.30 | X | 0 | 0 | 0 | |||
| JOYCE L MALAINY | ||||||||
| DIRECTOR | 1.30 | X | 0 | 0 | 0 | |||
| ROBERT MONTAGNESE | ||||||||
| PRESIDENT & CEO | 30.00 | 10.00 | X | 412705 | 0 | 100277 | ||
| CINDY WEBSTER | ||||||||
| V.P. FINANCIAL SERVICES | 30.00 | 10.00 | X | 165761 | 0 | 11087 | ||
| CRAIG CAIRNS | ||||||||
| VP MEDICAL AFFAIRS | 40.00 | 241641 | 0 | 16163 | X | |||
| DEBORAH YOUNG | ||||||||
| VP PATIENT CARE | 40.00 | 164135 | 0 | 10978 | X | |||
| SALLIE ARNETT | ||||||||
| VP INFO SYSTEMS | 40.00 | 162518 | 0 | 10870 | X | |||
| ANNE PETERSON | ||||||||
| VP HR AND SUPPORT SERVICES | 40.00 | 134272 | 0 | 8981 | X | |||
| VERONICA LINK | ||||||||
| VP PR & DEVELOPMENT | 14.00 | 26.00 | 152104 | 0 | 10174 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1433136 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 168530 | TotalOtherCompensation |
| Number Individuals GT100 K | 32 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| GE HEALTHCARE IITS | |||||
| 40 IDX DRIVE | SOUTH BERLINGTON | VT | 05403 | EQUIPMENT MAINTENANCE | 884790 |
| MEDICAL DOCTOR ASSOCIATES | |||||
| PO BOX 277185 | ATLANTA | GA | 30384 | PHYSICIAN SERVICES | 798967 |
| MEDICAL INFORMATION TECHNOLOGY | |||||
| MEDITECH CIRCLE | WESTWOOD | MA | 02090 | SOFTWARE MAINTENANCE | 621529 |
| TURNER CONSTRUCTION | |||||
| 375 HUDSON STREET | NEW YORK | NY | 10014 | CONSTRUCTION | 455143 |
| CAWLEY JOHNSON GROUP | |||||
| 4015 NINE MCFARLAND DRIVE SUITE 20 | ALPHARETTA | GA | 30004 | HEALTHCARE CONSULTANTS | 384316 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 19 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT REVENUE | 621110 | 175719432 | 175719432 |
| MEANINGFUL USE GRANT | 621110 | 2592428 | 2592428 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 178311860 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 299246 | TotalRevenueColumn |
| Exclusion | $299,246 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 669859 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 669859 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 38283 | Securities |
| Other | 18006 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 35294 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 38283 | Securities |
| Other | -17288 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 20995 | TotalRevenueColumn |
| Exclusion | $20,995 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| CAFETERIA | 722210 | 1189687 | $1,189,687 | |
| VHA FEES & REBATES | 621110 | 248350 | 248350 | |
| MISCELLANEOUS | 900099 | 7442 | 7442 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1445479 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 180077580 | TotalRevenueColumn |
| Related Or Exempt Function Income | 178567652 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $1,509,928 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 689830 | Total |
| Management And General | 689830 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 53386723 | Total |
| Program Services | 46783387 | ProgramServices |
| Management And General | 6603336 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17280471 | Total |
| Program Services | 14984197 | ProgramServices |
| Management And General | 2296274 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3917233 | Total |
| Program Services | 3418619 | ProgramServices |
| Management And General | 498614 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 350439 | Total |
| Management And General | 350439 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 319993 | Total |
| Management And General | 319993 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 32255 | Total |
| Program Services | 32255 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10071029 | Total |
| Program Services | 6902600 | ProgramServices |
| Management And General | 3168429 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 412269 | Total |
| Management And General | 412269 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1379375 | Total |
| Program Services | 1178390 | ProgramServices |
| Management And General | 200985 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 46913 | Total |
| Program Services | 44261 | ProgramServices |
| Management And General | 2652 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 390217 | Total |
| Program Services | 155946 | ProgramServices |
| Management And General | 234271 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 849456 | Total |
| Management And General | 849456 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10324626 | Total |
| Program Services | 7998170 | ProgramServices |
| Management And General | 2326456 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1370979 | Total |
| Program Services | 1370979 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 30191075 | 29172856 | 1018219 |
| BAD DEBT EXPENSE | 16258725 | 16258725 | |
| EQUIPMENT RENTAL | 2226321 | 1902624 | 323697 |
| MISCELLANEOUS | 77716 | 38858 | 38858 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 149575645 | Total |
| Program Services | 130241867 | ProgramServices |
| Management And General | 19333778 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10967375 | BOY |
| EOY | 3926984 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18671084 | BOY |
| EOY | 18726801 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2402193 | BOY |
| EOY | 2577491 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1645249 | BOY |
| EOY | 996896 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 211541121 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 113214999 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 77915943 | BOY |
| EOY | 98326122 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22515685 | BOY |
| EOY | 16811570 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5020808 | BOY |
| EOY | 6479153 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 139138337 | BOY |
| EOY | 147845017 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14168068 | BOY |
| EOY | 16513740 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28000000 | BOY |
| EOY | 29400000 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 40217408 | BOY |
| EOY | 43535133 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 82385476 | BOY |
| EOY | 89448873 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 56752861 | BOY |
| EOY | 58396144 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 56752861 | BOY |
| EOY | 58396144 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 139138337 | BOY |
| EOY | 147845017 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 30501935 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 707175 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | -29565827 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $2,273 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 2273 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | LICKING MEMORIAL HOSPITAL PAYS $42,887 IN ANNUAL DUES TO OHIO HOSPITAL ASSOCIATION(OHA). OF THE TOTAL DUES PAID, 5.3% OR $2,273 ARE USED BY OHA TO SUPPORT LOBBYING ACTIVITIES OF THE ASSOCIATION. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1802878 | OtherCostOrOtherBasis |
| Book Value | 1802878 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 103561094 | OtherCostOrOtherBasis |
| Depreciation | 34696270 | Depreciation |
| Book Value | 68864824 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2840000 | OtherCostOrOtherBasis |
| Depreciation | 2149403 | Depreciation |
| Book Value | 690597 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 102680774 | OtherCostOrOtherBasis |
| Depreciation | 76369326 | Depreciation |
| Book Value | 26311448 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 656375 | OtherCostOrOtherBasis |
| Book Value | 656375 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 98326122 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DEFERRED PENSION AND RETIREE LIABILITY | $38,535,258 |
| ACCRUED INTEREST PAYABLE | $42,864 |
| ACCRUED MALPRACTICE | $4,887,019 |
| THIRD PARTY SETTLEMENT | $69,992 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 43535133 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X, LINE 2: | ReturnReference |
| Explanation | THE INTERNAL REVENUE SERVICE HAS RULED THAT THE SYSTEM, HOSPITAL, PROFESSIONAL CORPORATION, AND FOUNDATION ARE TAX-EXEMPT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. GAAP REQUIRES THE SYSTEM TO EVALUATE ITS TAX POSITIONS AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF IT HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS). THE SYSTEM HAS EVALUATED ITS TAX POSITIONS AND HAS CONCLUDED THAT THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE SYSTEM IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE SYSTEM BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2008. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent250 | X | Pcent250 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 18244 | PersonsServed |
| Total Community Benefit Expense | 9890810 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1860761 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8030049 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06020 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 30426 | PersonsServed |
| Total Community Benefit Expense | 23043542 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 12204735 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 10838807 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08130 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 48670 | PersonsServed |
| Total Community Benefit Expense | 32934352 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 14065496 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 18868856 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.14150 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 22932 | PersonsServed |
| Total Community Benefit Expense | 1675226 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 147364 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1527862 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01150 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 693 | PersonsServed |
| Total Community Benefit Expense | 649045 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 14650 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 634395 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00480 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6477 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 6477 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1984 | PersonsServed |
| Total Community Benefit Expense | 345827 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 345827 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00260 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 25609 | PersonsServed |
| Total Community Benefit Expense | 2676575 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 162014 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2514561 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01890 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 74279 | PersonsServed |
| Total Community Benefit Expense | 35610927 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 14227510 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 21383417 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.16040 | PercentOfTotalExpense |
Physical Improvements And Housing PhysicalImprovementsAndHousing
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 238 | PersonsServed |
| Total Community Building Expense | 7251 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 7251 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 500 | PersonsServed |
| Total Community Building Expense | 28107 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 28107 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 41618 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 41618 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Environmental Improvements EnvironmentalImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 100 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 100 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 300 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 300 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 20 | PersonsServed |
| Total Community Building Expense | 34110 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 34110 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 127 | PersonsServed |
| Total Community Building Expense | 4545 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 4545 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 885 | PersonsServed |
| Total Community Building Expense | 116031 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 116031 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00090 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $16,258,725 | BadDebtExpenseAmount |
| Amount Attributable To | 4755677 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 31957570 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 33950517 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -1992947 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LICKING MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1320 WEST MAIN STREET | AddressLine1 |
| City | NEWARK | City |
| State | OH | State |
| ZIP Code | 43055 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LICKING MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 250.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Medical Indigency | X | MedicalIndigency |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS PREPARED BY LICKING MEMORIAL HEALTH SYSTEMS AND INCLUDES LICKING MEMORIAL HEALTH SYSTEMS, LICKING MEMORIAL HOSPITAL, LICKING MEMORIAL PROFESSIONAL CORPORATION, LICKING MEMORIAL HEALTH FOUNDATION. | |
| PART I, LINE 7: THE ORGANIZATION USED THE CBISA SOFTWARE TO DETERMINE THE COST ACCOUNTING METHODOLOGY. | |
| PART I, LINE 7, COLUMN (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 $ 16258725. | |
| PART II: IT IS IMPORTANT TO NOTE THAT ALL ACTIVITIES ASSOCIATED WITH LICKING MEMORIAL HEALTH SYSTEMS (LMHS) REFLECT AND FURTHER THE MISSION OF "IMPROVING THE HEALTH OF THE COMMUNITY". WE DEFINE THE HEALTH OF THE COMMUNITY IN A BROAD SENSE IN ORDER TO INCLUDE ACTIVITIES THAT ARE NOT NECESSARILY HEALTH AND MEDICALLY RELATED, BUT WHICH ARE CRITICAL TO SUSTAINING A HEALTHY COMMUNITY, SUCH AS STRONG SCHOOL SYSTEMS, YOUTH PROGRAMS AND ARTS. TO PROMOTE HEALTH EDUCATION TO THE COMMUNITY, WE PUBLISH THE COMMUNITY CONNECTION, A BI-MONTHLY MAGAZINE MAILED TO APPROXIMATELY 50,000 HOUSEHOLDS THAT HIGHLIGHTS ALL OF THE COMMUNITY BUILDING ACTIVITES THROUGHOUT THE YEAR. ADVOCACY FOR THE HEALTH OF THE COMMUNITY IS NOT ONLY EVIDENT THROUGH THE COMMUNITY CONNECTION PUBLICATIONS, BUT THROUGH VARIOUS HEALTH-RELATED EVENTS AND CLASSES INCLUDING HEALTH FAIRS, SCHOOL PRESENTATIONS, HEALTH IMPROVEMENT SCREENINGS, AND WORKSHOPS THAT AID IN OVERALL HEALTH EDUCATION OF THE COMMUNITY. LMHS REGULARLY WELCOMES COMMUNITY MEMBERS TO ATTEND FREE EDUCATIONAL PROGRAMS AT THE HOSPITAL. PROGRAMS ARE DESIGNED TO EMPOWER COMMUNITY MEMBERS WITH THE INFORMATION NEEDED TO IMPROVE THEIR HEALTH AND THE HEALTH OF THEIR FAMILIES. TO FURTHER "IMPROVE THE HEALTH OF THE COMMUNITY", LMHS SUSTAINS ECONOMIC DEVELOPMENT BY EXISTING AS THE COUNTY'S LARGEST EMPLOYER. | |
| PART III, LINE 4: LINE 2 - THE ORGANIZATION USES THE CBISA SOFTWARE FOR COSTING METHODOLOGY, A SOFTWARE PROGRAM ENDORSED BY BOTH THE OHIO HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION.LINE 3 - THE ORGANIZATION EMPLOYED A PATIENT SCORING METHODOLOGY WHICH COMBINES NUMEROUS FINANCIAL INDICATORS TO ARRIVE AT A NUMERIC CREDIT SCORE. THIS SCORE INCLUDES THE PATIENTS ABILITY TO PAY BASED ON THE ESTIMATED HOUSEHOLD INCOME AS WELL AS THE PROBABILITY OF PAYMENT BEING MADE BASED ON HISTORICAL CREDIT INFORMATION.LINE 4 - SEE PAGE 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. | |
| PART III, LINE 8: THE MEDICARE SHORTFALL REPRESENTS AN UNDERPAYMENT OF OUR COST FOR PROVIDING SERVICES TO TRADITIONAL MEDICARE PATIENTS, OUR LARGEST PAYER. SINCE THIS SHORTFALL RELATES TO SUCH A LARGE PORTION OF OUR COMMUNITY, WE FEEL THE COST SHORTFALL IS A RELEVANT FACTOR WHEN CONSIDERING COMMUNITY BENEFIT.WE USE THE MEDICARE COST REPORT FOR COSTING METHODOLOGY FOR CALCULATING THE MEDICARE SHORTFALL.IN ADDITION TO TRADITIONAL MEDICARE SHORTFALLS, THE HOSPITAL PROVIDES SERVICES TO MEDICARE HMO PATIENTS AT OR BELOW COST AS A FURTHER BENEFIT TO OUR COMMUNITY. BY ADOPTING THE SAME METHODOLOGY FOR TRADITIONAL MEDICARE ABOVE, THE MEDICARE HMO SHORTFALL AMOUNTED TO $1,740,321.ALONG THAT SAME LINE, THE LICKING MEMORIAL PROFESSIONAL CORPORATION, ANOTHER LMHS SUBSIDIARY, PROVIDED SERVICES TO MEDICARE (TRADITIONAL AND HMO) BENEFICIARIES AT A COST SHORTFALL OF $4,602,043 USING A CBISA SOFTWARE COSTING METHOD. THE CBISA SOFTWARE IS ENDORSED BY BOTH THE OHIO HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION AS A COSTING METHOD UTILIZED FOR DETERMINING SHORTFALLS. | |
| PART III, LINE 9B: THE PATIENT ACCOUNTING DEPARTMENT IS RESPONSIBLE FOR THE COLLECTION OF PATIENTS' ACCOUNTS. THE OBJECTIVE OF THE DEPARTMENT IS TO COLLECT ACCOUNTS DUE THE HOSPITAL WHILE MAINTAINING POSITIVE GUEST RELATIONS.-PRIOR TO OR UPON ADMISSION, PATIENT INFORMATION IS OBTAINED BY THE REGISTRATION DEPARTMENT. THIS INFORMATION IS FORWARDED TO THE PATIENT ACCOUNT REPRESENTATIVE FOR MEDASSIST, INC. UPON ADMISSION.-WHENEVER POSSIBLE, SELF-PAY INPATIENTS ARE INTERVIEWED BY THE PATIENT ACCOUNT REPRESENTATIVE PRIOR TO DISCHARGE. PATIENTS WILL BE SCREENED FOR POSSIBLE STATE OR FEDERAL PROGRAM ELIGIBILITY, SUCH AS MEDICAID ORSOCIAL SECURITY DISABILITY. IF PATIENTS DO NOT MEET THE CRITERIA FOR THESE PROGRAMS, THEY WILL BE INFORMED OF THE UNCOMPENSATED CARE PROGRAMS AVAILABLE.- ALL STATEMENTS CONTAIN INFORMATION AND GUIDELINES FOR UNCOMPENSATED CARE. | |
| PART V, SECTION B, LINE 20D: THE HOSPITAL HAS A FINANCIAL ASSISTANCE POLICY IN PLACE THAT DISCOUNTS CARE TO THOSE APPLYING FOR AND MEETING THE INCOME LIMITS FOR DISCOUNTED CARE AT A RATE THAT IS GREATER THAN THE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATE. | LICKING MEMORIAL HOSPITAL |
| PART VI, LINE 2: WITH A MISSION OF "IMPROVING THE HEALTH OF THE COMMUNITY", LMHS CONTINUOUSLY MONITORS AND ASSESSES THE NEEDS OF OUR COMMUNITY IN A VARIETY OF METHODS. OUR ENTIRE LEADERSHIP TEAM IS VERY ACTIVE IN THE COMMUNITY, SERVING ON LOCAL, NOT-FOR-PROFIT BOARDS AND IN SERVICE CLUBS SUCH AS ROTARY AND KIWANIS. AS THE LARGEST EMPLOYER IN LICKING COUNTY, THE COMMUNITY LOOKS TO OUR MANAGEMENT STAFF FOR SUPPORT AND INVOLVEMENT IN MOST, IF NOT ALL, MAJOR INITIATIVES. THIS COMMUNITY INVOLVEMENT PROVIDES THE OPPORTUNITY TO COLLECT INFORMATION REGARDING THE NEEDS OF THE DIFFERENT ORGANIZATIONS. SENIOR MANAGEMENT IS VERY RESPONSIVE IN PROVIDING ASSISTANCE WHERE NEEDED AS THE INFORMATION BECOMES AVAILABLE.THE BOARDS OF DIRECTORS FOR LICKING MEMORIAL HOSPITAL (LMH) AND THE HEALTH SYSTEMS ARE VERY INTERESTED AND ACTIVELY ENGAGED IN THE COMMUNITY; THEREFORE, THEY ARE A GREAT RESOURCE IN MAKING ADMINISTRATION AWARE OF NEEDS. IN ADDITION, THE BOARD RECEIVES A MONTHLY REPORT AT EACH BOARD MEETING, HIGHLIGHTING ALL OF THE COMMUNITY ACTIVITIES SUPPORTED BY THE HOSPITAL INCLUDING DONATIONS MADE DURING THAT MONTH, HEALTH FAIRS, HEALTH SCREENINGS, MANAGEMENT AND PHYSICIANS SPEAKING IN THE COMMUNITY, ETC. PROVIDING ALL OF THIS INFORMATION TO THE BOARD ALLOWS THEM TO BE SUPPORTIVE AS ADMINISTRATION RECOMMENDS IMPLEMENTING NEW SERVICES OR ENHANCING EXISTING OFFERINGS.ORGANIZED UNDER THE HOSPITAL CORPORATION IS A 75 MEMBER DEVELOPMENT COUNCIL WHOSE PURPOSE IS TO EDUCATE THE COMMUNITY ABOUT THE HOSPITAL AND TO COMPLETE FUNDRAISING ACTIVITIES IN SUPPORT OF THE ORGANIZATION. THE MEMBERS OF THE LMH DEVELOPMENT COUNCIL ARE COMMUNITY LEADERS REPRESENTING ALL AREAS OF BUSINESS, INDUSTRY AND EDUCATION IN THE COMMUNITY. THESE ARE INDIVIDUALS WHO HAVE THEIR "FINGERS ON THE PULSE" OF THE COMMUNITY, AND ONE OF THEIR RESPONSIBILITIES AS AMBASSADORS IS TO MAKE THE ADMINISTRATION AWARE OF NEEDS IN THE COMMUNITY ESPECIALLY PERTAINING TO HEALTH CARE. AMONG MANY OUTREACH ACTIVITIES OF THE DEVELOPMENT COUNCIL, PROBABLY THE MOST PRODUCTIVE ARE THE COMMUNITY LEADER ROUNDTABLES THAT ARE SPONSORED BY THIS GROUP. THESE ARE LUNCHEONS SCHEDULED MONTHLY WITH THE HEALTH SYSTEMS PRESIDENT & CEO. DEVELOPMENT COUNCIL MEMBERS SERVE AS HOSTS, AND THEY INVITE 20-25 PEOPLE WITH SIMILAR INTERESTS. SOME EXAMPLES OF RECENT ROUNDTABLE GROUPS INCLUDE SCHOOL NURSES, SCHOOL ATHLETIC DIRECTORS AND COACHES, REALTORS, FIRE CHIEFS, LOCAL POLITICIANS, ETC. THESE FORUMS ARE ALWAYS VERY INFORMATIVE FOR BOTH ATTENDEES AND THE ADMINISTRATION AS WE SHARE INFORMATION ABOUT THE HOSPITAL AND THEN ASK FOR FEEDBACK FROM THE COMMUNITY LEADERS WHO ARE PRESENT. MANY TIMES, IDEAS FOR HOSPITAL INITIATIVES COME FROM THESE EVENTS.ANOTHER ACTIVITY OF THE DEVELOPMENT COUNCIL IS A QUARTERLY CORPORATE BREAKFAST. THESE EDUCATIONAL SESSIONS NORMALLY DRAW 100-125 ATTENDEES FOR BREAKFAST AND PROVIDE AN OPPORTUNITY TO EDUCATE THE COMMUNITY LEADERSHIP REGARDING HOSPITAL ACTIVITIES AND TO PROVIDE AN OPEN FORUM TO DISCUSS HEALTH CARE AND OTHER NEEDS WITHIN THE COMMUNITY. SPEAKERS AT THESE EVENTS HAVE RANGED FROM PHYSICIANS SPEAKING ABOUT HEART, VASCULAR, ENDOCRINOLOGY, CARING FOR AGING PATIENTS AND SLEEP MEDICINE, TO OUR DIRECTOR OF PASTORAL CARE PRESENTING ON HOW HIS DEPARTMENT SERVES THE SPIRITUAL NEEDS OF HOSPITAL PATIENTS AND THE COMMUNITY.IN 2012, THE DEVELOPMENT COUNCIL CREATED AN ADDITIONAL EVENT THAT OFFERS COMMUNITY MEMBERS AN OPPORTUNITY TO MEET PHYSICIANS WHO HAVE JOINED THE LMH ACTIVE MEDICAL STAFF. THE NEW PHYSICIAN RECEPTION IS HELD TWICE EACH YEAR TO SHOWCASE THE NEW PHYSICIANS AND PROVIDE COMMUNITY MEMBERS WITH AN OPPORTUNITY TO ASK QUESTIONS TO ASSIST IN THEIR CHOICE OF NEW HEALTHCARE PROVIDERS. THESE EVENTS ALSO PROVIDE EXCELLENT FEEDBACK FROM COMMUNITY MEMBERS AND PHYSICIANS ALIKE. THE HEALTH SYSTEMS' WEBSITE PROVIDES DETAILED INFORMATION ON THE VARIOUS PROGRAMS AVAILABLE AND PROVIDES A MECHANISM FOR COMMUNITY FEEDBACK. ALL REQUESTS COMING THROUGH THE WEBSITE RECEIVE CAREFUL CONSIDERATION AND A DETAILED RESPONSE.AN AFFILIATED PHYSICIAN GROUP, KNOWN AS THE LICKING MEMORIAL PROFESSIONAL CORPORATION, PROVIDES PHYSICIAN INPUT REGARDING THE NEEDS THEY IDENTIFY IN THEIR DAILY PRACTICE AND COMMUNITY INVOLVEMENT. THESE OBSERVATIONS ARE DISCUSSED WITH ADMINISTRATION FOR DEVELOPMENT OF PROGRAMS AND SERVICES TO ADDRESS SUCH NEEDS. | |
| PART VI, LINE 3: THE HEALTH SYSTEMS PROVIDES ASSISTANCE TO THOSE WHO ARE ABOVE THE FEDERAL POVERTY LEVEL BY OFFERING DISCOUNTED CARE BASED ON A SLIDING SCALE UP TO 250% OF THE FEDERAL POVERTY LEVEL. IN ADDITION, THE ORGANIZATION PROVIDES FREE OR DISCOUNTED CARE FOR THOSE WHO ARE CONSIDERED MEDICALLY INDIGENT. IN 2012, LMHS PROVIDED $42.1 MILLION OF UNCOMPENSATED CARE AT STANDARD CHARGES, INCLUDING $23.0 MILLION OF CHARITY CARE. HOWEVER, LMHS PROVIDES CARE TO THE ENTIRE COMMUNITY, REGARDLESS OF INCOME LEVELS. THAT MESSAGE IS SHARED WITH THE COMMUNITY IN A VARIETY OF WAYS. THE HEALTH SYSTEMS' WEBSITE PROVIDES INFORMATION ON ASSISTANCE FOR PAYING HOSPITAL BILLS THROUGH THE HOSPITAL CARE ASSURANCE PROGRAM/ COMMUNITY ASSISTANCE PROGRAM. THIS ALSO IS COMMUNICATED THROUGH BROCHURES AND APPLICATIONS WHICH HIGHLIGHT THE INCOME LEVEL-BASED NEEDS FOR THE PATIENT. IN ADDITION, THE BILLING STATEMENT SENT TO THE PATIENT OR GUARANTOR PROVIDES INSTRUCTIONS FOR ACCESSING CHARITY CARE. THIS INFORMATION ALSO CAN BE ACCESSED THROUGH THE BILLING OFFICE. FURTHERMORE, THE HEALTH SYSTEMS CONTRACTS WITH AN ELIGIBILITY COMPANY TO SCREEN AND IDENTIFY PATIENTS WHO ARE ELIGIBLE FOR ASSISTANCE, AND EMPLOYS THE USE OF EARLY-OUT AGENCIES TO PERFORM SELF-PAY BILLING SERVICES. THESE AGENCIES ROUTINELY IDENTIFY PATIENTS WHO ARE ELIGIBLE FOR ASSISTANCE AND PROVIDE APPLICATIONS FOR COMPLETION. THE LMH DEVELOPMENT COUNCIL HAS BEEN EDUCATED ABOUT OUR COMMITMENT TO PROVIDE CARE FOR THE ENTIRE COMMUNITY THAT MESSAGE IS SHARED IN THE COMMUNITY THROUGH THEIR GRASS ROOTS EFFORTS. | |
| PART VI, LINE 4: LICKING MEMORIAL HOSPITAL LOCATED IN NEWARK, OHIO THIRTY THREE MILES EAST OF COLUMBUS. THE CITY OF NEWARK HAS A POPULATION OF ABOUT 48,000 PEOPLE WITH A MEDIAN INCOME OF APPROXIMATELY $38,000. THE HOSPITAL SERVES THE COMMUNITY OF NEWARK AND LICKING COUNTY. LICKING COUNTY HAS A POPULATION OF APPROXIMATELY 166,000 (PER U.S. CENSUS BUREAU), A PER CAPITA INCOME OF APPROXIMATELY $22,000 AND AN UNEMPLOYMENT RATE OF 6.7%. | |
| PART VI, LINE 5: THROUGH THE MISSION OF "IMPROVING THE HEALTH OF THE COMMUNITY", LMHS PROMOTES HEALTH EDUCATION AND WELLNESS IN VARIOUS WAYS. LMHS PROVIDES SERVICES, WHICH INCLUDE PARTICIPATION IN MANY COMMUNITY HEALTH FAIRS THROUGHOUT THE COUNTY TO ENCOURAGE AND ADVANCE HEALTHCARE EDUCATION IN AREA SCHOOLS, CHURCHES, AND BUSINESSES; PROVIDED MANY FREE CLASSES REGARDING TOPICS SUCH AS CHILDBIRTH, INFANT AND CHILD CPR, BREASTFEEDING, SIBLING PREPARATION, DIABETES, NEWBORN BASICS, AND TOBACCO CESSATION; PROVIDED SUPPORT GROUPS FOR VICTIMS AND FAMILIES OF CANCER, DIABETES, CHEMICAL DEPENDENCY, AND HEART DISEASE; PROVIDED ASSISTANCE TO EDUCATORS THROUGH COALITIONS WITH STUDENT NURSES, OCCUPATIONAL THERAPY, AND PHYSICAL THERAPY INTERNS; PROVIDED SPEAKERS TO SCHOOLS, BUSINESSES, AND VARIOUS ORGANIZATIONS ON TOPICS SUCH AS TOBACCO CESSATION, LEADING AN ACTIVE AND HEALTHY LIFESTYLE, AND DIABETES EDUCATION. THE SCHEDULE IS FOUND ONLINE OR PRINTED THROUGH OUR BI-MONTHLY COMMUNITY CONNECTION PUBLICATION FOR THE COMMUNITY TO ACKNOWLEDGE. LMHS ALSO PROMOTES HEALTH AND WELLNESS TO THE COMMUNITY THROUGH A VARIETY OF INITIATIVES. IN 2012, THE HEALTH SYSTEMS CREATED THE ACTIVE-FIT YOUTH WELLNESS PROGRAM, TARGETING YOUTH AGES 6-12. THE PROGRAM OFFERS A FREE ONLINE GOAL-ORIENTED WELLNESS ACTIVITY PLAN WITH INCENTIVES FOR THOSE WHO COMPLETE THEIR GOALS. THE PROGRAM ALSO FEATURES UNIQUE COMMUNITY EVENTS TO HELP THE PARTICIPANTS STAY ACTIVE AND LEARN HOW TO BETTER CARE FOR THEIR PERSONAL HEALTH. THE PROGRAM HAS BEEN PROMOTED DIRECTLY TO THE YOUTH WITH SCHOOL ASSEMBLY PRESENTATIONS AND THROUGH AN AGGRESSIVE ADVERTISING AND MARKETING CAMPAIGN TO THE COMMUNITY.THE HEALTH SYSTEMS ALSO EMPHASIZES THE NEED FOR EXCELLENT PERSONAL HEALTH TO A VARIETY OF DEMOGRAPHICS THROUGH SPECIAL EVENTS. FOR EXAMPLE, LMHS INVITES COMMUNITY MEMBERS EACH YEAR TO A RED DRESS GALA EVENT FEATURING SPEAKER PRESENTATIONS, DEMONSTRATIONS, HEALTH SCREENINGS AND HEART-HEALTHY FOODS. EACH SUMMER, LMHS OFFERS THE HEART TO PLAY PROGRAM TO LICKING COUNTY JUNIOR- AND HIGH SCHOOL STUDENTS. THE PROGRAM FEATURES HEALTH REVIEW EVENTS THROUGHOUT THE SUMMER MONTHS WITH AN EKG HEART SCREENING, IN ADDITION TO A HEALTH AND CONCUSSION SCREENING.THE HEALTH SYSTEMS ALSO DEVOTES RESOURCES TO A HEALTH-RELATED COMMUNITY BENEFIT PROJECT EACH YEAR. IN 2012, LMHS PROMOTED COMMUNITY HEALTH BY OFFERING ALL LICKING COUNTY HIGH SCHOOLS THEIR CHOICE OF EXERCISE EQUIPMENT TO BE UTILIZED BY THE STUDENT POPULATION. | |
| PART VI, LINE 6: LICKING MEMORIAL HEALTH SYSTEMS (THE SYSTEM) IS A NONPROFIT CORPORATION ORGANIZED UNDER THE LAWS OF THE STATE OF OHIO TO PROVIDE AND PROMOTE HEALTH CARE SERVICES IN CENTRAL OHIO.THE SYSTEM IS THE PARENT ORGANIZATION AND SOLE CORPORATE MEMBER OF LICKING MEMORIAL HOSPITAL (THE HOSPITAL), LICKING MEMORIAL HEALTH FOUNDATION (THE FOUNDATION), AND LICKING MEMORIAL PROFESSIONAL CORPORATION (THE PROFESSIONAL CORPORATION).THE PROFESSIONAL CORPORATION EMPLOYS A STAFF OF PHYSICIANS AND SUPPORT PERSONNEL TO FURTHER THE SYSTEM'S CHARITABLE PURPOSE. THE PROFESSIONAL CORPORATION HAS A SOLE PHYSICIAN SHAREHOLDER, WHO, UNDER A SHARED CONTROL AGREEMENT, ASSIGNED THE VOTING RIGHTS OF THE STOCK TO THE SYSTEM. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROBERT MONTAGNESE | ||||||||||||||
| PRESIDENT & CEO | 390932 | 0 | 1000 | 0 | 20773 | 0 | 100277 | 0 | 0 | 0 | 512982 | 0 | 0 | 0 |
| CINDY WEBSTER | ||||||||||||||
| V.P. FINANCIAL SERVICES | 150812 | 0 | 2316 | 0 | 12633 | 0 | 11087 | 0 | 0 | 0 | 176848 | 0 | 0 | 0 |
| CRAIG CAIRNS | ||||||||||||||
| VP MEDICAL AFFAIRS | 226076 | 0 | 2205 | 0 | 13360 | 0 | 16163 | 0 | 0 | 0 | 257804 | 0 | 0 | 0 |
| DEBORAH YOUNG | ||||||||||||||
| VP PATIENT CARE | 149202 | 0 | 2316 | 0 | 12617 | 0 | 10978 | 0 | 0 | 0 | 175113 | 0 | 0 | 0 |
| SALLIE ARNETT | ||||||||||||||
| VP INFO SYSTEMS | 147688 | 0 | 2229 | 0 | 12601 | 0 | 10870 | 0 | 0 | 0 | 173388 | 0 | 0 | 0 |
| VERONICA LINK | ||||||||||||||
| VP PR & DEVELOPMENT | 137354 | 0 | 2248 | 0 | 12502 | 0 | 10174 | 0 | 0 | 0 | 162278 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 4B | ReturnReference |
| Explanation | ROBERT MONTAGNESE, PRESIDENT, PARTICIPATES IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). A CONTRIBUTION WAS MADE TO THE PLAN ON HIS BEHALF FOR THE 2012 YEAR IN THE AMOUNT OF $72,672. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | A DRAFT OF THE RETURN IS REVIEWED FIRST BY INTERNAL MANAGEMENT. AFTER INTERNAL MANAGEMENT HAS REVIEWED THE RETURN AND ANY CHANGES ARE MADE A DRAFT IS MADE AVAILABLE FOR REVIEW AND PRESENTATION TO THE BOARD. ONCE THE COMMENTS FROM THE BOARD ARE REVIEWED THE FINAL RETURN IS PREPARED AND SIGNED BY THE VICE PRESIDENT OF FINANCIAL SERVICES. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION REQUIRES ALL BOARD MEMBERS AND KEY EMPLOYEES TO SIGN A CONFLICT OF INTEREST STATEMENT ONCE A YEAR. THE ORGANIZATION DOES NOT PERMIT BOARD MEMBERS TO HAVE A CONFLICT OF INTEREST. IF A BOARD MEMBER HAS A CONFLICT OF INTEREST THEY ARE ASKED TO RESIGN FROM THE BOARD. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION HAS AN INDEPENDENT COMPENSATION COMMITTEE THAT DETERMINES THE COMPENSATION FOR THE CEO THAT IS THEN APPROVED BY THE BOARD. THE CEO DETERMINES THE COMPENSATION FOR THE OTHER OFFICERS BASED UPON INDEPENDENT SALARY SURVEYS. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. | |
| FORM 990, PART XI, LINE 9: | CHANGE IN MINIMUM PENSION LIABILITY -2,947,803. CHANGE IN RETIREE BENEFIT PLAN -356,170. NET ASSET TRANSFERS WITH RELATED 501(C)(3) -26,261,854. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PAGE 12, PART XII LINE 2C: | THERE WAS NO CHANGE IN THE OVERSIGHT PROCESS OR SELECTION PROCESS OF THE INDEPENDENT AUDITOR. LICKING MEMORIAL HOSPITAL CONTINUES TO BE AUDITED AS PART OF THE LICKING MEMORIAL HEALTH SYSTEMS CONSOLIDATED GROUP. LICKING MEMORIAL HOSPITAL IS INCLUDED IN THE LICKING MEMORIAL HEALTH SYSTEMS CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION HAS A FINANCE COMMITTEE THAT OVERSEES THE AUDIT OF THE FINANCIAL STATEMENTS AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. | |
| FORM 990, PAGE 2 PROGRAM SERVICES | MONETARY INPUTS OUTPUTS TITLE/DEPARTMENT EXPENSES OFFSETS BENEFIT PERSONS 12 LEAD EKG PROJECT CARDIOLOGY (1712) 6,477 0 6,477 UNKNOWN 20TH CENTURY CLUB CASH DONATIONS DEVELOPMENT (1955) 1,260 0 1,260 UNKNOWN AARP SPEAKER PUBLIC RELATIONS (1956) 183 0 183 28 ACTIVE FIT PRESENTATIONS PUBLIC RELATIONS (1956) 22,451 0 22,451 7,582 ACTIVE FIT YOUTH WELLNESS EVENTS PUBLIC RELATIONS (1956) 9,684 0 9,684 520 ACTIVITY AND DIABETES PROCESS IMPROVEMENT (1945) 124 0 124 4 ADVANTAGE CLUB CASH DONATIONS DEVELOPMENT (1955) 300 0 300 UNKNOWN ALCOHOL & DRUG ADDICTION PROCESS IMPROVEMENT (1945) 364 0 364 16 AMERICAN CANCER SOCIETY CASH DONATIONS DEVELOPMENT (1955) 2,490 0 2,490 UNKNOWN AMERICAN RED CROSS IN KIND DONATIONS DEVELOPMENT (1955) 400 0 400 UNKNOWN AMERICAN RED CROSS OF LICKING COUNTY CASH DONATIONS DEVELOPMENT (1955) 1,875 0 1,875 UNKNOWN ANXIETY AND DEPRESSION PROCESS IMPROVEMENT (1945) 359 0 359 26 ARE YOU AT RISK FOR A HEART ATTACK? PROCESS IMPROVEMENT (1945) 381 0 381 19 ART FROM THE HEART DEVELOPMENT (1955) 4,545 0 4,545 127 ASK THE DOC AT SHEPHERD HILL OP CHEMICAL DEPENDENCY (1692) 11,527 0 11,527 1,230 ASTHMA AND ALLERGIES PROCESS IMPROVEMENT (1945) 165 0 165 3 BATTLE FOR 161 STICKING IT TO BREAST CANCER CASH DONATIONS DEVELOPMENT (1955) 500 0 500 UNKNOWN BEHAVIORAL HEALTH CARE PARTNERS CASH DONATIONS DEVELOPMENT (1955) 250 0 250 UNKNOWN BEHAVIORAL HEALTH CARE PARTNERS IN KIND DONATIONS DEVELOPMENT (1955) 900 0 900 UNKNOWN BETTER BREATHING PROCESS IMPROVEMENT (1945) 604 0 604 13 BEYOND NEW YEAR'S RESOLUTIONS PROCESS IMPROVEMENT (1945) 548 0 548 16 BIG BROTHERS/BIG SISTERS CASH DONATIONS DEVELOPMENT (1955) 5,550 0 5,550 UNKNOWN BIG BROTHERS/BIG SISTERS HOLIDAY HELP PROGRAM DEVELOPMENT (1955) 5,030 0 5,030 130 BOY SCOUTS OF AMERICA CAMP FALLING ROCK IN KIND DONATION DEVELOPMENT (1955) 500 0 500 UNKNOWN BOY SCOUTS OF AMERICA SIMON KENTON COUNCIL CASH DONATIONS DEVELOPMENT (1955) 2,000 0 2,000 UNKNOWN BREAST CA AWARENESS DAY FREE MAMMOGRAMS RADIOLOGY (1721) 13,486 0 13,486 53 BREAST CANCER AWARENESS & SCREENING EDUCATION (1616) 690 0 690 8 BREAST FEEDING BASICS MATERNAL CHILD (1646) 10,112 7,775 2,337 660 BREASTFEEDING PROMOTION & SUPPORT PROGRAM MATERNAL CHILD (1646) 56,320 0 56,320 352 BREATHE DEEP WALK/RALLY SPEAKER ONCOLOGY (7405) 955 0 955 UNKNOWN C TEC ANNUAL RECOGNITION BRUNCH CASH DONATIONS DEVELOPMENT (1955) 200 0 200 UNKNOWN C TEC MEDICAL ASSISTANT EXTERNSHIP PROGRAM EXECUTIVE ADMIN LMHP (7445) 10,655 0 10,655 4 C TEC OUTSTANDING STUDENT AWARD SPONSORSHIP DEVELOPMENT (1955) 200 0 200 UNKNOWN CADE AND KATELYN FUND COMMITTEE CASH DONATIONS DEVELOPMENT (1955) 400 0 400 UNKNOWN CALL TO COLLEGE MEMORIAL DONATION DEVELOPMENT (1955) 2,500 0 2,500 UNKNOWN CAMP FEELIN' FINE RESPIRATORY THERAPY (1736) 5,581 0 5,581 38 CAMP O'BANNON CASH DONATIONS DEVELOPMENT (1955) 1,850 0 1,850 UNKNOWN CAMP O'BANNON IN KIND DONATIONS DEVELOPMENT (1955) 700 0 700 UNKNOWN CAROL STRAWN CENTER CASH DONATIONS DEVELOPMENT (1955) 600 0 600 UNKNOWN CBISA SOFTWARE FISCAL SERVICES (1901) 900 0 900 UNKNOWN CENTER FOR DISABILITY SERVICES IN KIND DONATIONS DEVELOPMENT (1955) 3,050 0 3,050 UNKNOWN CENTER FOR VISUALLY IMPAIRED IN KIND DONATIONS DEVELOPMENT (1955) 200 0 200 UNKNOWN CHAPEL GROVE SPEAKER PUBLIC RELATIONS (1956) 535 0 535 52 CHERRY VALLEY ELEMENTARY IN KIND DONATIONS DEVELOPMENT (1955) 225 0 225 UNKNOWN CHILD ADVOCACY CENTER OF LICKING COUNTY CASH DONATION DEVELOPMENT (1955) 150 0 150 UNKNOWN CHILDREN'S READING FOUNDATION OF LICKING COUNTY CASH DONATIONS DEVELOPMENT (1955) 2,500 0 2,500 UNKNOWN CHRISTIAN COMPANIONS OF SECOND CHURCH OF CHRIST SPEAKER PUBLIC RELATIONS (1956) 1,014 0 1,014 40 CITIZENS FOR PARKS, PATHS AND TRAILS CASH DONATIONS DEVELOPMENT (1955) 2,500 0 2,500 UNKNOWN CITY OF NEWARK PARKS AND RECREATION COMMUNITY SUPPORT DEVELOPMENT (1955) 306 0 306 UNKNOWN CLINICAL EDUCATION OF ECHOSONOGRAPHERS (CARDIOLOGY) CARDIOLOGY (1712) 18,188 0 18,188 6 COMMUNITY BENEFIT REPORTING HOURS FISCAL SERVICES (1901) 6,693 0 6,693 UNKNOWN COMMUNITY BOARD/COMMITTEE MEETINGS (COMMUNITY BENEFIT) EXECUTIVE ADMIN (1950) 19,483 0 19,483 200 COMMUNITY BOARD/COMMITTEE MEETINGS (COMMUNITY SUPPORT) EXECUTIVE ADMIN (1950) 17,907 0 17,907 UNKNOWN COMMUNITY BOARD/COMMITTEE MEETINGS (HOUSING REHABILITATION) EXECUTIVE ADMIN (1950) 992 0 992 238 COMMUNITY BOARD/COMMITTEE MEETINGS (PHYSICAL IMPROVEMENTS) EXECUTIVE ADMIN (1950) 1,675 0 1,675 UNKNOWN COMMUNITY BOARD/COMMITTEE MEETINGS (WORKFORCE DEVELOPMENT) EXECUTIVE ADMIN (1950) 5,282 0 5,282 UNKNOWN COMMUNITY CASE MANAGEMENT SERVICES COMMUNITY CASE MANAGEMENT (1976) 724,536 98,171 626,365 UNKNOWN COMMUNITY HEALTH & RECOVERY BOARD CASH DONATIONS DEVELOPMENT (1955) 10,000 0 10,000 UNKNOWN COMMUNITY HEALTH ASSESSMENT COMMITTEE PROCESS IMPROVEMENT (1945) 1,877 0 1,877 UNKNOWN COMMUNITY NEEDS ASSESSMENT COSTS FISCAL SERVICES (1901) 11,105 0 11,105 UNKNOWN COSTS ASSOCIATED WITH POWER OUTAGE PROCESS IMPROVEMENT (1945) 4,129 0 4,129 UNKNOWN COTC LPN CLASS PUBLIC RELATIONS (1956) 132 0 132 31 DAWES ARBORETUM CASH DONATIONS DEVELOPMENT (1955) 900 0 900 UNKNOWN DAWES ARBORETUM EDUCATIONAL SERIES PUBLIC RELATIONS (1956) 526 0 526 102 DELTA KAPPA GAMMA SPEAKER PUBLIC RELATIONS (1956) 439 0 439 25 DENISON UNIVERSITY EMPLOYEE HEALTH FAIR PUBLIC RELATIONS (1956) 177 0 177 250 DENTISTRY FROM THE HEART IN KIND DONATIONS DEVELOPMENT (1955) 159 0 159 UNKNOWN DINING WITH DIABETES PROCESS IMPROVEMENT (1945) 3,400 0 3,400 85 DINING WITH DIABETES HOLIDAY REUNION PUBLIC RELATIONS (1956) 291 0 291 115 DONATION OF CARDIO EQUIPMENT TO HIGH SCHOOLS DEVELOPMENT (1955) 75,260 0 75,260 UNKNOWN DONATION OF MEAT TO SALVATION ARMY DEVELOPMENT (1955) 5,690 0 5,690 UNKNOWN DONATION OF SUPPLIES TO IMPOVERISHED COUNTRIES PURCHASING (1675) 113,318 0 113,318 UNKNOWN DONATION OF UNBRANDED WATER IN KIND DEVELOPMENT (1955) 198 0 198 UNKNOWN DRUG ASSISTANT INDIGENT DRUG RECOVERY EXECUTIVE ADMIN LMHP (7445) 54,419 0 54,419 2,571 EASING THE FEAR OF CANCER PROCESS IMPROVEMENT (1945) 119 0 119 2 EASTSIDE EXPRESS BASEBALL CASH DONATIONS DEVELOPMENT (1955) 1,000 0 1,000 UNKNOWN EASY EXERCISES FOR HOME OR WORK PROCESS IMPROVEMENT (1945) 140 0 140 5 EMERGENCY SERVICES FOR INDIGENT PATIENTS FISCAL SERVICES (1901) 166,207 0 166,207 UNKNOWN FAMILY & FRIENDS INFANT AND CHILD CPR MATERNAL CHILD (1646) 1,152 515 637 104 FLOWER PLANTING NEWARK CITY SQUARE VOLUNTEERS (1970) 434 0 434 UNKNOWN GET YOUNG WELLNESS EXPO DERMATOLOGY DOCTOR'S PARK 2 (7417) 1,259 0 1,259 UNKNOWN GLENN'S MARKET SCREENINGS COMMUNITY CASE MANAGEMENT (1976) 1,428 0 1,428 88 GRANVILLE AREA CHAMBER OF COMMERCE CASH DONATIONS DEVELOPMENT (1955) 500 0 500 UNKNOWN GRANVILLE ELEMENTARY AND INTERMEDIATE SCHOOL PTO CASH DONATIONS DEVELOPMENT (1955) 500 0 500 UNKNOWN GRANVILLE HIGH SCHOOL CASH DONATIONS DEVELOPMENT (1955) 1,500 0 1,500 UNKNOWN GRANVILLE KIWANIS CLUB SPEAKER PUBLIC RELATIONS (1956) 182 0 182 50 GRANVILLE MIDDLE SCHOOL SPEAKER PUBLIC RELATIONS (1956) 370 0 370 45 GRANVILLE RECREATION DISTRICT CASH DONATIONS DEVELOPMENT (1955) 750 0 750 UNKNOWN GRANVILLE ROTARY FOUNDATION CASH DONATIONS DEVELOPMENT (1955) 1,500 0 1,500 UNKNOWN HARRY & DAVID SPEAKER PUBLIC RELATIONS (1956) 192 0 192 96 HARTFORD FAIR HEALTH SCREENINGS & HEALTH EDUCATION PUBLIC RELATIONS (1956) 8,633 0 8,633 1,200 HEALTHCARE MEDIA INTERVIEWS PUBLIC RELATIONS (1956) 119 0 119 UNKNOWN | COMMUNITY BENEFIT FOR LICKING MEMORIAL HEALTH SYSTEM CONSOLIDATED GROUP |
| HEALTHY DINING CHOICES PROCESS IMPROVEMENT (1945) 148 0 148 9 HEALTHY MEALS FROM START TO FINISH PROCESS IMPROVEMENT (1945) 298 0 298 10 HEARING LOSS PROCESS IMPROVEMENT (1945) 188 0 188 6 HEART FAILURE PROCESS IMPROVEMENT (1945) 323 0 323 12 HEARTBEATS OF LICKING COUNTY CASH DONATIONS DEVELOPMENT (1955) 450 0 450 UNKNOWN HEARTBURN & REFLUX PROCESS IMPROVEMENT (1945) 1,267 0 1,267 29 HEATH CHURCH OF CHRIST SPEAKERS BUREAU PUBLIC RELATIONS (1956) 151 0 151 49 HEATH FIRE DEPARTMENT OPEN HOUSE PUBLIC RELATIONS (1956) 167 0 167 60 HEATH HIGH SCHOOL CASH DONATIONS DEVELOPMENT (1955) 375 0 375 UNKNOWN HEATH SERTOMA YOUTH ATHLETIC ASSOCIATION CASH DONATIONS DEVELOPMENT (1955) 450 0 450 UNKNOWN HEBRON BABY PANTRY IN KIND DONATIONS DEVELOPMENT (1955) 550 0 550 UNKNOWN HERITAGE MIDDLE SCHOOL SPEAKER PUBLIC RELATIONS (1956) 252 0 252 124 HOSPICE OF CENTRAL OHIO CASH DONATIONS DEVELOPMENT (1955) 800 0 800 UNKNOWN HOSPICE OF CENTRAL OHIO COMMUNITY SUPPORT DEVELOPMENT (1955) 260 0 260 UNKNOWN HOW TO READ A FOOD LABEL PROCESS IMPROVEMENT (1945) 132 0 132 7 IMMUNIZATION OF PATIENTS AGES 65 AND OVER FOR TD EXECUTIVE ADMIN LMHP (7445) 6,479 0 6,479 243 JUVENILE DIABETES RESEARCH FOUNDATION IN KIND DONATIONS DEVELOPMENT (1955) 127 0 127 UNKNOWN KIWANIS CLUB OF GRANVILLE CASH DONATIONS DEVELOPMENT (1955) 150 0 150 UNKNOWN LAKEWOOD GIRLS SUMMER SOFTBALL CASH DONATIONS DEVELOPMENT (1955) 450 0 450 UNKNOWN LAKEWOOD LITTLE LEAGUE CASH DONATIONS DEVELOPMENT (1955) 350 0 350 UNKNOWN LAKEWOOD YOUTH BASEBALL ASSOCIATION CASH DONATIONS DEVELOPMENT (1955) 625 0 625 UNKNOWN LCESC JR. HIGH CAREER EXPLORATION HUMAN RESOURCES (1951) 928 0 928 20 LEADS HEADSTART SPEAKER PUBLIC RELATIONS (1956) 300 0 300 146 LEGEND ELEMENTARY IN KIND DONATIONS DEVELOPMENT (1955) 120 0 120 UNKNOWN LIBERTY MIDDLE SCHOOL SPEAKERS BUREAU PUBLIC RELATIONS (1956) 820 0 820 336 LICCO INC. IN KIND DONATIONS DEVELOPMENT (1955) 450 0 450 UNKNOWN LICKING COUNTY AGING PROGRAM IN KIND DONATIONS DEVELOPMENT (1955) 3,875 0 3,875 UNKNOWN LICKING COUNTY AGING PROGRAM SPEAKER PUBLIC RELATIONS (1956) 278 0 278 39 LICKING COUNTY CHAMBER OF COMMERCE CASH DONATIONS DEVELOPMENT (1955) 12,110 0 12,110 UNKNOWN LICKING COUNTY CHAMBER OF COMMERCE GROUND HOG BREAKFAST DEVELOPMENT (1955) 15,157 0 15,157 500 LICKING COUNTY CHAMBER OF COMMERCE BIZ FEST & TASTE OF LICKING CO. COMMUNITY CASE MANAGEMENT (1976) 381 0 381 100 LICKING COUNTY COALITION FOR HOUSING CASH DONATIONS DEVELOPMENT (1955) 650 0 650 UNKNOWN LICKING COUNTY COALITION OF CARE CASH DONATIONS DEVELOPMENT (1955) 500 0 500 UNKNOWN LICKING COUNTY DIABETES FORUM PUBLIC RELATIONS (1956) 226 0 226 25 LICKING COUNTY FAMILY YMCA CASH DONATIONS DEVELOPMENT (1955) 6,750 0 6,750 UNKNOWN LICKING COUNTY FAMILY YMCA IN KIND DONATIONS DEVELOPMENT (1955) 1,100 0 1,100 UNKNOWN LICKING COUNTY GOVERNMENT SPEAKER PUBLIC RELATIONS (1956) 181 0 181 90 LICKING COUNTY HEALTH DEPARTMENT CASH DONATIONS DEVELOPMENT (1955) 400 0 400 UNKNOWN LICKING COUNTY HEALTH DEPARTMENT CHLAMYDIA/GC SCREENINGS LAB (1702) 5,005 0 5,005 126 LICKING COUNTY HISTORICAL SOCIETY CASH DONATIONS DEVELOPMENT (1955) 525 0 525 UNKNOWN LICKING COUNTY HUMANE SOCIETY CASH DONATIONS DEVELOPMENT (1955) 300 0 300 UNKNOWN LICKING COUNTY PRAYER PARTNERS CASH DONATIONS DEVELOPMENT (1955) 1,000 0 1,000 UNKNOWN LICKING COUNTY RETIRED TEACHERS SPEAKER PUBLIC RELATIONS (1956) 108 0 108 40 LICKING COUNTY SAFETY COUNCIL SPEAKER PUBLIC RELATIONS (1956) 376 0 376 26 LICKING COUNTY SHERIFF'S DEPARTMENT CASH DONATIONS DEVELOPMENT (1955) 292 0 292 UNKNOWN LICKING COUNTY SOIL & WATER CONSERVATION DISTRICT CASH DONATIONS DEVELOPMENT (1955) 100 0 100 UNKNOWN LICKING COUNTY SPECIAL OLYMPICS CASH DONATIONS DEVELOPMENT (1955) 100 0 100 UNKNOWN LICKING COUNTY SPORTS ASSOCIATION CASH DONATIONS DEVELOPMENT (1955) 325 0 325 UNKNOWN LICKING KNOX GOODWILL SPEAKER PUBLIC RELATIONS (1956) 104 0 104 12 LICKING KNOX GOODWILL INDUSTRIES IN KIND DONATIONS DEVELOPMENT (1955) 200 0 200 UNKNOWN LICKING VALLEY HERITAGE SOCIETY CASH DONATIONS DEVELOPMENT (1955) 600 0 600 UNKNOWN LICKING VALLEY HIGH SCHOOL CASH DONATIONS DEVELOPMENT (1955) 200 0 200 UNKNOWN LICKING VALLEY HIGH SCHOOL IN KIND DONATIONS DEVELOPMENT (1955) 147 0 147 UNKNOWN LICKING VALLEY YOUTH SPORTS ASSOCIATION CASH DONATIONS DEVELOPMENT (1955) 850 0 850 UNKNOWN LICKING/KNOX COUNTY DENTAL HYGIENE COMPONENT SPEAKER PUBLIC RELATIONS (1956) 296 0 296 10 LOOK UP CENTER CASH DONATIONS DEVELOPMENT (1955) 5,000 0 5,000 UNKNOWN LOOK UP CENTER IN KIND DONATIONS DEVELOPMENT (1955) 2,550 0 2,550 UNKNOWN LOSING WEIGHT THE SAFE AND EFFECTIVE WAY PROCESS IMPROVEMENT (1945) 899 0 899 65 LUNGEVITY SPEAKERS BUREAU PUBLIC RELATIONS (1956) 2,625 0 2,625 200 LUNGEVITY FOUNDATION CASH DONATIONS DEVELOPMENT (1955) 500 0 500 UNKNOWN MASSAGE IN HEALTH CARE PROCESS IMPROVEMENT (1945) 107 0 107 12 MEDICATION FOR DIABETES PROCESS IMPROVEMENT (1945) 213 0 213 5 MENTAL HEALTH AMERICA SPEAKERS PUBLIC RELATIONS (1956) 171 0 171 19 MENTAL HEALTH AMERICA OF LICKING COUNTY CASH DONATIONS DEVELOPMENT (1955) 1,100 0 1,100 UNKNOWN MISSION TRIP DRUGS AND SUPPLIES DEVELOPMENT (1955) 2,930 0 2,930 UNKNOWN MONROE TOWNSHIP FIRE DEPARTMENT SPEAKER PUBLIC RELATIONS (1956) 369 0 369 54 MONTESSORI SCHOOL SPEAKERS BUREAU PUBLIC RELATIONS (1956) 143 0 143 20 MOUND CITY LITTLE LEAGUE CASH DONATIONS DEVELOPMENT (1955) 600 0 600 UNKNOWN MOVIE NIGHT HEALTH SCREENINGS PUBLIC RELATIONS (1956) 118 0 118 70 MPW LUNCH AND LEARN PUBLIC RELATIONS (1956) 240 0 240 20 NATIONAL MULTIPLE SCLEROSIS SOCIETY CASH DONATIONS DEVELOPMENT (1955) 500 0 500 UNKNOWN NEW ALBANY BOY'S LACROSSE SPEAKERS BUREAU PUBLIC RELATIONS (1956) 144 0 144 200 NEWARK CAMPUS DEVELOPMENT FUND CASH DONATIONS DEVELOPMENT (1955) 25,000 0 25,000 UNKNOWN NEWARK CATHOLIC COMMUNITY SUPPORT DEVELOPMENT (1955) 114 0 114 UNKNOWN NEWARK CATHOLIC HIGH SCHOOL ATHLETIC DEPT. CASH DONATIONS DEVELOPMENT (1955) 650 0 650 UNKNOWN NEWARK CITY SCHOOLS CASH DONATIONS DEVELOPMENT (1955) 1,050 0 1,050 UNKNOWN NEWARK GENERALS HOCKEY CLUB CASH DONATIONS DEVELOPMENT (1955) 2,000 0 2,000 UNKNOWN NEWARK GRANVILLE SYMPHONY ORCHESTRA CASH DONATIONS DEVELOPMENT (1955) 2,500 0 2,500 UNKNOWN NEWARK KIWANIS CLUB CASH DONATIONS DEVELOPMENT (1955) 750 0 750 UNKNOWN NEWARK MIDLAND THEATRE CASH DONATIONS DEVELOPMENT (1955) 1,150 0 1,150 UNKNOWN NEWARK PARKS AND RECREATION DISTRICT SPEAKER PUBLIC RELATIONS (1956) 240 0 240 50 NEWARK PUBLIC LIBRARY SPEAKER PUBLIC RELATIONS (1956) 429 0 429 30 NEWBORN BASICS MATERNAL CHILD (1646) 1,362 460 902 92 NORTH NEWARK BASEBALL CASH DONATIONS DEVELOPMENT (1955) 100 0 100 UNKNOWN NORTH NEWARK BASEBALL IN KIND DONATIONS DEVELOPMENT (1955) 620 0 620 UNKNOWN NORTH NEWARK LITTLE LEAGUE VARSITY AND FARM CASH DONATIONS DEVELOPMENT (1955) 600 0 600 UNKNOWN NORTHRIDGE ATHLETIC BOOSTERS CASH DONATIONS DEVELOPMENT (1955) 500 0 500 UNKNOWN OHIO CANCER RESEARCH ASSOCIATES CASH DONATIONS DEVELOPMENT (1955) 3,250 0 3,250 UNKNOWN OPERATION FEED IN KIND DONATIONS VOLUNTEERS (1970) 18,771 0 18,771 UNKNOWN OPPORTUNITY LINKS SPEAKER PUBLIC RELATIONS (1956) 426 0 426 120 OUR SAVIOR LUTHERAN IN KIND DONATIONS DEVELOPMENT (1955) 360 0 360 UNKNOWN PACKAGING CORP OF AMERICA SPEAKER PUBLIC RELATIONS (1956) 117 0 117 75 PAR EXCELLENCE SPEAKERS PUBLIC RELATIONS (1956) 218 0 218 113 PARKINSON SUPPORT GROUP SPEAKER PUBLIC RELATIONS (1956) 196 0 196 27 | ||
| PATASKALA AREA CHAMBER OF COMMERCE CASH DONATIONS DEVELOPMENT (1955) 340 0 340 UNKNOWN PATASKALA ELEMENTARY SCHOOL VISIT VOLUNTEERS (1970) 412 0 412 110 PATASKALA RECREATION ASSOCIATION (PRA) CASH DONATIONS DEVELOPMENT (1955) 100 0 100 UNKNOWN PATASKALA'S STERLING THEATER CASH DONATIONS DEVELOPMENT (1955) 250 0 250 UNKNOWN PATHWAYS OF CENTRAL OHIO CASH DONATIONS DEVELOPMENT (1955) 1,000 0 1,000 UNKNOWN PEDIATRIC DENTAL CLINIC DENTAL CLINIC (1958) 96,000 40,363 55,637 UNKNOWN PELOTONIA CASH DONATIONS DEVELOPMENT (1955) 2,500 0 2,500 UNKNOWN PRE KINDERGARTEN PHYSICALS FAMILY PRACTICE EAST (7425) 475 0 475 UNKNOWN PRECEPTING NURSING STUDENTS 4N & 4S 4 SOUTH (1614) 19,545 0 19,545 10 PRECEPTING NURSING STUDENTS 5S 5 SOUTH (1612) 5,099 0 5,099 3 PRECEPTING NURSING STUDENTS GI LAB ENDO DIAGNOSTIC LAB (1676) 1,950 0 1,950 1 PRECEPTING NURSING STUDENTS HOME HEALTH CARE HOME HEALTH CARE (1978) 1,216 0 1,216 2 PRECEPTING NURSING STUDENTS ICU, CCU, ER INTENSIVE CARE (1640) 36,314 0 36,314 22 PRECEPTING NURSING STUDENTS MATERNAL CHILD & LABOR AND DELIVERY MATERNAL CHILD (1646) 19,477 0 19,477 7 PRECEPTING NURSING STUDENTS OUTPATIENT CLINIC OUTPATIENT CLINIC (1685) 2,359 0 2,359 1 PRECEPTING NURSING STUDENTS WOUND CLINIC WOUND CLINIC (1677) 4,224 0 4,224 2 PRECEPTING STUDENTS OCCUPATIONAL THERAPY OCCUPATIONAL THERAPY (1700) 14,164 0 14,164 4 PRECEPTING STUDENTS PACU/OR SURGERY (1660) 28,274 0 28,274 13 PRECEPTING STUDENTS PHARMACY PHARMACY (1730) 132,638 14,650 117,988 16 PRECEPTING STUDENTS RADIOLOGY RADIOLOGY (1721) 171,969 0 171,969 49 PRECEPTORSHIPS FOR CERTIFIED NURSE PRACTITIONER STUDENTS FMC FAMILY PRACTICE EAST (7425) 7,625 0 7,625 1 PRECEPTORSHIPS FOR CERTIFIED NURSE PRACTITIONER STUDENTS PEDS PEDIATRICS (7460) 51,435 0 51,435 11 PRECEPTORSHIPS FOR ULTRASOUND STUDENTS VASCULAR LAB NEURO VASCULAR LAB (1674) 15,233 0 15,233 3 PRECEPTORSHIPS FOR WOMEN'S HEALTH STUDENTS WOMENS HEALTH CENTER (7455) 6,935 0 6,935 1 PUBLIC HEALTH PARTNERSHIP, INC. THINK PINK CASH DONATIONS DEVELOPMENT (1955) 1,000 0 1,000 UNKNOWN RADON: WHAT YOU NEED TO KNOW PROCESS IMPROVEMENT (1945) 286 0 286 12 RED CROSS BLOOD DRIVE EDUCATION (1616) 6,083 0 6,083 254 RED DRESS EVENT PUBLIC RELATIONS (1956) 33,540 0 33,540 350 REESE ADULT DAY CENTER SPEAKER PUBLIC RELATIONS (1956) 109 0 109 7 RELAY FOR LIFE COMMUNITY SUPPORT DEVELOPMENT (1955) 110 0 110 UNKNOWN RELAY FOR LIFE IN KIND DONATIONS DEVELOPMENT (1955) 118 0 118 UNKNOWN RELAY FOR LIFE SPEAKER ONCOLOGY (7405) 478 0 478 UNKNOWN REPUBLICAN WOMEN EDUCATION SESSION PUBLIC RELATIONS (1956) 337 0 337 35 RESOURCE CENTER/MEDICAL LIBRARY RESOURCE CENTER (1975) 3,638 0 3,638 UNKNOWN ROTARY CLUB OF GRANVILLE CASH DONATIONS DEVELOPMENT (1955) 1,750 0 1,750 UNKNOWN ROTARY CLUB OF NEWARK IN KIND DONATIONS FOOD SERVICE (1801) 3,906 0 3,906 UNKNOWN ROTARY CLUB OF NEWARK HEATH CASH DONATIONS DEVELOPMENT (1955) 1,000 0 1,000 UNKNOWN ROTARY CLUB OF NEWARK HEATH SPEAKER PUBLIC RELATIONS (1956) 134 0 134 76 ROTARY CLUB OF PATASKALA CASH DONATIONS DEVELOPMENT (1955) 375 0 375 UNKNOWN ROTATOR CUFF REPAIR PROCESS IMPROVEMENT (1945) 528 0 528 37 SAINT VINCENT HAVEN CASH DONATIONS DEVELOPMENT (1955) 100 0 100 UNKNOWN SAINTS PETER AND PAUL RETREAT CENTER SPEAKERS BUREAU PUBLIC RELATIONS (1956) 1,473 0 1,473 15 SALVATION ARMY IN KIND DONATIONS DEVELOPMENT (1955) 475 0 475 UNKNOWN SALVATION ARMY GIRLS PROGRAM SPEAKER PUBLIC RELATIONS (1956) 316 0 316 33 SAVING MONEY ON HEALTH CARE PROCESS IMPROVEMENT (1945) 107 0 107 3 SEASONING INSTEAD OF SALT PROCESS IMPROVEMENT (1945) 134 0 134 19 SHERIDAN HIGH SCHOOL HEALTH EXPO PUBLIC RELATIONS (1956) 270 0 270 60 SIBLING PREPARATION CLASS MATERNAL CHILD (1646) 174 80 94 23 SKIN CANCER AWARENESS AND SCREENING PROCESS IMPROVEMENT (1945) 1,766 0 1,766 31 SMART GROCERY SHOPPING PROCESS IMPROVEMENT (1945) 111 0 111 3 SOUTHWEST LICKING YOUTH BASEBALL CASH DONATIONS DEVELOPMENT (1955) 3,614 0 3,614 UNKNOWN SPORTS PHYSICALS & ECG'S TAMARACK SPORTS PHYSICALS (7487) 50,311 0 50,311 1,536 ST. FRANCIS DE SALES SCHOOL & PARISH CASH DONATIONS DEVELOPMENT (1955) 100 0 100 UNKNOWN ST. FRANCIS PARISH FESTIVAL COMMUNITY SUPPORT DEVELOPMENT (1955) 266 0 266 UNKNOWN STAYING ACTIVE WITH ARTHRITIS PROCESS IMPROVEMENT (1945) 234 0 234 14 STAYING INDEPENDENT FOR LIFE PROCESS IMPROVEMENT (1945) 127 0 127 9 STUDENT INTERNSHIPS COMMUNITY CASE MANAGEMENT (DIETICIAN) COMMUNITY CASE MANAGEMENT (1976) 14,195 0 14,195 7 STUDENT INTERNSHIPS LABORATORY LAB (1702) 32,469 0 32,469 4 STUDENT INTERNSHIPS PHYSICAL THERAPY & SPEECH THERAPY REHAB CENTER (1737) 31,746 0 31,746 5 STUDENT INTERNSHIPS RESPIRATORY THERAPY RESPIRATORY THERAPY (1736) 3,155 0 3,155 2 STUDENT NURSE & OTHER HEALTH PROFESSIONALS MANAGEMENT PROCESS EDUCATION (1616) 14,631 0 14,631 UNKNOWN STUDENT NURSE & OTHER HEALTH PROFESSIONALS ORIENTATION EDUCATION (1616) 5,549 0 5,549 519 SUMMER FOOD SAFETY PROCESS IMPROVEMENT (1945) 122 0 122 2 TAMARACK FARMS DAIRY HEALTH FAIR SCREENINGS PUBLIC RELATIONS (1956) 230 0 230 21 TAXI TOKENS FISCAL SERVICES (1901) 521 0 521 UNKNOWN TEAM OHIO BASKETBALL CLUB #1020530 CASH DONATIONS DEVELOPMENT (1955) 200 0 200 UNKNOWN THE ENERGY COOPERATIVE CASH DONATIONS DEVELOPMENT (1955) 300 0 300 UNKNOWN THE MAIN PLACE SPEAKERS BUREAU PUBLIC RELATIONS (1956) 168 0 168 18 THE MEDICAL MANAGEMENT OF DIABETES PROCESS IMPROVEMENT (1945) 470 0 470 8 THE WORKS IN KIND DONATIONS FOOD SERVICE (1801) 6,974 0 6,974 UNKNOWN THE WORKS SPEAKER PUBLIC RELATIONS (1956) 465 0 465 300 THYROID DISEASE PROCESS IMPROVEMENT (1945) 544 0 544 35 TIPS TO QUIT SMOKING PROCESS IMPROVEMENT (1945) 109 0 109 6 TOBACCO CESSATION PROGRAM TOBACCO CESSATION (1693) 190,433 0 190,433 365 TOPS HEALTHY WEIGHT LOSS GROUP EDUCATION PUBLIC RELATIONS (1956) 318 0 318 27 TOTAL KNEE REPLACEMENT PROCESS IMPROVEMENT (1945) 287 0 287 24 UNITED WAY AGENCIES CASH DONATIONS DEVELOPMENT (1955) 500 0 500 UNKNOWN UNITED WAY DAY OF CARING IN KIND DONATIONS DEVELOPMENT (1955) 2,030 0 2,030 UNKNOWN UTICA SERTOMA CLUB CASH DONATIONS DEVELOPMENT (1955) 1,000 0 1,000 UNKNOWN VELVET ICE CREAM SPEAKER PUBLIC RELATIONS (1956) 573 0 573 81 VOLUNTEERS TWIGS & EVENTS VOLUNTEERS (1970) 0 0 0 274 WATKINS MEMORIAL CASH DONATIONS DEVELOPMENT (1955) 1,150 0 1,150 UNKNOWN WATKINS MIDDLE SCHOOL SPEAKERS BUREAU PUBLIC RELATIONS (1956) 476 0 476 139 WEATHERVANE PLAYHOUSE CASH DONATIONS DEVELOPMENT (1955) 1,250 0 1,250 UNKNOWN WELLNESS CENTER AT C TEC COMMUNITY BENEFIT C TEC (1977) 132,342 0 132,342 325 WEST LICKING FIRE DEPARTMENT SPEAKER & SCREENINGS PUBLIC RELATIONS (1956) 305 0 305 100 WEST LICKING FIREFIGHTERS ASSOCIATION CASH DONATIONS DEVELOPMENT (1955) 300 0 300 UNKNOWN WEST MAIN STREET BILL BOARD IN KIND DONATIONS PUBLIC RELATIONS (1956) 500 0 500 UNKNOWN WOMEN AND AGING PROCESS IMPROVEMENT (1945) 749 0 749 21 WOUNDED WARRIOR CASH DONATIONS DEVELOPMENT (1955) 295 0 295 UNKNOWN YES CLUB SPEAKER PUBLIC RELATIONS (1956) 179 0 179 60 YMCA HEALTH AND FITNESS FEST PUBLIC RELATIONS (1956) 9,703 0 9,703 300 ZONTA CLUB OF NEWARK CASH DONATIONS DEVELOPMENT (1955) 500 0 500 UNKNOWN MISCELLANEOUS IN-KIND DONATIONS 353 0 353 UNKNOWN MISCELLANEOUS CASH DONATIONS 100 0 100 UNKNOWN MISCELLANEOUS COMMUNITY HEALTH EDUCATION 696 0 696 UNKNOWN NUMBER OF PROGRAMS 300 GRAND TOTALS 2,792,606 162,014 2,630,592 26,494 | ||
| TOTAL OFFSETTING NET EXPENSE REVENUE BENEFIT PERSONS BENEFITS FOR POOR TRADITIONAL CHARITY CARE $12,658,645 $1,860,761 $10,797,884 18,244 UNPAID COST OF MEDICAID $34,660,479 $18,253,339 $16,407,140 30,426 GRAND TOTALS $50,111,730 $20,276,114 $29,835,616 75,164 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| LICKING MEMORIAL HEALTH SYSTEMS | |||||||||||
| 1320 WEST MAIN STREET | NEWARK | OH | 43055 | 311096218 | PARENT COMPANY FOR THE NONPROFIT OPERATION OF HEALTHCARE ORGANIZATIONS | OH | 501(C)(3) | 11 TYPE III - FI | N/A | 0 | |
| LICKING MEMORIAL HEALTH FOUNDATION | |||||||||||
| 1320 WEST MAIN STREET | NEWARK | OH | 43055 | 311096217 | PROVIDE FUNDING FOR HEALTHCARE PROGRAMS | OH | 501(C)(3) | 11 TYPE I | 0 | LICKING MEMORIAL HEALTH SYSTEMS | |
| LICKING MEMORIAL PROFESSIONAL CORPORATION | |||||||||||
| 1320 WEST MAIN STREET | NEWARK | OH | 43055 | 311425530 | HEALTHCARE ORGANIZATION | OH | 501(C)(3) | 9 | 0 | LICKING MEMORIAL HEALTH SYSTEMS | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Comments