ALLIANCE COMMUNITY HEALTH FOUNDATION: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
ALLIANCE COMMUNITY HEALTH FOUNDATION (EIN 34-1531817)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-10-08
IRS object ID
201202849349300020
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-10-08T13:16:50-07:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN341531817EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ALLIANCE COMMUNITY HOSPITAL FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlALLINameControl
Phone3305966000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1200 E STATE STAddressLine1
CityALLIANCECity
StateOHState
ZIP Code44601ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDale WellsName
TitleChief Financial OfficerTitle
Phone3305967066Phone
Date Signed2012-10-08DateSigned
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDale W WellsNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1200 E State StAddressLine1
CityAllianceCity
StateOHState
ZIP Code44601ZIPCode
FieldValueIRS element (for citing)
Gross Receipts735398GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1986YearFormation
State Legal DomicileOHStateLegalDomicile
Activity Or Mission DescriptionThe 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body4NbrVotingMembersGoverningBody
Nbr Independent Voting Members3NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers151TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year508936ContributionsGrantsPriorYear
Contributions Grants Current Year225839ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year93374InvestmentIncomePriorYear
Investment Income Current Year77958InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year602310TotalRevenuePriorYear
Total Revenue Current Year303797TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year213691GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY34003GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year9987TotalFundrsngExpCurrentYear
Other Expense Prior Year18774OtherExpensePriorYear
Other Expenses Current Year17121OtherExpensesCurrentYear
Total Expenses Prior Year232465TotalExpensesPriorYear
Total Expenses Current Year51124TotalExpensesCurrentYear
Revenues Less Expenses Prior Year369845RevenuesLessExpensesPriorYear
Revenues Less Expenses CY252673RevenuesLessExpensesCY
Total Assets BOY2729199TotalAssetsBOY
Total Assets EOY3040448TotalAssetsEOY
Total Liabilities BOY0TotalLiabilitiesBOY
Total Liabilities EOY0TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY2729199NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY3040448NetAssetsOrFundBalancesEOY
Mission DescriptionTo 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense28959Expense
Grants0Grants
Revenue0Revenue
DescriptionAlliance Community Hospital Foundation supports Alliance Community Hospital for building and medical equipment expenses. Purchases and improvements in 2011 included equipment for Lab of $5,614, Materials Management of $6,465, Community Care Center of $1,381, OB of $648, Outpatient Therapy of $3,144, MRI of $2,961, and AED's of $3,517. Additionally, supplies for Community Care Center of $1,917 and Pediatrics of $1,565, plus an additional $1,747 to the hospital for smaller purchases were made in 2011.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense2044Expense
Grants0Grants
Revenue0Revenue
DescriptionThe Foundation supports Alliance Community Hospital for indigent patient care. In 2011, they provided prescription drug assistance of $1,729 and an equipment purchase for Hospice patients of $315.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense3000Expense
Grants0Grants
Revenue0Revenue
DescriptionThe Foundation awarded nursing scholarships based on academic eligibility and financial need totaling $3,000 in 2011.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense591Expense
Grants0Grants
Revenue0Revenue
DescriptionOther program service expenses of Visiting Nurse and Hospice for brochures and supplies for patients and patient families equaling $591.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp591TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt0TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev0TotalOfOtherProgramServiceRev
Total Program Service Expense34594TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest1ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Excess Business Holdings0ExcessBusinessHoldings
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members4NbrVotingGoverningBodyMembers
Number Independent Voting Members3NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonDale W WellsNamePerson
Telephone Number3305967066TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1200 E STATE STAddressLine1
CityALLIANCECity
StateOHState
ZIP Code44601ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (5 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
Mike Hoover
President1XX000
Ron Lyons
Vice President1XX000
David Lundgren
Secretary1XX000
Dale Wells
Treasurer; CFO, Alliance Community Hospital1XX019839018153
Stan Jonas
CEO, Alliance Community Hospital1X038924523103
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs587635TotalReportableCompFrmRltdOrgs
Total Other Compensation41256TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Federated Campaigns0FederatedCampaigns
Membership Dues0MembershipDues
Fundraising Events58047FundraisingEvents
Related Organizations20344RelatedOrganizations
Government Grants0GovernmentGrants
All Other Contributions147448AllOtherContributions
Noncash Contributions1150NoncashContributions
Total Contributions225839TotalContributions
Total Program Service Revenue0TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column79559TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$79,559ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities430000Securities
Other0Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities431601Securities
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-1601Securities
Other0Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-1601TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion-$1,601ExclusionAmount
FieldValueIRS element (for citing)
Cntrbtns Rprtd Fundraising Events58047CntrbtnsRprtdFundraisingEvents
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column303797TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$77,958ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total28959Total
Program Services28959ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total5044Total
Program Services5044ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total
Fundraising0Fundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total5988Total
Program Services0ProgramServices
Management And General5988ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total555Total
Program Services0ProgramServices
Management And General555ManagementAndGeneral
Fundraising0Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
Hospice fundraising expenses7543007543
Charity Ball Auction items2444002444
Visiting Nurse & Hospice brochures and supplies59159100

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total51124Total
Program Services34594ProgramServices
Management And General6543ManagementAndGeneral
Fundraising9987Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY23004BOY
EOY32349EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY2706195BOY
EOY3008099EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY2729199BOY
EOY3040448EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY750567BOY
EOY888136EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1120986BOY
EOY1294616EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY857646BOY
EOY857696EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2729199BOY
EOY3040448EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2729199BOY
EOY3040448EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses252673ReconcilationRevenueExpenses
Reconcilation Other Changes58576ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type1XSupportingOrg509a3Type1
Certification CheckboxXCertificationCheckbox
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1Alliance Community HospitalBusinessNameLine1
FieldValueIRS element (for citing)
EIN340714581EIN
Type Of OrganizationHospital, Line 3TypeOfOrganization
Listed In Governing Doc1ListedInGoverningDoc
Amount$31,594Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts31594SumOfAmounts

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

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

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance857646BeginningOfYearBalance
Contributions50Contributions
Investment Earnings Or Losses0InvestmentEarningsOrLosses
Grants Or Scholarships0GrantsOrScholarships
Other Expenditures0OtherExpenditures
Administrative Expenses0AdministrativeExpenses
End Of Year Balance857696EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance493942BeginningOfYearBalance
Contributions363704Contributions
Investment Earnings Or Losses0InvestmentEarningsOrLosses
Grants Or Scholarships0GrantsOrScholarships
Other Expenditures0OtherExpenditures
Administrative Expenses0AdministrativeExpenses
End Of Year Balance857646EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance2666BeginningOfYearBalance
Contributions491276Contributions
Investment Earnings Or Losses0InvestmentEarningsOrLosses
Grants Or Scholarships0GrantsOrScholarships
Other Expenditures0OtherExpenditures
Administrative Expenses0AdministrativeExpenses
End Of Year Balance493942EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance10885BeginningOfYearBalance
Contributions1412Contributions
Investment Earnings Or Losses0InvestmentEarningsOrLosses
Grants Or Scholarships0GrantsOrScholarships
Other Expenditures9631OtherExpenditures
Administrative Expenses0AdministrativeExpenses
End Of Year Balance2666EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0BoardDesignatedEOYBalance
Permanent Endowment EOY Balance1PermanentEndowmentEOYBalance
Term Endowment EOY Balance0TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Investments Program Related InvestmentsProgramRelated (3 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
Assets Limited As To Use: Internally Designated24751F
Assets Limited As To Use: Externally Restricted886769F
Long-term Investments2096579F
FieldValueIRS element (for citing)
Total Of Book Value Program Related3008099TotalOfBookValueProgramRelated

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierSchD_P05_S00_L04Identifier
Return ReferenceSchedule D, Part V, Line 4ReturnReference
ExplanationThe 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.Explanation

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1Hospice 5KNameOfEvent1
Gross Receipts Event127420GrossReceiptsEvent1
Charitable Contributions Event10CharitableContributionsEvent1
Gross Revenue Event127420GrossRevenueEvent1
Cash Prizes Event1500CashPrizesEvent1
Non Cash Prizes Event1800NonCashPrizesEvent1
Rent Facility Costs Event10RentFacilityCostsEvent1
Food And Beverage Event1390FoodAndBeverageEvent1
Entertainment Event1150EntertainmentEvent1
Other Direct Expenses Event15703OtherDirectExpensesEvent1
Name Of Event2Charity BallNameOfEvent2
Gross Receipts Event230627GrossReceiptsEvent2
Charitable Contributions Event20CharitableContributionsEvent2
Gross Revenue Event230627GrossRevenueEvent2
Cash Prizes Event20CashPrizesEvent2
Non Cash Prizes Event22369NonCashPrizesEvent2
Rent Facility Costs Event20RentFacilityCostsEvent2
Food And Beverage Event20FoodAndBeverageEvent2
Entertainment Event20EntertainmentEvent2
Other Direct Expenses Event275OtherDirectExpensesEvent2
Total Number Of Other Events0TotalNumberOfOtherEvents
Gross Receipts Total58047GrossReceiptsTotal
Charitable Contributions Total0CharitableContributionsTotal
Gross Revenue Total Events58047GrossRevenueTotalEvents
Cash Prizes Total Events500CashPrizesTotalEvents
Non Cash Prizes Total Events3169NonCashPrizesTotalEvents
Rent Facility Costs Total Events0RentFacilityCostsTotalEvents
Food And Beverage Total Events390FoodAndBeverageTotalEvents
Entertainment Total Events150EntertainmentTotalEvents
Other Direct Expenses Total Events5778OtherDirectExpensesTotalEvents
Direct Expense Summary Events9987DirectExpenseSummaryEvents
Net Income Summary48060NetIncomeSummary

Form990 Schedule G Part IV Form990ScheduleGPartIV

FieldValueIRS element (for citing)
IdentifierSchG_P02_S00_L01Identifier
Return ReferenceSchedule G, Part II, Line 1ReturnReference
ExplanationThe Charity Ball event recognized contribution and expense activity in 2011 with the event being held in 2012.Explanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1Alliance Community HospitalBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1200 E State StreetAddressLine1
CityAllianceCity
StateOHState
ZIP Code44601ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient340714581EINOfRecipient
IRC Section501(c)(3)IRCSection
Amount Of Cash Grant28959AmountOfCashGrant
Amount Of Non Cash Assistance0AmountOfNonCashAssistance
Purpose Of Grantmedical equipment and building improvementsPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII (2 entries)

Type Of GrantTypeOfGrantNumber Of RecipientsNumberOfRecipientsAmount Of Cash GrantAmountOfCashGrantAmount Of Non Cash AssistanceAmountOfNonCashAssistanceMethod Of ValuationMethodOfValuationDescription Of Non Cash AssistanceDescriptionOfNonCashAssistance
Indigent Patient Care161729315purchase priceTV for hospice patients
Nursing scholarships230000

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierSchI_P01_S00_L02Identifier
Return ReferenceSchedule I, Part I, Line 2ReturnReference
ExplanationAlliance 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 Interagency Council on Homelessness, 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.Explanation

Schedule J IRS990ScheduleJ

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

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Dale Wells
01808150175750007555012251021819600
Stan Jonas
037274500016500013031013094041537000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSchJ_P01_S00_L03Identifier
Return ReferenceSchedule J, Part I, Line 3ReturnReference
ExplanationAlliance Community Hospital Foundation's Schedule J Part II 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.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
F990_P06_S0A_L01aForm 990, Part VI, Section A, Line 1aThe 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_L06Form 990, Part VI, Section A, Line 6See Schedule O comment for Part VI line 1a.
F990_P06_S0A_L07aForm 990, Part VI, Section A, Line 7aSee Schedule O comment for Part VI line 1a.
F990_P06_S0A_L07bForm 990, Part VI, Section A, Line 7bSee Schedule O comment for Part VI line 1a.
F990_P06_S0B_L11bForm 990, Part VI, Section B, Line 11bThe Form 990 is reviewed by the CFO 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_L12cForm 990, Part VI, Section B, Line 12cMembers 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_L15Form 990, Part VI, Section B, Line 15No 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_L17Form 990, Part VI, Section C, Line 17Ohio 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_L19Form 990, Part VI, Section C, Line 19The 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.
F990_P07_S0A_L01aForm 990, Part VII, Section A, Line 1aEstimated hours per week devoted to a related organization for compensation reported in col. (E) or (F) is reported on Part VII for Dale Wells and Stan Jonas, employees of Allliance Community Hospital, a related organization. They devote approximately 40 hours per week to the related organization.
F990_P11_S00_L05Form 990, Part XI, Line 5Change in unrealized gains and losses on other than trading securities = $58,576

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Alliance Citizens' Health Association
200 E State StAllianceOH44601341531815Manage Health FacilOH501(C)(3)Sch A, 11b, IIN/A0
Alliance Community Hospital
200 E State StAllianceOH44601340714581Community HospitalOH501(C)(3)Sch A, Ln 30Alliance Citizens' Health Assn
Alliance Comm Hospital Auxiliary
200 E State StAllianceOH44601340777659Volunteer ServicesOH501(C)(3)Sch A, 11c, III-FIN/A0
Alliance Health Institute
200 E State StAllianceOH44601341932972Support ACHOH501(C)(3)Sch A, 11a, I0Alliance Citizens' Health Assn
Caring Hands
885 Sawburg RdAllianceOH44601341505340Private Duty NursingOH501(C)(3)Sch A, 11c, III-FI0Alliance Citizens' Health Assn

Form990 Schedule R Part IV Form990ScheduleRPartIV (7 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnershipBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Alliance Health Partners
200 E State StAllianceOH44601341884059PHOOHN/AC000
Alliance Hospitalist Group
200 E State StAllianceOH44601203188585Dr OfficesOHC001Alliance Comm Hospital
Alliance Community Radiologists Inc
200 E State StAllianceOH44601205698786Dr OfficesOHC001Alliance Comm Hospital
Alliance Medical Associates Inc
200 E State StAllianceOH44601911889215Dr OfficesOHC001Alliance Comm Hospital
Alliance Pulmonary Associates Inc
200 E State StAllianceOH44601204083441Dr OfficesOHC001Alliance Comm Hospital
Health Alliance Inc
200 E State StAllianceOH44601341531993Dr OfficesOHC001All Citizens Health Assn
NEO Surgical Associates Inc
200 E State StAllianceOH44601200760723Dr OfficesOHC001Alliance Comm Hospital
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
IdentifierSchR_P04_S00_L00Identifier
Return ReferenceSchedule R, Part IVReturnReference
ExplanationThe 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.Explanation

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