2012-10-08T13:16:50-07:00 2011-12-31 990 2011-01-01 341531817 ALLIANCE COMMUNITY HOSPITAL FOUNDATION ALLI 3305966000 200 E STATE ST ALLIANCE OH 44601 Dale Wells 3305967066 2012-10-08 2011 2016-02-24 21:20:13Z Dale W Wells 200 E State St Alliance OH 44601 735398 0 X X 1986 OH The Alliance Community Hospital Foundation's mission is to contribute to hospital fundraising, maintain community involvement and healthcare awareness, and grow as a philanthropic spirit of Alliance Community Hospital. 4 3 0 151 0 0 508936 225839 0 0 93374 77958 0 0 602310 303797 213691 34003 0 0 0 0 0 0 9987 18774 17121 232465 51124 369845 252673 2729199 3040448 0 0 2729199 3040448 To assist Alliance Community Hospital financially in its mission of delivering quality health care in the community, maintain community involvement and health care awareness. The Foundation also provides support to other local non-profits. 0 0 28959 0 0 Alliance 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. 2044 0 0 The 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. 3000 0 0 The Foundation awarded nursing scholarships based on academic eligibility and financial need totaling $3,000 in 2011. 591 0 0 Other program service expenses of Visiting Nurse and Hospice for brochures and supplies for patients and patient families equaling $591. 591 0 0 34594 1 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 X 4 3 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X Dale W Wells 3305967066 200 E STATE ST ALLIANCE OH 44601 X Mike Hoover 1 X X 0 0 0 Ron Lyons 1 X X 0 0 0 David Lundgren 1 X X 0 0 0 Dale Wells 1 X X 0 198390 18153 Stan Jonas 1 X 0 389245 23103 0 587635 41256 0 0 1 0 0 0 0 58047 20344 0 147448 1150 225839 0 79559 0 0 79559 0 0 0 0 0 0 0 0 0 0 430000 0 431601 0 -1601 0 -1601 0 0 -1601 58047 0 303797 0 0 77958 28959 28959 5044 5044 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5988 0 5988 0 0 0 0 0 0 0 0 0 555 0 555 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Hospice fundraising expenses 7543 0 0 7543 Charity Ball Auction items 2444 0 0 2444 Visiting Nurse & Hospice brochures and supplies 591 591 0 0 51124 34594 6543 9987 23004 32349 2706195 3008099 2729199 3040448 0 0 X 750567 888136 1120986 1294616 857646 857696 2729199 3040448 2729199 3040448 X 252673 58576 X 0 1 1 X 0 X X X 0 0 0 Alliance Community Hospital 340714581 Hospital, Line 3 1 31594 1 31594 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 857646 50 0 0 0 0 857696 493942 363704 0 0 0 0 857646 2666 491276 0 0 0 0 493942 10885 1412 0 0 9631 0 2666 0 1 0 0 0 Assets Limited As To Use: Internally Designated 24751 F Assets Limited As To Use: Externally Restricted 886769 F Long-term Investments 2096579 F 3008099 SchD_P05_S00_L04 Schedule D, Part V, Line 4 The intended use of the organization's endowment funds is to hold the principal in perpetuity and use the interest for the general operations of the organization. Hospice 5K 27420 0 27420 500 800 0 390 150 5703 Charity Ball 30627 0 30627 0 2369 0 0 0 75 0 58047 0 58047 500 3169 0 390 150 5778 9987 48060 SchG_P02_S00_L01 Schedule G, Part II, Line 1 The Charity Ball event recognized contribution and expense activity in 2011 with the event being held in 2012. 1 Alliance Community Hospital 200 E State Street Alliance OH 44601 340714581 501(c)(3) 28959 0 medical equipment and building improvements 1 0 Indigent Patient Care 16 1729 315 purchase price TV for hospice patients Nursing scholarships 2 3000 0 SchI_P01_S00_L02 Schedule I, Part I, Line 2 Alliance Community Hospital Foundation was created to benefit Alliance Community Hospital's (ACH) mission which is to provide care to all, regardless of ability to pay. Funds given to ACH are used to purchase medical equipment, contribute to hospital building improvements, and provide for patients needs. Alliance Community Hospital Foundation has not provided grants to organizations outside its control. It worked in conjunction with other community, non-profit organizations to raise funds on their behalf. As such, these organizations such as the local YMCA, Neighborhood Center, Stark County 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. 0 0 0 0 0 0 0 0 0 Dale Wells 0 180815 0 17575 0 0 0 7555 0 12251 0 218196 0 0 Stan Jonas 0 372745 0 0 0 16500 0 13031 0 13094 0 415370 0 0 SchJ_P01_S00_L03 Schedule J, Part I, Line 3 Alliance 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. F990_P06_S0A_L01a Form 990, Part VI, Section A, Line 1a The governing body of Alliance Community Hospital Foundation (per its Code of Regulations) has delegated authority to the Board of Alliance Citizens' Health Association (the Member), a related organization, as follows: 1.) Power to elect and remove members of the Board of Trustees and/or Officers of the corporation. 2.) Approve the annual operating budgets; capital expenditures budgets; capital expenditures or dispositions of capital assets with a value in excess of such limits as shall be set from time to time by the Member; any action which requires Certificate of Need approval from the State Health Planning Development Agency; and any purchase, sale, lease, disposition, or hypothecation of real property. 3.) The incurrence of any obligation(s), liability(ies), and/or debt(s) requiring a mortgage on or security interest in any part of the assets of the corporation. 4.) Power to determine, upon dissolution of the corporation, the organization or organizations to which its remaining assets will be distributed. F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 See Schedule O comment for Part VI line 1a. F990_P06_S0A_L07a Form 990, Part VI, Section A, Line 7a See Schedule O comment for Part VI line 1a. F990_P06_S0A_L07b Form 990, Part VI, Section A, Line 7b See Schedule O comment for Part VI line 1a. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b The 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_L12c Form 990, Part VI, Section B, Line 12c Members of the Board of Trustees are required to annually review and sign a conflict of interest policy. Under that policy, the Board member (i) has a duty to disclose any conflict, and (ii) must recuse themselves from a vote and or decision when such conflict arises. If this policy is violated, then the Board shall take appropriate action which may include an investigation and disciplinary action. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 No compensation is paid directly by Alliance Community Hospital Foundation; however, certain officers and top officials of this organization are compensated by Alliance Community Hospital, a related organization. That compensation is determined by an independent (noncompensated) committee from the Board of Trustees. This committee annually reviews compensation by obtaining market surveys of the positions. F990_P06_S0C_L17 Form 990, Part VI, Section C, Line 17 Ohio does not require the Form 990 to be filed with the Ohio Attorney General's Office. Instead, a "Verification of Filing with the Internal Revenue Service" form is completed stating that we did file Form 990 by the required due date. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The organization makes its governing documents available to the public via the Ohio Secretary of State's website. Financial statements are available in the NRMSIR filing database at www.emma.msrb.org. The conflict of interest policy is available upon request. F990_P07_S0A_L01a Form 990, Part VII, Section A, Line 1a Estimated 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_L05 Form 990, Part XI, Line 5 Change in unrealized gains and losses on other than trading securities = $58,576 Alliance Citizens' Health Association 200 E State St Alliance OH 44601 341531815 Manage Health Facil OH 501(C)(3) Sch A, 11b, II N/A 0 Alliance Community Hospital 200 E State St Alliance OH 44601 340714581 Community Hospital OH 501(C)(3) Sch A, Ln 3 Alliance Citizens' Health Assn 0 Alliance Comm Hospital Auxiliary 200 E State St Alliance OH 44601 340777659 Volunteer Services OH 501(C)(3) Sch A, 11c, III-FI N/A 0 Alliance Health Institute 200 E State St Alliance OH 44601 341932972 Support ACH OH 501(C)(3) Sch A, 11a, I Alliance Citizens' Health Assn 0 Caring Hands 885 Sawburg Rd Alliance OH 44601 341505340 Private Duty Nursing OH 501(C)(3) Sch A, 11c, III-FI Alliance Citizens' Health Assn 0 Alliance Health Partners 200 E State St Alliance OH 44601 341884059 PHO OH N/A C 0 0 0 Alliance Hospitalist Group 200 E State St Alliance OH 44601 203188585 Dr Offices OH Alliance Comm Hospital C 0 0 1 Alliance Community Radiologists Inc 200 E State St Alliance OH 44601 205698786 Dr Offices OH Alliance Comm Hospital C 0 0 1 Alliance Medical Associates Inc 200 E State St Alliance OH 44601 911889215 Dr Offices OH Alliance Comm Hospital C 0 0 1 Alliance Pulmonary Associates Inc 200 E State St Alliance OH 44601 204083441 Dr Offices OH Alliance Comm Hospital C 0 0 1 Health Alliance Inc 200 E State St Alliance OH 44601 341531993 Dr Offices OH All Citizens Health Assn C 0 0 1 NEO Surgical Associates Inc 200 E State St Alliance OH 44601 200760723 Dr Offices OH Alliance Comm Hospital C 0 0 1 0 1 1 0 0 0 0 0 0 0 1 0 1 1 1 0 0 0 SchR_P04_S00_L00 Schedule R, Part IV The 100% ownership in column (h) of Part IV is based on voting power, not total value of all outstanding shares; thus columns (f) and (g) are 0.