ASHLAND COMMUNITY HEALTH SERVICES: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
ASHLAND COMMUNITY HEALTH SERVICES (EIN 93-1213059)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-03-09
IRS object ID
201220699349300347
Schema version
2010v3.4
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)
Timestamp2012-03-09T16:19:11-06:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line13000 NORTHUP WAY SUITE 200AddressLine1
CityBELLEVUECity
StateWAState
ZIP Code980041446ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN931213059EIN

Name Name

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

US Address USAddress

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

Officer Officer

FieldValueIRS element (for citing)
NameMARK MARCHETTIName
TitlePRESIDENT/CEOTitle
Phone5412014000Phone
Date Signed2012-03-01DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone4252506100Phone
Date Prepared2012-03-01DatePrepared
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

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

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1280 MAPLE STREETAddressLine1
CityASHLANDCity
StateORState
ZIP Code97520ZIPCode
FieldValueIRS element (for citing)
Gross Receipts51825268GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.ASHLANDHOSPITAL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1996YearFormation
State Legal DomicileORStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE HIGH QUALITY CARE THAT IMPROVES THE HEALTH OF PATIENTS, FAMILIES, AND THE COMMUNITY.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees470TotalNbrEmployees
Total Nbr Volunteers160TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year303011ContributionsGrantsPriorYear
Contributions Grants Current Year367088ContributionsGrantsCurrentYear
Program Service Revenue Prior Year49776569ProgramServiceRevenuePriorYear
Program Service Revenue CY50723766ProgramServiceRevenueCY
Investment Income Prior Year52803InvestmentIncomePriorYear
Investment Income Current Year28940InvestmentIncomeCurrentYear
Other Revenue Prior Year1318233OtherRevenuePriorYear
Other Revenue Current Year705474OtherRevenueCurrentYear
Total Revenue Prior Year51450616TotalRevenuePriorYear
Total Revenue Current Year51825268TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year24502551SalariesEtcPriorYear
Salaries Etc Current Year26846653SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year24935366OtherExpensePriorYear
Other Expenses Current Year25304307OtherExpensesCurrentYear
Total Expenses Prior Year49437917TotalExpensesPriorYear
Total Expenses Current Year52150960TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2012699RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-325692RevenuesLessExpensesCY
Total Assets BOY42770823TotalAssetsBOY
Total Assets EOY41905474TotalAssetsEOY
Total Liabilities BOY16648939TotalLiabilitiesBOY
Total Liabilities EOY16097882TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY26121884NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY25807592NetAssetsOrFundBalancesEOY
Mission DescriptionTHE MISSION OF ASHLAND COMMUNITY HOSPITAL IS TO PROVIDE COMPASSIONATE, HIGH QUALITY CARE THAT IMPROVES THE OVERALL HEALTH OF OUR PATIENTS, THEIR FAMILIES AND THE COMMUNITY BY WORKING IN PARTNERSHIP WITH OUR PHYSICIANS AND OTHER REGIONAL HEALTHCARE PROVIDERS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense37713300Expense
Revenue50723766Revenue
DescriptionPROVISION OF HEALTHCARE SERVICES TO RESIDENTS WITHIN OUR GEOGRAPHIC REGION, INCLUDING A SIGNIFICANT PORTION OF SERVICES TO MEDICARE/MEDICAID PATIENTS ($57 MILLION GROSS) AND CHARITY CARE ($1.6 MILLION GROSS).Description
Total Program Service Expense37713300TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
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 With109682NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees470NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure0WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledORStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonCHRISTY NIKOLANamePerson
Telephone Number5412014004TelephoneNumber

Address US AddressUS

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

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
DOUGLAS DIEL MD
CHAIR8.00XX000
RICK MORRIS
MEMBER2.00X000
MARIE DONOVAN
PAST CHAIR/MEMBER2.00XX000
REV HARVEY RAY
CHAIR-ELECT/SECRETARY6.00XX000
DOUGLAS GENTRY
CHAIR-ELECT/TREASURER6.00XX000
ANNE GOLDEN
SECRETARY6.00XX000
VALRI WILLIAMS
TREASURER6.00XX000
TOM REID
MEMBER2.00X000
MARK MARCHETTI
CEO40.00XX201009023541
LINDA BUTLER
MEMBER2.00X000
CAROL CHRISTLIEB
MEMBER2.00X000
STEVE MINER
MEMBER2.00X000
DOUGLAS MORRISON MD
MEMBER2.00X000
AREBI GARSA
CFO40.00X000
DAVID CANDELARIA
HOSPITALIST40.00180395017617X
BETH LEONE
HOSPITALIST40.00185318018740X
AGNIESKA DOBIECKA
HOSPITALIST40.00183421021533X
PAM ATOR
HOSPITALIST40.0019119406071X
JOHN KULSBUN
HOSPITALIST40.00164115013722X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1105452TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation101224TotalOtherCompensation
Number Individuals GT100 K26NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
BE SMITH INC
9777 RIDGE DRIVE SUITE 300LENESAKS66219TEMP STAFFING/RECRUITING642479
ASHLAND ANESTHESIA ASSOCIATES
638 NORTH MAIN STASHLANDOR97520ANESTHESIA PROVIDERS566711
ASHLAND EMERGENCY ASSOCITATES PC
1370 LITHIA WAYTALENTOR97540ER PHYSICIANS520051
GARSA AREBI
2071 EMERALD DRLONGMONTCO80504CONTRACT CFO485090
DIVERSIFIED CLINICAL SERVICES
4500 SALISBURY ROAD SUITE 300JACKSONVILLEFL32216WOUND CLINIC MANAGEMENT SERVICES464576
FieldValueIRS element (for citing)
Number Of Contractors GT100 K15NumberOfContractorsGT100K
Government Grants19465GovernmentGrants
All Other Contributions347623AllOtherContributions
Total Contributions367088TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
HOSPITAL SERVICES6219902686875826868758
MEDICARE/MEDICAID SERV6219902385500823855008
FieldValueIRS element (for citing)
Total Program Service Revenue50723766TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column28940TotalRevenueColumn
Exclusion$28,940ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real49307Real
Personal79703Personal

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real49307Real
Personal79703Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column129010TotalRevenueColumn
Exclusion$129,010ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
OTHER REVENUE900099286445$286,445
NONPATIENT FOOD SALES722210186265$186,265
PASSTHROUGH INCOME621990103754$103,754
FieldValueIRS element (for citing)
Total Other Revenue576464TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column51825268TotalRevenueColumn
Related Or Exempt Function Income50723766RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$734,414ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total203379Total
Management And General203379ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total20293054Total
Program Services15470265ProgramServices
Management And General4822789ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1377978Total
Program Services1040234ProgramServices
Management And General337744ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3332691Total
Program Services2479271ProgramServices
Management And General853420ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1639551Total
Program Services1237695ProgramServices
Management And General401856ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total231411Total
Management And General231411ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total596023Total
Management And General596023ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total8950518Total
Program Services5274722ProgramServices
Management And General3675796ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total160968Total
Program Services409ProgramServices
Management And General160559ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total4068570Total
Program Services3382569ProgramServices
Management And General686001ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total234571Total
Program Services7470ProgramServices
Management And General227101ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total601129Total
Program Services155794ProgramServices
Management And General445335ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total137545Total
Program Services102770ProgramServices
Management And General34775ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total1642Total
Management And General1642ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total354088Total
Program Services354088ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2607472Total
Program Services1399935ProgramServices
Management And General1207537ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total246865Total
Program Services246865ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
OTHER EXPENSES25077442066952440792
MEDICAL SUPPLIES AND EQ20535602053560
BAD DEBT15413111541311
PHARMACEUTICAL DRUGS776232776232
MAINTENANCE AND REPAIRS1406418637954262

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total94017Total
Program Services36779ProgramServices
Management And General57238ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total52150960Total
Program Services37713300ProgramServices
Management And General14437660ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY4499082BOY
EOY2645088EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1856343BOY
EOY2589274EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY6414797BOY
EOY7021382EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY291486BOY
EOY154751EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1277086BOY
EOY1351882EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY459814BOY
EOY506106EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis47432790LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec23187085LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY25692739BOY
EOY24245705EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY201484BOY
EOY212426EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2077992BOY
EOY3178860EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY42770823BOY
EOY41905474EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY6406903BOY
EOY6760073EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY9187372BOY
EOY8724560EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1054664BOY
EOY613249EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY16648939BOY
EOY16097882EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY26121884BOY
EOY25528498EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY279094EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY26121884BOY
EOY25807592EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY42770823BOY
EOY41905474EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-325692ReconcilationRevenueExpenses
Reconcilation Other Changes11400ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

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

Schedule D IRS990ScheduleD

Land Land

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

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis509382OtherCostOrOtherBasis
Depreciation260612Depreciation
Book Value248770BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis26305937OtherCostOrOtherBasis
Depreciation6568158Depreciation
Book Value19737779BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis18073545OtherCostOrOtherBasis
Depreciation14196696Depreciation
Book Value3876849BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2237515OtherCostOrOtherBasis
Depreciation2161619Depreciation
Book Value75896BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings24245705TotalOfBookValueLandBuildings

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
RESTRICTED CASH2816678
INVESTMENT IN JOINT VENTURE220559
INVESTMENT IN REAL ESTATE120000
MISCELLANEOUS RECEIVABLES21623
FieldValueIRS element (for citing)
Total Book Value Other Assets3178860TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
ESTIMATED MEDICAL MALPRACTICE LIABILITY$100,000
CAPITAL LEASE OBLIGATIONS$513,249
FieldValueIRS element (for citing)
Total Of Amounts613249TotalOfAmounts
Total Revenue51825268TotalRevenue
Total Expenses52150960TotalExpenses
Excess Or Deficit For Year-325692ExcessOrDeficitForYear
Net Unrealized GL On Investments11400NetUnrealizedGLOnInvestments
Total Adjustments11400TotalAdjustments
Excess Or Deficit Per FS-314292ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt50074234TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments11400NetUnrealizedGainsInvestments
Other Revenues-1541311OtherRevenues
Revenue Not Rptd F990-1529911RevenueNotRptdF990
Revenue Subtotal51604145RevenueSubtotal
Other Revenues Not Included221123OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt221123RevenueNotRptdOnFinStmt
Total Revenue Per Form99051825268TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt50609649TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal50609649ExpensesSubtotal
Other Expenses Not Included1541311OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt1541311ExpensesNotRptdOnFinStmt
Total Expenses Per Form99052150960TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
ExplanationTHE HOSPITAL HAS ADOPTED GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE STANDARD REQUIRES THE HOSPITAL TO DETERMINE WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION ON THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE HOSPITAL RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS AS A RESULT OF THE ADOPTION OF THE STANDARD.Explanation

Schedule H IRS990ScheduleH

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

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense897702TotalCommunityBenefitExpense
Net Community Benefit Expense897702NetCommunityBenefitExpense
Percent Of Total Expense0.01770PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense4176141TotalCommunityBenefitExpense
Direct Offsetting Revenue4664097DirectOffsettingRevenue
Net Community Benefit Expense-487956NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense5073843TotalCommunityBenefitExpense
Direct Offsetting Revenue4664097DirectOffsettingRevenue
Net Community Benefit Expense409746NetCommunityBenefitExpense
Percent Of Total Expense0.01770PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense259963TotalCommunityBenefitExpense
Direct Offsetting Revenue74600DirectOffsettingRevenue
Net Community Benefit Expense185363NetCommunityBenefitExpense
Percent Of Total Expense0.00370PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense4042TotalCommunityBenefitExpense
Net Community Benefit Expense4042NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense7480519TotalCommunityBenefitExpense
Direct Offsetting Revenue7962944DirectOffsettingRevenue
Net Community Benefit Expense-482425NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense22399TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense22399NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense7766923TotalCommunityBenefitExpense
Direct Offsetting Revenue8037544DirectOffsettingRevenue
Net Community Benefit Expense-270621NetCommunityBenefitExpense
Percent Of Total Expense0.00420PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense12840766TotalCommunityBenefitExpense
Direct Offsetting Revenue12701641DirectOffsettingRevenue
Net Community Benefit Expense139125NetCommunityBenefitExpense
Percent Of Total Expense0.02190PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense3143TotalCommunityBuildingExpense
Net Community Building Expense3143NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense3143TotalCommunityBuildingExpense
Net Community Building Expense3143NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Other Other

FieldValueIRS element (for citing)
Number Of Activities Or Programs5NumberOfActivitiesOrPrograms
Total Community Building Expense13922TotalCommunityBuildingExpense
Net Community Building Expense13922NetCommunityBuildingExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs7NumberOfActivitiesOrPrograms
Total Community Building Expense20208TotalCommunityBuildingExpense
Net Community Building Expense20208NetCommunityBuildingExpense
Percent Of Total Expense0.00050PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$830,890BadDebtExpenseAmount
Amount Reimbursed By Medicare10643739AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare15715198CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-5071459MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

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

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

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

Address Address

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

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1ASHLAND COMMUNITY HEALTHCARE SERVICESBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)

ExplanationExplanationReturn ReferenceReturnReferenceIdentifierIdentifier
PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDE THE EMERGENCY ROOM, OBSTETRICS, HOME HEALTH, AND HOSPICE.
PART I, L7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A,) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $1,541,311.
ASHLAND COMMUNITY HOSPITAL PREPARES A COMMUNITY BENEFIT REPORT FOR THE STATE OF OREGON.PART 1, LINE 6A
PART II: IN LATE 2009, THE CITY OF ASHLAND CREATED AN ECONOMIC DEVELOPMENT COMMITTEE TO BRING TOGETHER BUSINESS LEADERS AND COMMUNITY REPRESENTATIVES FOR THE PURPOSE OF CREATING A COMPREHENSIVE ECONOMIC DEVELOPMENT STRATEGY FOR THE CITY. MEMBERS OF THE COMMITTEE WERE APPOINTED BY THE MAYOR. THE COMMITTEE IS CHAIRED BY A MEMBER OF ASHLAND CITY COUNCIL AND STAFF SUPPORT IS PROVIDED BY CITY PLANNING DEPARTMENT STAFF. THE COMMITTEE CONTINUED TO MEET THOUGHOUT CALANDER YEAR 2010 AND THE FIRST-HALF OF CALENDAR 2011.THE CHARGE TO THE ECONOMIC DEVELOPMENT COMMITTEE INCLUDED:- REVIEW OF CURRENT COUNCIL GOALS RELATED TO ECONOMIC DEVELOPMENT- CONSIDERATION OF CITY GOVERNMENT'S ROLE IN ECONOMIC DEVELOPMENT- IDENTIFICATION OF OVERALL GOALS FOR ECONOMIC DEVELOPMENT- IDENTIFICATION OF SPECIFIC ACTIONS/TACTICS TO REACH IDENTIFIED GOALSTHE ECONOMY OF ASHLAND IS LARGELY DRIVEN BY TOURISM, BASED ON THE PRESENCE OF THE OREGON SHAKESPEARE FESTIVAL, AND TO A LESSER EXTENT BY THE AVAILABILITY OF A WIDE RANGE OF OUTDOOR ACTIVITIES SUCH AS SKIING, WHITE WATER RAFTING, AND FISHING. THESE ARE SEASONAL ACTIVITIES SUPPORTING RELATIVELY LOW-PAID, SEASONAL, SERVICE SECTOR JOBS. THE GOAL OF CITY ECONOMIC DEVELOPMENT EFFORTS IS TO DIVERSIFY THE ECONOMY, REDUCE SEASONAL FLUCTUATIONS IN ECONOMIC ACTIVITY, AND CREATE A STABLE BASE OF HIGHER-WAGE PROFESSIONAL AND TECHNICAL JOBS. ASHLAND COMMUNITY HOSPITAL IS THE CITY'S THIRD LARGEST EMPLOYER. THE HOSPITAL IS BOTH A SIGNIFICANT CONTRIBUTOR TO AND RELIANT ON THE CITY'S ECONOMIC WELL BEING. SINCE A HEALTHY AND SUSTAINABLE ECONOMY IS CRITICAL TO THE HEALTH AND WELL BEING OF ANY COMMUNITY, THE HOSPITAL CONTRIBUTES TO THE CITY'S COMMUNITY DEVELOPMENT EFFORTS AS PART OF ITS LARGER MISSION OF IMPROVING THE OVERALL HEALTH OF THE COMMUNITY.
PART III, LINE 4: THE FOLLOWING IS FROM THE "PATIENT ACCOUNTS RECEIVABLES, NET" PARAGRAPH IN NOTE 1 OF THE HOSPITAL'S FINANCIAL STATEMENTS: "THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE SELF-PAY AND MISCELLANEOUS COMMERCIAL INSURANCE ACCOUNTS. PATIENTS ARE NOT REQUIRED TO PROVIDE COLLATERAL FOR SERVICES RENDERED. PAYMENT FOR SERVICES IS REQUIRED UPON RECEIPT OF AN INVOICE, AFTER PAYMENT BY INSURANCE, IF ANY. SELF-PAY ACCOUNTS ARE ANALYZED FOR COLLECTABILITY BASED ON THE MONTHS PAST DUE AND PAYMENT HISTORY. AN ALLOWANCE IS ESTIMATED FOR THESE ACCOUNTS BASED ON THE HISTORICAL EXPERIENCE OF THE HOSPITAL. ACCOUNTS THAT ARE DETERMINED TO BE UNCOLLECTIBLE ARE SENT TO A COLLECTION AGENCY AND WRITTEN OFF AT THAT TIME."THE AMOUNT OF BAD DEBT EXPENSE (AT COST) REPORTED IN PART III, LINE 2 IS CALCULATED AS FOLLOWS: PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES, AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD PARTY PAYORS.
PART III, LINE 8: OVER THE PAST 20 YEARS, THE POPULATION OF ASHLAND HAS AGED CONSIDERABLY AS THE CITY HAS GAINED THE REPUTATION AS A DESIRABLE "RETIREMENT" COMMUNITY. THIS IS EVIDENCED BY THE CLOSURE OF TWO OF THE CITY'S FIVE ELEMENTARY SCHOOLS WITHIN THE PAST TEN YEARS AND THE SIGNIFICANT INCREASE IN THE PERCENTAGE OF THE HOSPITAL'S REVENUE THROUGH THE MEDICARE PROGRAM FROM 40% IN 2003-2004 TO 52.7% TODAY. THIS SHIFT IN PAYOR MIX HAS HAD A SIGNIFICANT NEGATIVE IMPACT ON THE HOSPITAL'S FINANCIAL PERFORMANCE, RESULTING IN A NEGATIVE OPERATING MARGIN.WHILE THE INCREASED RELIANCE ON REIMBURSEMENT THROUGH THE MEDICARE PROGRAM HAS CREATED FINANCIAL STRESS FOR THE ORGANIZATION, THE HOSPITAL REMAINS COMMITTED TO ITS MISSION OF MEETING THE HEALTH CARE NEEDS OF ITS COMMUNITY. IN 2008, THE HOSPITAL CREATED THE ACH CENTER FOR INTERNAL MEDICINE, A PROVIDER-BASED INTERNAL MEDICINE CLINIC, TO ADDRESS THE LACK OF ACCESS TO PRIMARY CARE FOR MEDICARE RECIPIENTS. DESPITE ENHANCED REIMBURSEMENT FROM MEDICARE AS A PROVIDER-BASED MODEL, THE CLINIC OPERATES AT A LOSS. SIMILARLY, THE HOSPITAL PROVIDES HOME HEALTH AND HOSPICE SERVICES, BOTH AT NEGATIVE MARGIN, YET BOTH VALUABLE SERVICES TO THE COMMUNITY. OTHER OF THE HOSPITAL'S SERVICES HEAVILY DEPENDENT ON REIMBURSEMENT THROUGH THE MEDICARE PROGRAM, SUCH ORTHOPEDIC JOINT REPLACEMENT AND RETINA SURGERY, RESULT IN NEGATIVE MARGINS BUT CONTINUE TO BE PROVIDED BY THE HOSPITAL BECAUSE THEY ARE CONSIDERED VITAL TO "THE OVERALL HEALTH OF PATIENTS, THEIR FAMILIES AND THE COMMUNITY" CONSISTENT WITH THE HOSPITAL'S MISSION.
PART III, LINE 9B: THE HOSPITAL HAS A WRITTEN DEBT COLLECTION POLICY. THE POLICY DOES NOT CONTAIN PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE.
PART VI, LINE 2: ASHLAND COMMUNITY HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES THROUGH ITS PLANNING PROCESSES, INCLUDING THE LONG-RANGE STRATEGIC PLAN, MEDICAL STAFF DEVELOPMENT PLAN, MARKETING PLAN, AND PROGRAM/BUSINESS PLANNING. PLANNING INPUTS INCLUDE: SERVICE AREA DEMOGRAPHICS INCLUDING POPULATION AND AGE PROJECTIONS; MEDICAL STAFF INTERVIEW FINDINGS; MEDICAL STAFF COMPOSITION, PRACTICE PATTERNS, AND AGE TO PROJECT PROVIDER NEEDS BY SPECIALTY; CURRENT AND HISTORIC SERVICE VOLUMES AND TRENDS; COMMUNITY PERCEPTION SURVEY DATA; MARKET SHARE ANALYSIS; COMPETITOR POSITIONS; PATIENT SURVEY DATA COMMUNITY INPUT THROUGH THE BOARD OF DIRECTORS; AND FOCUS GROUPS OF FORMER PATIENTS AND COMMUNITY MEMBERS.
PART VI, LINE 3: ASHLAND COMMUNITY HOSPITAL EDUCATES PATIENTS WHO MIGHT BE ELIGIBLE FOR FINANCIAL ASSISTANCE IN A NUMBER OF WAYS. THERE ARE SIGNS POSTED IN ADMITTING AREAS THAT ADVISE PATIENTS OF OUR CHARITY CARE POLICY. OHP APPLICATIONS ARE GIVEN TO ANYONE UNDER THE AGE OF 18 THAT PROCESS THROUGH OUR E.R. STATEMENTS ADVISE PATIENTS THAT THAT THEY MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE AND THE PHONE NUMBER TO CONTACT FOR FURTHER INFORMATION. MEETING ARE HELD AT LOCAL PHYSICIAN OFFICES TO INFORM THEM OF OUR FINANCIAL ASSISTANCE PROGRAMS SO THEY MAY PASS IT HE INFORMATION ALONG TO THEIR PATIENTS. PATIENTS ARE ALSO NOTIFIED OF FINANCIAL OPTION WHEN SPEAKING WITH OUR PATIENT ACCOUNTS OFFICE.
PART VI, LINE 4: ASHLAND COMMUNITY HOSPITAL IS A 49-BED ACUTE CARE COMMUNITY HOSPITAL LOCATED IN ASHLAND, OREGON, A COMMUNITY OF APPROXIMATELY 20,000 RESIDENTS LOCATED IN THE SOUTHERN-MOST PART OF THE STATE, APPROXIMATELY 15 MILES FROM THE CALIFORNIA BORDER. FOUNDED IN 1907, ASHLAND COMMUNITY HOSPITAL EXISTS TODAY AS A PRIVATE, NON-PROFIT 501-C-3 CORPORATION. GOVERNANCE OF THE ORGANIZATION IS PROVIDED BY A 13-MEMBER BOARD OF DIRECTORS, APPOINTED BY THE ASHLAND CITY COUNCIL, WHO VOLUNTEER THEIR TIME AND EXPERTISE ON BEHALF OF THE COMMUNITY. THE HOSPITAL IS ACCREDITED BY DNV HEALTHCARE INC AND IS CERTIFIED FOR PARTICIPATION IN THE MEDICARE PROGRAM.ASHLAND COMMUNITY HOSPITAL PROVIDES A WIDE RANGE OF HEALTH CARE AND RELATED SERVICES AS DEEMED APPROPRIATE IN ACCORDANCE WITH THE HOSPITALS MISSION, VISION AND STRATEGIC PLANS, AVAILABLE RESOURCES, COMMUNITY NEED, FEDERAL AND STATE LAW AND REGULATION AND PROFESSIONAL PRACTICE STANDARDS. THESE SERVICES INCLUDE INPATIENT AND OUTPATIENT CARE, EMERGENCY CARE, DIAGNOSTIC AND TREATMENT SERVICES, HOME HEALTH AND HOSPICE CARE, AND HEALTH OUTREACH SERVICES. ASHLAND COMMUNITY HOSPITAL DEFINES ITS PRIMARY SERVICES AREAS AS THE COMMUNITIES OF ASHLAND AND TALENT AND AREAS SOUTH TO THE CALIFORNIA BORDER, COMPRISED OF POSTAL ZIP CODES 97520 AND 97540, WITH A POPULATION OF APPROXIMATELY 35,000. THE SECONDARY SERVICE AREA INCLUDES THE COMMUNITIES OF PHOENIX AND MEDFORD NORTH OF ASHLAND, WITH POSTAL ZIP CODES 97504, 97501, AND 97535 AND A POPULATION OF APPROXIMATELY 92,000. THE HOSPITAL DRAWS FROM A BROADER GEOGRAPHIC AREA FOR CERTAIN SPECIALTY SERVICES NOT WIDELY AVAILABLE, INCLUDING COMPREHENSIVE WOUND CARE AND RETINA SURGERY.THE POPULATION OF THE HOSPITAL'S PRIMARY SERVICE IS PROJECTED TO INCREASE BY APPROXIMATELY 6.3% OVER THE FIVE YEAR PERIOD 2009-2014. SIMILARLY, THE POPULATION OF THE SECONDARY SERVICE AREA IS PROJECTED TO INCREASE BY 6.7% OVER THE SAME PERIOD. ALMOST 50% OF THE POPULATION GROWTH IN BOTH THE PRIMARY AND SECONDARY SERVICE AREAS IS PROJECTED TO OCCUR IN THE 65+ AGE COHORT. THE SIGNIFICANT INCREASE IN THE PORTION OF THE HOSPITAL'S TOTAL REVENUE DERIVING FROM THE MEDICARE PROGRAM, FROM APPROXIMATELY 40% OF GROSS REVENUE IN 2004 TO 52% IN 2011, SUPPORTS THESE PROJECTIONS.
PART VI, LINE 6: AS A NON-PROFIT, MISSION DRIVEN ORGANIZATION, ASHLAND COMMUNITY HOSPITAL IS COMMITTED TO THE PROVISION OF COMPASSIONATE, HIGH-QUALITY CARE THAT IMPROVES THE OVERALL HEALTH OF PATIENTS, THEIR FAMILIES AND THE COMMUNITY AND TO THE FURTHERANCE OF ITS EXEMPT PURPOSE. 1. THE HOSPITAL MAINTAINS A CURRENT STRATEGIC PLAN TO GUIDE THE LONG-TERM STRATEGIC DIRECTION OF THE HOSPITAL TO BEST MEET THE NEEDS OF THE COMMUNITY. 2. THE HOSPITAL'S MEDICAL STAFF IS OPEN TO ANY PHYSICIAN OR ALLIED HEALTH PROVIDER WHO IS LICENSED IN THE STATE OF OREGON AND ABLE TO DEMONSTRATE CURRENT COMPETENCE.3. THE HOSPITAL HAS CREATED A MEDICAL STAFF DEVELOPMENT PLAN TO DEFINE THE NUMBER AND TYPES OF PHYSICIANS NEEDED TO MEET COMMUNITY NEED. THE PLAN IS UPDATED ON A REGULAR BASIS. 4. THE HOSPITAL'S PHYSICIAN RECRUITMENT SUPPORT PROGRAM PROVIDES FINANCIAL ASSISTANCE FOR NEW PHYSICIANS ESTABLISHING PRACTICES WITHIN THE COMMUNITY, WITHIN THE CONSTRAINTS OF FEDERAL LAW AND REGULATION.5. IN 2008, THE HOSPITAL ESTABLISHED THE ASHLAND CENTER FOR INTERNAL MEDICINE TO ADDRESS ACCESS ISSUES FOR MEDICARE PATIENTS. ADDITIONAL PHYSICIANS WERE ADDED TO THE CLINIC IN 2010 AND 2011.6. THE HOSPITAL MAINTAINS A PHYSICIAN HOSPITALIST PROGRAM TO SUPPORT THE AVAILABILITY OF IN-PATIENT CARE, AT A NET COST OF APPROXIMATELY $600,000 PER YEAR. 7. HOSPITAL GOVERNANCE IS PROVIDED BY A 13-MEMBER BOARD OF DIRECTORS, APPOINTED BY THE ASHLAND CITY COUNCIL. DIRECTORS OF ARE MEMBERS OF THE HOSPITAL'S SERVICE AREA AND RECEIVE NO COMPENSATION FOR THEIR SERVICES.8. THROUGH THE HOSPITAL AND ITS FOUNDATION, FUNDS ARE USED TO SUPPORT A VARIETY OF HEALTH AND RELATED COMMUNITY ORGANIZATIONS AND ACTIVITIES INCLUDING LA CLINICA DEL VALLE, COMMUNITY HEALTH CENTER, THE CHILDREN'S ADVOCACY CENTER, AND THE HEARTS AND VINES FOUNDATION.9. THE HOSPITAL OPERATES HEALTH CLINICS IN MIDDLE-SCHOOLS AND HIGH SCHOOLS IN ASHLAND AND TALENT.10. THROUGH FUNDING, IN KIND CONTRIBUTIONS, AND/OR STAFF PARTICIPATION THE HOSPITAL SUPPORTS A VARIETY OF COMMUNITY ACTIVITIES SUCH AS THE 4TH OF JULY CELEBRATION AND HOLIDAY FESTIVAL OF LIGHTS.11. THROUGH ITS EMPLOYEE VOLUNTEER RECOGNITION PROGRAM, THE HOSPITAL PROVIDES GRANTS TO NON-PROFIT ORGANIZATIONS WITH WHICH EMPLOYEES VOLUNTEER.12. THE HOSPITAL'S TUITION REIMBURSEMENT PROGRAM PROVIDES EMPLOYEES UP TO $2,500 PER SCHOOL YEAR FOR TUITION, BOOKS AND FEES THEREBY SUPPORTING THE DEVELOPMENT OF NEEDED HEALTH CARE PROFESSIONALS.13. THE HOSPITAL SUPPORTS A MONTHLY MEDICAL EDUCATION PROGRAM FOR MEMBERS OF THE MEDICAL STAFF.14. THE HOSPITAL'S CHARITY CARE PROGRAM PROVIDES FINANCIAL ASSISTANCE TO ASSIST WITH MEDICAL EXPENSES.15. THE HOSPITAL PARTICIPATES IN THE VOLPACT PROGRAM, A PATIENT FINANCIAL AIDE PROGRAM SPONSORED BY THE JACKSON COUNTY MEDICAL SOCIETY.
ORPART VI, LINE 7REPORTS FILED WITH STATES

Schedule J IRS990ScheduleJ

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

Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
MARK MARCHETTI
1982660002743000235410224550000
DAVID CANDELARIA
1791270001268000176170198012000
BETH LEONE
1785070006811000187400204058000
AGNIESKA DOBIECKA
1775070005914000215330204954000
PAM ATOR
1775070001368700060710197265000
JOHN KULSBUN
1628130001302000137220177837000

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
ASHLAND ANESTHESIA ASSOCIATES
AAA IS OWNED 1/3 BY DOUGLAS DIEHL, MD, A HOSPITAL BOARD MEMBER.566711AAA PROVIDES ANESTHESIA SERVICES TO THE HOSPITAL.0
HILLVIEW PROPERTIESHULL PROPERTIES
ENTITIES OWNED BY LINDA BUTLER, A BOARD MEMBER OF THE HOSPITAL64708THE HOSPITAL RENTS PROPERTY FROM THESE ENTITIES.0
AREBI GARSA
OFFICER AND INDEPENDENT CONTRACTOR485090MR. GARSA IS THE HOSPITAL CFO AS A CONTRACTED EMPLOYEE. TRANSACTION AMOUNT REPRESENTS FEES PAID TO MR. GARSA DURING THE TAX YEAR FOR SERVICES PERFORMED IN THE CAPACITY OF CFO.0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 1THE HOSPITAL HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE BOARD CHAIR, CHAIR ELECT, SECRETARY, TREASURER, IMMEDIATE PAST CHAIR AND THE CEO. THE COMMITTEE IS AUTHORIZED TO TRANSACT THE BUSINESS OF THE BOARD IN THE INTERIM BETWEEN MEETINGS OF THE FULL BOARD WHEN A MEETING OF THE FULL BOARD IS NOT FEASIBLE; ALSO TO ADVISE THE BOARD CHAIR AND CEO. THERE ARE, HOWEVER, POWERS SPECIFICALLY RESERVED TO THE FULL BOARD BY THE HOSPITAL'S BYLAWS INCLUDING: AUTHORIZATION OF DISTRIBUTIONS; RECOMMENDATION OR APPROVAL OF DISSOLUTION, MERGER, OR SALE; ELECTION, APPOINTMENT OR REMOVAL OF DIRECTORS; AND THE ADOPTION, AMENDMENT OR REPEAL OF ARTICLES OF INCORPORATION OR BYLAWS.
FORM 990, PART VI, SECTION A, LINE 6THE ORGANIZATION HAS ONE MEMBER, THE CITY OF ASHLAND.
FORM 990, PART VI, SECTION A, LINE 7ATHE ORGANIZATION'S MEMBER HAS THE AUTHORITY AND RESPONSIBILITY TO APPOINT, AND REMOVE FOR CAUSE, THE ORGANIZATION'S DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7BTHE ORGANIZATION'S MEMBER HAS THE AUTHORITY AND RESPONSIBILITY TO APPROVE OR DISAPPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION WHICH HAVE BEEN PROPOSED OR CONCURED IN BY THE BOARD. THE MEMBER ALSO HAS THE AUTHORITY TO DISSOLVE THE CORPORATION IN THE EVENT OF AN UNCURED BREACH BY THE CORPORATION IN THE FACILITIES LEASE TO WHICH THE CITY AND THE CORPORATION ARE PARTIES.
FORM 990, PART VI, SECTION B, LINE 11THE FINANCE COMMITTEE REVIEWS FORM 990 AND A COPY IS SENT OUT TO THE FULL BOARD PRIOR TO FILING.
THE ORGANIZATION ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY DOING AN ANNUAL REVIEW OF THE POLICY AND OBTAINING NEW ACKNOWLEDGEMENT SIGNATURES ON THE POLICY BY THE BOARD OF DIRECTORS. THE ORGANIZATION FOLLOWS UP ON ANY POTENTIAL CONFLICT AS NEEDED. WHENEVER ANY DIRECTOR FIRST BECOMES AWARE THAT HE OR SHE HAS OR MAY HAVE ANY CONFLICT OF INTEREST, THAT DIRECTOR MUST PROMPTLY DISCLOSE THE EXISTENCE OF THAT CONFLICT TO THE BOARD OF DIRECTORS. FULL DISCLOSURE OF ALL MATERIAL FACTS CONCERNING THE CONFLICT IS ENCOURAGED, AND DISCLOSURE WILL BE DULY RECORDED IN THE BOARD MINUTES. IF THE DIRECTOR MAKES FULL DISCLOSURE AS DESCRIBED ABOVE, THE DIRECTOR MAY THEREAFTER ENGAGE IN ANY DISCUSSION ON THE MATTER AND MAY VOTE, UNLESS THE BOARD OF DIRECTORS BELIEVES THAT THE NATURE AND EXTENT OF THE CONFLICT OF INTEREST WARRANTS THE DIRECTOR'S EXCLUSION FROM EITHER OR BOTH OF THE DISCUSSION AND VOTE. IF THE DIRECTOR DOES NOT MAKE FULL DISCLOSURE, HE OR SHE THEREAFTER MUST LEAVE THE MEETING ROOM DURING ANY DISCUSSION OR VOTE ON THE MATTER.FORM 990, PART VI, SECTION B, LINE 12C
THE CEO'S COMPENSATION IS DETERMINED BY THE BOARD OF DIRECTORS. THE VP OF HUMAN RESOURCES GATHERS WAGE AND BENEFIT DATA FROM THE OREGON HOSPITAL ASSOCIATION SALARY SURVEY (WAGE WATCH) AND THE NORTHWEST HOSPITAL EXECUTIVE SURVEY CONDUCTED BY OLNEY ASSOCIATES, INC. THE DATA IS PROVIDED TO THE BOARD CHAIR AND REVIEWED BY THE EXECUTIVE COMMITTEE. THE BOARD THEN DETERMINES THE COMPENSATION FOR THE CEO. COMPENSATION FOR THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES IS BASED ON THE OREGON HOSPITAL ASSOCIATION SALARY SURVEY (WAGE WATCH) AND LOCAL SURVEYS. THE VP OF HUMAN RESOURCES MAKES A RECOMMENDATION TO THE CEO FOR ALL ADJUSTMENTS TO SALARY RANGES. REVIEW OF COMPENSATION LAST TOOK PLACE DURING FISCAL YEAR 2011.FORM 990, PART VI, SECTION B, LINE 15A
THE ORGANIZATION'S FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. THE CONFLICT OF INTEREST POLICY IS NOT AVAILABLE TO THE PUBLIC.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 11,400.FORM 990, PART XI, LINE 5:
THE AUDIT COMMITTEE HAS NOT CHANGED ITS PROCEDURES FROM THE PRIOR YEAR.FORM 990, PART XII, LINE 2C

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

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

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1280 MAPLE STREETAddressLine1
CityASHLANDCity
StateORState
ZIP Code97520ZIPCode
FieldValueIRS element (for citing)
EIN930691238EIN
Primary ActivitiesSUPPORT ASHLAND COMMUNITY HOSPITALPrimaryActivities
Legal Domicile StateORLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity StatusLINE 7PublicCharityStatus
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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