MCCULLOUGH-HYDE MEMORIAL HOSPITAL INCORPORATED: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- MCCULLOUGH-HYDE MEMORIAL HOSPITAL INCORPORATED (EIN 31-0650283)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-15
- IRS object ID
- 201223209349304552
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-15T12:24:30-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351178661 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUE & CO LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8800 LYRA DRIVE SUITE 450 | AddressLine1 |
| City | COLUMBUS | City |
| State | OH | State |
| ZIP Code | 43240 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 310650283 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCCULLOUGH-HYDE MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MCCU | NameControl |
| Phone | 5135245310 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 NORTH POPLAR STREET | AddressLine1 |
| City | OXFORD | City |
| State | OH | State |
| ZIP Code | 45056 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN CLEMENTS | Name |
| Title | VICE PRESIDENT/CFO | Title |
| Phone | 5135245310 | Phone |
| Date Signed | 2012-10-31 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | NANCY KIRCHNER | Name |
| PTIN | P00386751 | PTIN |
| Phone | 6148852583 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JOHN CLEMENTS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 NORTH POPLAR STREET | AddressLine1 |
| City | OXFORD | City |
| State | OH | State |
| ZIP Code | 45056 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 63344749 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.MHMH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1953 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | ACUTE CARE HOSPITAL FACILITY DELIVERING QUALITY SERVICES TO OUR PATIENTS AND THE COMMUNITIES WE SERVE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 642 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 168995 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -39715 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 472450 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 320518 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 64810749 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 61910538 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 14279 | InvestmentIncomePriorYear |
| Investment Income Current Year | 83268 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 897708 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1030425 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 66195186 | TotalRevenuePriorYear |
| Total Revenue Current Year | 63344749 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 10000 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 34322 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 28783775 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 28385199 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 36832589 | OtherExpensePriorYear |
| Other Expenses Current Year | 33959927 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 65626364 | TotalExpensesPriorYear |
| Total Expenses Current Year | 62379448 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 568822 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 965301 | RevenuesLessExpensesCY |
| Total Assets BOY | 50013680 | TotalAssetsBOY |
| Total Assets EOY | 45819702 | TotalAssetsEOY |
| Total Liabilities BOY | 27186878 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 22027599 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 22826802 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 23792103 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | ACUTE CARE HOSPITAL FACILITY DELIVERING QUALITY SERVICES TO OUR PATIENTS AND THE COMMUNITIES WE SERVE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 4237617 | Expense |
| Revenue | 20507580 | Revenue |
| Description | OPERATING ROOM-CONSISTING OF INPATIENT (34%) AND OUTPATIENT (66%) SURGICAL SERVICES INCLUDING GENERAL SURGERY (1,621 PROCEDURES), ENDOSCOPY AND MINOR PROCEDURES (3,526 PROCEDURES) AND POST ANESTHESIA CARE UNIT. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 4617910 | Expense |
| Revenue | 15727056 | Revenue |
| Description | PHARMACY-CONSISTING OF CARE PROVIDED TO INPATIENTS (26%) AND OUTPATIENTS (74%). OUTPATIENT CARE INCLUDES A MAJOR PROGRAM FOR ONCOLOGY TREATMENT. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 4170728 | Expense |
| Revenue | 26176606 | Revenue |
| Description | IMAGING-COMPRISED OF A FULL RANGE OF RADIOLOGY SERVICES INCLUDING XRAY, ULTRASOUND, CT, MRI AND NUCLEAR MEDICINE. TOTAL PROCEDURE VOLUME IS 43,379 CONSISTING OF IP CARE (26%) AND OUTPATIENT CARE (74%). | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 40030689 | Expense |
| Grants | 17500 | Grants |
| Description | INPATIENT VOLUME CONSISTED OF 2,608 DISCHARGES AND 9,943 PATIENT DAYS WITH AN AVERAGE LENGTH OF STAY OF 3.5 DAYS. IN ADDITION, 744 OBSERVATION DAYS OF SERVICE WERE PROVIDED. OVERALL, INPATIENT AND OUTPATIENT CARE REPRESENT 29% AND 81% OF GROSS PATIENT REVENUE, RESPECTIVELY. BAD DEBT EXPENSE IS INCLUDED IN THIS NUMBER. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 40030689 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 17500 | TotalOfOtherProgramServiceGrnt |
| Total Program Service Expense | 53056944 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 64 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 642 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IN | StatesWhereCopyOfReturnIsFiled |
| States Where Copy Of Return Is Filed | OH | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAMES MILLER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5135245310 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 NORTH POPLAR STREET | AddressLine1 |
| City | OXFORD | City |
| State | OH | State |
| ZIP Code | 450561292 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| JOHN HARLAND MD | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| SUSAN CROSS LIPNICKEY | |||||||
| VICE CHAIRMAN | 1.00 | X | 0 | 0 | 0 | ||
| JACK MANN | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| RICHARD M NORMAN | |||||||
| SECRETARY-TREASURER | 1.00 | X | 0 | 0 | 0 | ||
| ALAN OAK | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| WILLIAM R RICHARDSON | |||||||
| CHAIRMAN | 1.00 | X | 0 | 0 | 0 | ||
| WILLIAM DOUGLAS ROSS DO | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| MICHAEL RUDOLPH | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| THOMAS W SPEH | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| PAIGE WOOD | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| BRYAN HEHEMANN | |||||||
| CEO | 40.00 | 202613 | 0 | 14797 | X | ||
| JOHN CLEMENTS | |||||||
| VP & CFO | 40.00 | 96330 | 0 | 4938 | X | ||
| PAMELA COLLINS | |||||||
| VP & CPSO | 40.00 | 127687 | 0 | 7511 | X | ||
| TAMMY WOOD | |||||||
| VP & CAO | 40.00 | 118501 | 0 | 14378 | X | ||
| KENNETH KELLER | |||||||
| PHYSICIAN | 40.00 | 244989 | 0 | 3654 | X | ||
| MATTHEW BIRKLE | |||||||
| PHYSICIAN | 40.00 | 247235 | 0 | 3686 | X | ||
| RODNEY HOLDERMAN | |||||||
| PHARMACY DIRECTOR | 40.00 | 121681 | 0 | 15560 | X | ||
| MARK CRISTELL | |||||||
| PT DIRECTOR | 40.00 | 126735 | 0 | 15632 | X | ||
| MATTHEW DAGGY | |||||||
| PHYSICIAN | 40.00 | 111347 | 0 | 1708 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1397118 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 81864 | TotalOtherCompensation |
| Number Individuals GT100 K | 14 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| HUMANA | |||||
| 101 EAST MAIN STREET | LOUISVILLE | KY | 40202 | HEALTH INSURANCE | 1857637 |
| CPSI | |||||
| 600 WALL STREET | MOBILE | AL | 36695 | COMPUTER SYSTEMS | 742147 |
| MAYO MEDICAL LABORATORIES | |||||
| 200 FIRST STREET SW | ROCHESTER | MN | 55905 | MEDICAL | 427977 |
| SOAP | |||||
| 118 EAST SUPERIOR STREET | WAYLAND | MI | 49348 | TRANSCRIPTION | 388191 |
| MASTERPLAN | |||||
| 9582 TOPANGA CANYON BLVD | CHASTSWORTH | CA | 91311 | BIOMEDICAL | 353731 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 34 | NumberOfContractorsGT100K |
| Related Organizations | 206331 | RelatedOrganizations |
| All Other Contributions | 114187 | AllOtherContributions |
| Total Contributions | 320518 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICES | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 61910538 | TotalRevenueColumn |
| Related Or Exempt Function Income | 61910538 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 61910538 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 82344 | TotalRevenueColumn |
| Exclusion | $82,344 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 292371 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 292371 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 292371 | TotalRevenueColumn |
| Unrelated Business Revenue | 168995 | UnrelatedBusinessRevenue |
| Exclusion | $123,376 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 924 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 924 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 924 | TotalRevenueColumn |
| Exclusion | $924 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| DIETARY | 722210 | 237350 | $237,350 | |
| MISCELLANEOUS | 900099 | 170610 | 170610 | |
| OCCUPATIONAL HEALTH | 624310 | 154749 | 154749 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 175345 | TotalRevenueColumn |
| Related Or Exempt Function Income | 175345 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 738054 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 63344749 | TotalRevenueColumn |
| Related Or Exempt Function Income | 62411242 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 168995 | UnrelatedBusinessRevenue |
| Exclusion | $443,994 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34322 | Total |
| Program Services | 34322 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22394180 | Total |
| Program Services | 20668042 | ProgramServices |
| Management And General | 1726138 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 342714 | Total |
| Program Services | 246754 | ProgramServices |
| Management And General | 95960 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4053719 | Total |
| Program Services | 2918678 | ProgramServices |
| Management And General | 1135041 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1594586 | Total |
| Program Services | 1148102 | ProgramServices |
| Management And General | 446484 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 228287 | Total |
| Management And General | 228287 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 162726 | Total |
| Management And General | 162726 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7503758 | Total |
| Program Services | 6414465 | ProgramServices |
| Management And General | 1089293 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 296384 | Total |
| Program Services | 210735 | ProgramServices |
| Management And General | 85649 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 810632 | Total |
| Program Services | 624749 | ProgramServices |
| Management And General | 185883 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 802638 | Total |
| Program Services | 800284 | ProgramServices |
| Management And General | 2354 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2463001 | Total |
| Program Services | 1084111 | ProgramServices |
| Management And General | 1378890 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 48457 | Total |
| Program Services | 20541 | ProgramServices |
| Management And General | 27916 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 49705 | Total |
| Program Services | 37191 | ProgramServices |
| Management And General | 12514 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 806496 | Total |
| Management And General | 806496 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4130611 | Total |
| Program Services | 2932734 | ProgramServices |
| Management And General | 1197877 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 502035 | Total |
| Program Services | 373033 | ProgramServices |
| Management And General | 129002 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 9414011 | 9336988 | 77023 |
| BAD DEBT | 6013424 | 6013424 | |
| OTHER EXPENSES | 727762 | 192791 | 534971 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 62379448 | Total |
| Program Services | 53056944 | ProgramServices |
| Management And General | 9322504 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 700 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6276513 | BOY |
| EOY | 3495515 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8061967 | BOY |
| EOY | 8206772 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1143460 | BOY |
| EOY | 1176581 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 906249 | BOY |
| EOY | 1302270 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 72678641 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 43821722 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30233845 | BOY |
| EOY | 28856919 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3391646 | BOY |
| EOY | 2780945 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50013680 | BOY |
| EOY | 45819702 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5334341 | BOY |
| EOY | 4241958 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19461501 | BOY |
| EOY | 17328895 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2391036 | BOY |
| EOY | 456746 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27186878 | BOY |
| EOY | 22027599 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22826802 | BOY |
| EOY | 23792103 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22826802 | BOY |
| EOY | 23792103 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50013680 | BOY |
| EOY | 45819702 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 965301 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $6,500 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 6500 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | SUPPORT PROVIDED THROUGH DUES PAID TO OHA AND AHA OHA = $1,469 AHA = $5,031 | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 548616 | OtherCostOrOtherBasis |
| Book Value | 548616 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 26251708 | OtherCostOrOtherBasis |
| Depreciation | 12778270 | Depreciation |
| Book Value | 13473438 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5718699 | OtherCostOrOtherBasis |
| Depreciation | 2096242 | Depreciation |
| Book Value | 3622457 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 39829167 | OtherCostOrOtherBasis |
| Depreciation | 28947210 | Depreciation |
| Book Value | 10881957 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 330451 | OtherCostOrOtherBasis |
| Book Value | 330451 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 28856919 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| UNAMORTIZED FINANCE COSTS | 122537 |
| DOCTORS' LOANS RECEIVABLE | 942035 |
| CASH SURRENDER VALUE | 36629 |
| DUE FROM RELATED PARTY | 1679744 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 2780945 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | ESTIMATED THIRD PARTY SETTLEMENTS | Description |
| Amount | $456,746 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 456746 | TotalOfAmounts |
| Total Revenue | 63344749 | TotalRevenue |
| Total Expenses | 62379448 | TotalExpenses |
| Excess Or Deficit For Year | 965301 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | 965301 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 63344749 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 63344749 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 63344749 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 62379448 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 62379448 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 62379448 | TotalExpensesPerForm990 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1397381 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1397381 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02480 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5477152 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3680357 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1796795 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03190 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6874533 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3680357 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3194176 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05670 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 89496 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 89496 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00160 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 89496 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 89496 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00160 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6964029 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3680357 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3283672 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05830 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 43693 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 43693 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00080 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 43693 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 43693 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00080 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $2,525,638 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 9376842 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 11734125 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -2357283 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 5 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (5 entries)
| Facility NumberFacilityNumber | Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Licensed HospitalLicensedHospital | General Medical And SurgicalGeneralMedicalAndSurgical | Er24 HoursEr24Hours | Er OtherErOther | OtherOther |
|---|---|---|---|---|---|---|---|---|---|
| MCCULLOUGH HYDE MEMORIAL HOSPITAL | |||||||||
| 1 | 110 N POPLAR STREET | OXFORD | OH | 45056 | X | X | X | X | DSH |
| MCCULLOUGH HYDE MEMORIAL HOSPITAL | |||||||||
| 2 | 5151 MORNING SUN RD | OXFORD | OH | 45056 | X | PHYSICAL THERAPY | |||
| MCCULLOUGH HYDE MEMORIAL HOSPITAL | |||||||||
| 3 | 10058 COOLEY RD | BROOKVILLE | IN | 47012 | X | OUTPATIENT | |||
| MCCULLOUGH HYDE MEMORIAL HOSPITAL | |||||||||
| 4 | 1390 EATON RD | HAMILTON | OH | 45013 | X | PHYSICAL THERAPY | |||
| MCCULLOUGH HYDE MEMORIAL HOSPITAL | |||||||||
| 5 | 2449 ROSS-MILLVILLE RD | HAMILTON | OH | 45013 | X | OUTPATIENT-URGENT CARE-PT | |||
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCCULLOUGH-HYDE MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 6013424. | |
| PART II: MCCULLOUGH-HYDE MEMORIAL HOSPITAL PROMOTES HEALTH AND WELLBEING IN OUR COMMUNITY IN NUMEROUS WAYS NOT LISTED IN THE COMMUNITY EVENTS AND PROGRAMS SECTION OF THE 990. EXAMPLES INCLUDE: 1. MHMH HELPED PROMOTE WELLNESS BY PROVIDING MEETING SPACE TO THE INFANT/CHILD LOSS BEREAVEMENT SUPPORT GROUP AND FIBROMYALGIA SUPPORT GROUP. 2. MHMH ASSISTED OUR LOCAL SCHOOL DISTRICT WITH IDENTIFIEDHEALTH/WELLNESS NEEDS. EXAMPLES INCLUDE: A. DEVELOPED AND PROVIDED CRISIS CARDS FOR ALL 8TH GRADERS AND ALL COUNSELORS IN THE SCHOOL DISTRICT B. DEVELOPED CURRICULUM THAT COMBINED TRADITIONAL LEARNING WITH EXERCISE TO HELP FIGHT OBESITY IN OUR ELEMENTARY STUDENTS C. DEVELOPED AND HELD MINI HEALTH SEMINARS FOR 6TH GRADE STUDENTS ON SLEEP, NUTRITION, EXERCISE AND MENTAL HEALTH 3. MHMH PROVIDED OFFICE SPACE AND MEETING SPACE FOR THE OXFORD COLLEGE CORNER CLINIC, WHICH IS A CLINIC THAT PROVIDES FREE HEALTH CARE TO THE UNINSURED AND UNDERINSURED ADULTS IN OUR COMMUNITY 4. MHMH IMPROVED THEIR EMPLOYEE WELLNESS PROGRAM BY: A. IMPLEMENTING A HEALTH RISK ASSESSMENT FOR THEIR EMPLOYEES TO IDENTIFY HEALTH NEEDS/CONCERNS IN OUR EMPLOYEE POPULATION B. OFFERING MAMMOGRAMS AND PROSTATE SCREENING TO APPROPRIATE EMPLOYEES FREE OF CHARGE C. INCENTIVIZING EMPLOYEES TO ADOPT HEALTHIER BEHAVIOR | |
| PART III, LINE 4: THE HOSPITAL HAS A DETAILED FINANCIAL ASSISTANCE POLICY WHICH STATES THAT TO PARTICIPATE IN CHARITY CARE CANDIDATES MUST COOPERATE FULLY. IN ADDITION THE HOSPITAL EDUCATES PATIENTS WITH LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THIS REASON THE ORGANIZATION BELIEVES THAT IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE. | |
| PART III, LINE 8: THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED DECEMBER 31, 2011 REPORT: HOSPITAL STATEMENT OF REIMBURSABLE COST. | |
| PART III, LINE 9B: ONCE IT HAS BEEN DETERMINED THAT A PATIENT QUALIFIES FOR CHARITY CARE/FINANCIAL ASSISTANCE, COLLECTION PRACTICES ARE STOPPED. | |
| PART V, SECTION B, LINE 19D: DISCOUNT BASED ON AVG COMMERCIAL INSURANCE WRITEDOWN | MCCULLOUGH-HYDE MEMORIAL HOSPITAL |
| PART VI, LINE 2: MCCULLOUGH-HYDE USES A PROCESS OF ASSESSMENT TO GAUGE THE HEALTHCARE NEEDS OF THE COMMUNITY WE SERVE. THE COMPONENTS OF THAT PROCESS FOR 2011 WERE:1. A NINE-MONTH STRATEGIC PLANNING PROCESS WITH INPUT FROM VARIOUS STAKEHOLDER GROUPS INCLUDING THE MEDICAL STAFF, THE LOCAL COMMUNITY FOUNDATION, THE LOCAL FREE MEDICAL CLINIC (OXFORD COLLEGE CORNER CLINIC), THE LOCAL SOCIAL NEEDS UMBRELLA ORGANIZATION (FAMILY RESOURCE CENTER), AND SEVERAL SMALLER FOCUS GROUPS OF PATIENTS, COMMUNITY LEADERS, AND NON-PATIENTS.2. ALL UNINSURED EMERGENCY DEPARTMENT PATIENTS ARE ASSESSED BY STAFF AND REFERRED TO THE LOCAL FREE MEDICAL CLINIC FOR FOLLOW-UP CARE AND ASSISTANCE, WHEN APPROPRIATE. THAT DATA INFORMS POTENTIAL EDUCATION AND SERVICE PROGRAMS THAT THE HOSPITAL OFFERS TO THE COMMUNITY.3. ON-GOING PARTNERSHIPS WITH MIAMI UNIVERSITY, THE CITY OF OXFORD, AND THE LOCAL SCHOOL DISTRICT TO JOINTLY ADDRESS SPECIFIC HEALTH CARE NEEDS OF THEIR RESPECTIVE POPULATIONS.4. AN ON-GOING, LESS FORMAL PROGRAM, GATHERS INPUT FROM MINISTERS IN OUR CHAPLAIN PROGRAM AND FROM OUR MANY VOLUNTEERS. | |
| PART VI, LINE 3: FINANCIAL COUNSELORS ARE LOCATED IN THE PATIENT ACCESS AREAS AND PATIENTS ARE OFTEN REFERRED TO THEM AFTER THE COMPLETION OF THE REGISTRATION PROCESS. IN THE EVENT THAT FINANCIAL COUNSELORS ARE NOT AVAILABLE PATIENT ACCESS STAFF IS EDUCATED ON THE CHARITY CARE/FINANCIAL ASSISTANCE POLICIES AND HAVE APPLICATIONS AVAILABLE. CHARITY CARE INFORMATION IS ALSO INCLUDED ON OUR PATIENT STATEMENTS. ALL CUSTOMER SERVICE REPRESENTATIVES ARE FAMILIAR WITH OUR POLICIES AND CAN SPEAK TO OUR CUSTOMERS ABOUT CHARITY CARE/FINANCIAL ASSISTANCE ELIGIBILITY. BROCHURES EXPLAINING CHARITY CARE/FINANCIAL ASSISTANCE ARE ALSO AVAILABLE IN VARIOUS LOCATIONS THROUGHOUT THE HOSPITAL. | |
| PART VI, LINE 4: MCCULLOUGH HYDE MEMORIAL HOSPITAL SERVES A DIVERSE DEMOGRAPHIC INCLUDING THE NORTHWESTERN CORNER OF BUTLER COUNTY, OHIO, THE SOUTHWESTERN CORNER OF PREBLE COUNTY, OHIO AND THE COUNTIES OF FRANKLIN, UNION AND FAYETTE IN INDIANA. THE MAIN CAMPUS IS LOCATED IN OXFORD, OHIO, THE HOME OF MIAMI UNIVERSITY WITH A POPULATION RANGING TO NEARLY 30,000 DURING THE SCHOOL YEAR TO HALF THAT NUMBER DURING THE SUMMER.MHMH COUNTS ITS PRIMARY SERVICE AREA AS THE FOLLOWING: OXFORD,OH - 45056 - POPULATION 29,739 BROOKVILLE, IN - 47012 - POPULATION 10,455 COLLEGE CORNER, OH - 45003 - POPULATION 971 EATON, OH - 45320 - POPULATION 15,354 SOMERSVILLE, OH - 45064 - 2,963 CAMDEN, OH - 45311 - 7,215 LIBERTY, IN - 47353 - 5,698 WEST COLLEGE CORNER, IN - 47003 - 834 TOTAL PRIMARY SERVICE AREA POPULATION = 73,229AND ITS PRIMARY AND ITS SECONDARY SERVICE AREAS ARE THE FOLLOWING: HAMILTON, OH - 45013 - 54,814 CONNERSVILLE, IN - 47331 - 23,438 METAMORA, IN - 47030 - 1,631 OKEANA, OH - 45053 - 3,712 TOTAL SECONDARY SERVICE AREA POPULATION = 83,595IN TERMS OF SOCIO-ECONOMIC DEMOGRAPHICS, THE EDUCATIONAL ATTAINMENT IS LOWER THAN COUNTY, STATE AND NATIONAL AVERAGES AND THE UNEMPLOYMENT HIGHER THAN COUNTY, STATE AND NATIONAL AVERAGES IN ALL OF THE UNINCORPORATED AND RURAL AREAS SERVED BY MHMH. ALL OF THE AREAS IN INDIANA AND THE RURAL AREAS IN PREBLE AND BUTLER COUNTIES (CAMDEN, SOMERVILLE) ARE DESIGNATED AS HEALTH PROFESSIONAL SHORTAGE AREAS BY THE NATIONAL HEALTH SERVICE CORPS.MCCULLOUGH HYDE HAS RECRUITED, SUPPORTED AND WILL CONTINUE TO RECRUIT AND SUPPORT BOTH PRIMARY CARE PHYSICIANS AND SPECIALISTS TO MEET THE NEEDS OF RESIDENTS OF THESE COMMUNITIES. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 0 | RecordsMaintained |
Recipient Table RecipientTable (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|
| TALAWANDA SCHOOL DISTRICT | ||||||
| 131 WEST CHESTER ST | OXFORD | OH | 45056 | 316005340 | 10000 | SCHOOL PROGRAMS |
| SANE OF BUTLER COUNTY | ||||||
| PO BOX 18818 | FAIRFIELD | OH | 45018 | 311604036 | 7500 | FORENSIC CARE |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BRYAN HEHEMANN | |||||||||||||
| 198026 | 0 | 0 | 0 | 4587 | 0 | 938 | 0 | 13859 | 0 | 217410 | 0 | 0 | 0 |
| KENNETH KELLER | |||||||||||||
| 240419 | 0 | 0 | 0 | 4570 | 0 | 0 | 0 | 3654 | 0 | 248643 | 0 | 0 | 0 |
| MATTHEW BIRKLE | |||||||||||||
| 247235 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 3686 | 0 | 250921 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 4B | ReturnReference |
| Explanation | BRYAN HEHEMANN - LIFE INSURANCE POLICY - PAID UP POLICY AT 65. FACE AMOUNT IS 100K WITH CASH SURRENDER VALUE. THERE IS AN ANNUAL PREMIUM OF $8,874 WITH THE VALUE AT 12/31/11 AT $36,629. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Issuer EINIssuerEIN | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|
| BUTLER COUNTY-SERIES 2009A | ||||||
| 316000061 | 2003-05-07 | 17223844 | CONTRUCTION/EXPANSION | 0 | 0 | 0 |
| BUTLER COUNTY-SERIES 2009B | ||||||
| 316000061 | 2003-05-07 | 4776156 | CONTRUCTION/EXPANSION | 0 | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Total ProceedsTotalProceeds | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|
| 17223844 | 176587 | 1735397 | 2011 | 1 | 0 | 1 | 1 |
| 477156 | 49807 | 489470 | 2011 | 1 | 0 | 1 | 1 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 1 |
| 0 | 0 | 0 | 0 | 1 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 | 0 |
| 0 | 0 | 0 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (4 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE 990 IS PREPARED BY THE CPA FIRM, BLUE & CO LLC AND PRESENTED TO CFO AND FINANCE COMMITTEE FOR REVIEW. THE 990 IS THEN PRESENTED AT THE BOARD MEETING. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANNUALLY THE CORPORATE COMPLIANCE OFFICER REQUIRES THE OFFICERS, TRUSTEES, DIRECTORS AND KEY EMPLOYEES TO DISCLOSE IN WRITING ANY INTEREST THAT COULD GIVE RISE TO CONFLICTS. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE PROCESS FOR DETERMINING COMPENSATION INCLUDES INDEPENDENT CONSULTANT INPUT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY STUDY AND APPROVAL BY THE BOARD. |
| FORM 990, PART VI, SECTION C, LINE 19 | UPON INDIVIDUAL REQUEST |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCCULLOUGH-HYDE MEMORIAL HOSPITAL ENDOWMENT | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 NORTH POPLAR | AddressLine1 |
| City | OXFORD | City |
| State | OH | State |
| ZIP Code | 45056 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237374256 | EIN |
| Primary Activities | OBTAIN CHARITABLE CONTRIBUTIONS, MANAGE THEM AND DISBURSE BY BOARD DIRECTION | PrimaryActivities |
| Legal Domicile State | OH | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | LINE 11A, I | PublicCharityStatus |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCCULLOUGH-HYDE MEMORIAL HOSPITAL ENDOWMENT | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionType |
| Amount Involved | 206331 | AmountInvolved |