2011-11-10T11:44:01-06:00 2010-12-31 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2010-01-01 341893452 UHHSCSAHS - CUYAHOGA INC UHHS 4407402180 6935 TREELINE DRIVE NO J BRECKSVILLE OH 441413393 ALLEN TRACY 4407402180 2011-11-07 1 BERNIE OSTROWSKI 6148493000 2010 2016-02-24 21:20:13Z ALLEN TRACY 6935 TREELINE DRIVE NO J BRECKSVILLE OH 441413393 73147580 0 X N/A X 1999 OH SEE SCHEDULE OUHHS/CSAHS-CUYAHOGA, INC (CUYAHOGA) IS AN ORGANIZATION JOINTLY OWNED BY THE SISTERS OF CHARITY HEALTH SYSTEM AND UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. (THE MEMBERS) OPERATED FOR THE EXCLUSIVE BENEFIT OF THE MEMBERS AND THEIR RELATED SUBSIDIARIES. BOTH MEMBERS ARE TAX-EXEMPT 501(C)3 CHARITABLE ORGANIZATIONS. CUYAHOGA PROVIDES ADMINISTRATIVE SUPPORT SERVICES FOR ORGANIZATIONS OPERATED BY THE MEMBERS. THE ADMINISTRATIVE SUPPORT SERVICES PROVIDED PRINCIPALLY INCLUDE: ACCOUNTING, PAYROLL, ACCOUNTS PAYABLE, PATIENT BILLING, REIMBURSEMENT, AND INFORMATION TECHNOLOGY SUPPORT. MEMBERS REIMBURSE CUYAHOGA FOR THE ADMINISTRATIVE SERVICES PROVIDED BASED UPON MUTUALLY AGREED UPON ALLOCATIONS. 4 4 1680 4 0 0 2947818 0 256337279 0 390396 1319 9533702 73146261 269209195 73147580 0 0 0 0 127655574 66502725 0 0 0 132943356 6096576 260598930 72599301 8610265 548279 217044547 13270046 55524404 9996411 161520143 3273635 X UHHS/CSAHS-CUYAHOGA, INC (CUYAHOGA) IS AN ORGANIZATION JOINTLY OWNED BY THE SISTERS OF CHARITY HEALTH SYSTEM AND UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. (THE MEMBERS) OPERATED FOR THE EXCLUSIVE BENEFIT OF THE MEMBERS AND THEIR RELATED SUBSIDIARIES. BOTH MEMBERS ARE TAX-EXEMPT 501(C)3 CHARITABLE ORGANIZATIONS. CUYAHOGA PROVIDES ADMINISTRATIVE SUPPORT SERVICES FOR ORGANIZATIONS OPERATED BY THE MEMBERS. THE ADMINISTRATIVE SUPPORT SERVICES PROVIDED PRINCIPALLY INCLUDE: ACCOUNTING, PAYROLL, ACCOUNTS PAYABLE, PATIENT BILLING, REIMBURSEMENT, AND INFORMATION TECHNOLOGY SUPPORT. MEMBERS REIMBURSE CUYAHOGA FOR THE ADMINISTRATIVE SERVICES PROVIDED BASED UPON MUTUALLY AGREED UPON ALLOCATIONS. THIS MISSION STATEMENT IS PENDING FORMAL BOARD APPROVAL. 0 1 0 0 0 SEE PART III, LINE 1 MISSION STATEMENT. 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 1 10 0 1 1680 1 0 0 0 0 0 0 0 0 0 0 X 4 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X MARY KOWTUN 4407402181 6935 TREELINE DRIVE BRECKSVILLE OH 441413393 X PATRICK MCMAHON 2.00 X X 0 0 0 ALLEN TRACY 2.00 X X 0 0 0 MELISSA ROGERS 2.00 X X 0 0 0 PAUL TAIT 2.00 X X 0 0 0 JOHN RUSNACZYK 40.00 X 178947 0 26123 ROBERT KALISZEWSKI 40.00 X 121097 0 8072 DANIEL EVANS 40.00 X 119107 0 7348 CHRISTINE SCHUTTE 40.00 X 103982 0 4876 523133 0 46419 4 0 1 0 MEDICAL INFORMATION TECHNOLOGY PO BOX 74569 CHICAGO IL 60696 IT SUPPORT 697696 SISTERS OF CHARITY HEALTH SYSTEM 2475 EAST 22ND STREET CLEVELAND OH 44115 MANAGEMENT SERVICES 314110 VELOCITY TECHNOLOGY 850 3RD AVE 1003 NEW YORK NY 10022 IT SUPPORT 267396 HUMAN ARC 1457 EAST 40TH STREET CLEVELAND OH 44103 COLLECTION SERVICES 242683 PLANTE & MORAN PLLC 27400 NORTHWESTERN HIGHWAY SOUTHFIELD MI 48034 AUDITING 158500 9 1319 1319 LEASED EMPLOYEE-SJMC 561000 61359901 61359901 MEMBER REVENUES 561000 10993726 10993726 BANKRUPTCY/LEHMAN PROC 900099 771997 771997 20637 20637 73146261 73147580 0 0 73147580 205070 205070 53092747 53092747 211559 211559 12703900 12703900 289449 289449 86944 86944 456106 456106 629541 629541 2077761 2077761 608527 608527 22738 22738 1965 1965 610054 610054 48206 48206 COLLECTION FEES 1209568 1209568 BANK FEES 317376 317376 DUES/SUBSCRIPTIONS 17979 17979 MISCELLANEOUS OTHER EXP 9811 9811 72599301 0 72599301 0 6766 82068727 816525 874455 18380608 1182429 5526286 1487148 694162 13068274 10271089 84132925 2797185 22982556 1585076 7779745 217044547 13270046 34918343 2216666 771996 1317741 18516324 7779745 55524404 9996411 X 146954706 3273635 2346187 0 12219250 0 161520143 3273635 217044547 13270046 X 548279 -158794787 X X 0 1 1 X 0 X 204666 193088 11578 12863608 10078001 2785607 2797185 ST JOHN MEDICAL CENTER - LEASING ARRANGEMENT 7779745 7779745 ST JOHN MED CTR - LEASING/BENEFITS 7779745 7779745 73147580 72599301 548279 -28177 -28177 520102 73119259 -28321 -28321 73147580 0 73147580 72599157 0 72599157 144 144 72599301 PART XI, LINE 8 - OTHER ADJUSTMENTS: CONTRACTUAL EXPENSE FOR CLOSED ENTITY, PROFESSIONAL MEDICAL EQUIPMENT -28,321. FRANCHISE EXPENSE FOR CLOSED ENTITY, PROFESSIONAL MEDICAL EQUIPMENT 144. PART XII, LINE 2D - OTHER ADJUSTMENTS: CONTRACTUAL EXPENSE FOR CLOSED ENTITY, PROFESSIONAL MEDICAL EQUIPMENT -28,321. PART XIII, LINE 4B - OTHER ADJUSTMENTS: FRANCHISE EXPENSE FOR CLOSED ENTITY, PROFESSIONAL MEDICAL EQUIPMENT 144. X X X X 0 0 0 0 0 0 0 0 0 JOHN RUSNACZYK 168947 0 10000 0 0 0 15083 0 11040 0 205070 0 0 0 ENDING BALANCE SHEET FOR NET ASSETS DETERMINED AT 12/31/09 2010-01-01 47326015 ASSET APPRAISAL AND ASSUMPTION OF LIABILITIES 340714756 ST VINCENT CHARITY MED CTR 2351 EAST 22ND STREET CLEVELAND OH 44115 501(C)(3) ENDING BALANCE SHEET FOR NET ASSETS DETERMINED AT 12/31/09 2010-01-01 45631275 ASSET APPRAISAL AND ASSUMPTION OF LIABILITIES 341260978 ST JOHN MEDICAL CENTER 29000 CENTER RIDGE RD WESTLAKE OH 44145 501(C)(3) 1 1 0 0 PART II, LINE 2E: THE FOLLOWING INDIVIDUALS LISTED IN FORM 990, PART VII AS A TRUSTEE, DIRECTOR, OR OFFICER BECAME AN OFFICER, TRUSTEE, OR LEASED EMPLOYEE OF ONE OF THE TRANSFEREE ORGANIZATIONS LISTED IN PART II LINE 1: PAUL TAIT, BOARD DIRECTOR AND SECRETARY OF THIS ORGANIZATION, IS ALSO AN OFFICER AND TRUSTEE OF ST. JOHN MEDICAL CENTER; PATRICK MCMAHON, BOARD DIRECTOR AND CHAIRPERSON OF THIS ORGANIZATION, IS ALSO AN OFFICER AND TRUSTEE OF ST. VINCENT CHARITY MEDICAL CENTER; AND ALLEN TRACY, BOARD DIRECTOR AND PRESIDENT/CEO OF THIS ORGANIZATION, IS AN OFFICER AND LEASED EMPLOYEE FROM UNIVERSITY HOSPITAL HEALTH SYSTEM TO ST. JOHN MEDICAL CENTER. CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 ON JANUARY 1, 2010 AT 12:01 A.M., UHHS/CSAHS-CUYAHOGA, INC (CUYAHOGA) TRANSFERRED HOSPITAL ASSETS AND OPERATIONS TO THE RELATED BUT SEPARATE LEGAL ENTITIES OF ST. VINCENT CHARITY MEDICAL CENTER (TAX ID 34-0714756) OWNED BY THE SISTERS OF CHARITY HEALTH SYSTEM AND ST. JOHN MEDICAL CENTER, (TAX ID 34-1260978) A JOINTLY OWNED HOSPITAL BETWEEN THE SISTERS OF CHARITY HEALTH SYSTEM AND UNIVERSITY HOSPITALS HEALTH SYSTEM. CUYAHOGA EXCLUSIVELY OPERATES AS A SUPPORTING ORGANIZATION PROVIDING ADMINISTRATIVE SUPPORT SERVICES TO THE SISTERS OF CHARITY HEALTH SYSTEM AND UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. (JOINTLY, THE MEMBERS) AND CERTAIN OF THEIR SUBSIDIARIES. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS TWO CORPORATE MEMBERS: SISTER OF CHARITY HEALTH SYSTEM AND UNIVERSITY HOSPITALS HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S MEMBER MAY ELECT MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN DECISIONS OF THE GOVERNING BODY, SUCH AS APPROVAL OF BUDGETS, CAPITAL EXPENDITURES AND ACQUISITION OF LAND, MUST BE APPROVED BY THE BOARD OF THE MEMBER ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 AFTER THE 990 RETURN IS REVIEWED INTERNALLY; IT IS SUBMITTED FOR REVIEW TO OUR TAX AUDITOR. THEY REVIEW FOR COMPLETENESS AND COMMUNICATE ANY CONCERNS THAT THEY IDENTIFY WITHIN THE DOCUMENTS AND WORKSHEETS OF THE TAX RETURN. ITEMS IDENTIFIED ARE REVIEWED BY STAFF AND ANY NEEDED CORRECTIONS ARE MADE. THE RETURN IS THEN PROVIDED TO THE CFO FOR REVIEW AND APPROVAL. IT IS THEN SUBMITTED TO THE BOARD FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS IN PLACE A CONFLICT OF INTEREST POLICY AS WELL AS A NON-RETALIATION POLICY (WHISTLE-BLOWER) MANAGED THRU ST JOHN MEDICAL CENTER'S COMPLIANCE OFFICER. THE CONFLICT OF INTEREST FORMS ARE SENT OUT ANNUALLY TO ADMINISTRATION, AND OTHER LEADERSHIP EMPLOYEES AS WELL AS BOARD MEMBERS. THE FORMS ARE RETURNED TO ADMINISTRATION. ONCE RETURNED, THEY ARE REVIEWED BY THE COMPLIANCE OFFICER AND CEO TO DETERMINE IF ANYTHING WOULD BE DEEMED A POTENTIAL CONFLICT OF INTEREST. IF THERE IS A CONFLICT, THE CEO, COMPLIANCE OFFICER AND EMPLOYEE/INDIVIDUAL MEET TO DISCUSS. THE RESULTS OF THOSE MEETINGS ARE AN AGENDA ITEM AT THE ORGANIZATION'S ADMINISTRATIVE COMPLIANCE COMMITTEE MEETING AND IT IS FURTHER DISCUSSED THERE. ONCE A DECISION IS MADE REGARDING THE CONFLICT, FOLLOW-UP IS MADE BY THE COMPLIANCE OFFICER/CEO WITH THE EMPLOYEE, IF APPROPRIATE. THE ORGANIZATION ALSO DISCUSSES THE RESULTS OF THE CONFLICT OF INTERESTS AT THE AUDIT COMMITTEE AND COMPLIANCE COMMITTEE OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD REVIEWS EACH EXECUTIVE POSITION AT THE CORPORATE LEVEL. EXECUTIVE POSITIONS INCLUDE CEO, OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. THE ORGANIZATION UTILIZES AN OUTSIDE CONSULTING FIRM TO COMPLETE MARKET ANALYSIS, WHICH OCCURS ANNUALLY IN JANUARY FOR EACH EXECUTIVE POSITION. THE RESULTS ARE SUBMITTED TO THE BOARD. THE BOARD REVIEWS THE RECOMMENDATIONS OF THE CEO AGAINST THE EXTERNAL DATA. THE BOARD THEN ACTS ON THAT RECOMMENDATION. THIS PROCESS WAS LAST COMPLETED IN 2011. FORM 990, PART VI, SECTION C, LINE 18 FORMS 990 AND 1023 ARE AVAILABLE TO PUBLIC UPON REQUEST AT THE FINANCIAL SERVICE CENTER LOCATION. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, THE FINANCIAL STATEMENTS, AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE TO PUBLIC UPON REQUEST AT THE FINANCIAL SERVICE CENTER LOCATIONS. FORM 990, PART VII, SECTION A: A KEY EMPLOYEE WAS BEING PAID BY AN UNRELATED ORGANIZATION (SISTERS OF CHARITY HEALTH SYSTEM, SCHS - 50% MEMBER OF THIS ORGANIZATION). THAT EMPLOYEE WORKED AT THIS ORGANIZATION ONLY, AND COMPENSATION WAS TREATED AS IF PAID BY THIS ORGANIZATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: ASSET TRANSFER TO ST VINCENT CHARITY MEDICAL CENTER -47,326,015. ASSET TRANSFER TO ST JOHN MEDICAL CENTER -45,631,275. PAID OUT CAPITAL TO HOLDING CO REPORTED ON 1120 -65,837,497. TOTAL TO FORM 990, PART XI, LINE 5: -158,794,787. UHHSCSAHS-CUYAHOGA HOLDING COMPANY INC 6935 TREELINE DRIVE BRECKSVILLE OH 44141 341895400 HOLDING CO OH UHHSCSAHS CUYAHOGA INC C -28172 1.00000 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 UHHSCSAHS CUYAHOGA HOLDING CO C 65837497 ACTUAL