2011-10-03T11:59:24-07:00 2010-12-31 990 2010-01-01 341531817 ALLIANCE COMMUNITY HOSPITAL FOUNDATION ALLI 3305966000 200 E State Street Alliance OH 44601 Dale Wells 3305967066 2011-10-03 2010 2016-03-07 17:11:31Z Dale W Wells 200 E State Street Alliance OH 44601 1053611 0 X X 1986 OH The Alliance Community Hospital Foundation's mission is to contribute to hospital fundraising, maintain community involvement and healthcare awareness, and grow as a philanthropic spirit of Alliance Community Hospital. 4 3 0 94 0 0 138515 508936 0 0 73667 93374 0 0 212182 602310 68651 213691 0 0 0 0 0 0 8385 22247 18774 90898 232465 121284 369845 2361106 2729199 0 0 2361106 2729199 To assist Alliance Community Hospital financially in its mission of delivering quality health care in the community, maintain community involvement and health care awareness. The Foundation also provides support to other local non-profits. 0 0 199493 0 0 Alliance Community Hospital Foundation supports Alliance Community Hospital for building and medical equipment expenses. Purchases and improvements in 2010 included Digital Mammography equipment of $169,951, a ventilator and cholesterol analyzer for the Cardio Pulmonary Department totaling $14,298, improvements to the fitness stairwell of $5,725 plus an additional $9,519 to ACH for smaller purchases or improvements. 14104 0 0 Support to Alliance Community Hospital for indigent patient care. In 2010, the Foundation provided $11,389 for indigent patient hospital expenses and an additional $2,715 for indigent patient prescriptions and other medical assistance. 2688 0 0 ACHF supports Alliance Community Hospital's Visiting Nurse and Hospice patients and patient families. The Foundation provided financial support to purchase informational brochures to be used during the patient care phase and bereavement process. 2661 94 0 Other program service expenses. 2661 94 0 218946 1 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 X 4 3 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Dale Wells 3305967066 200 E State Street Alliance OH 44601 X Mike Hoover 1 X X 0 0 0 Ron Lyons 1 X X 0 0 0 David Lundgren 1 X X 0 0 0 Dale Wells 1 X X 0 163215 18989 Stan Jonas 1 X 0 379677 27002 0 542892 45991 0 0 1 0 0 0 0 28463 32491 0 447982 1275 508936 0 76892 0 0 76892 0 0 0 0 0 0 0 0 0 0 467783 0 451301 0 16482 0 16482 0 0 16482 28433 0 602310 0 0 93374 199587 199587 14104 14104 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4916 0 4916 0 0 0 0 0 0 0 0 0 218 0 218 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Hospice Fundraising Expenses 8385 0 0 8385 Visitng Nurse & Hospice patient/family brochures 2688 2688 0 0 Other Unrestricted Fund Expenses 2567 2567 0 0 0 0 0 0 232465 218946 5134 8385 5268 23004 2355838 2706195 2361106 2729199 0 0 X 639007 750567 1228157 1120986 493942 857646 2361106 2729199 2361106 2729199 X 369845 -1752 X 0 1 1 X 0 X X X 0 0 0 Alliance Community Hospital 340714581 Hospital, Line 3 1 216285 1 216285 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 493942 363704 0 0 0 0 857646 2666 491276 0 0 0 0 493942 10885 1412 0 0 9631 0 2666 0 1 0 0 0 Assets Limited As To Use: Internally Designated 27694 F Assets Limited As To Use: Externally Resticted by Donors 853133 F Long-term Investments 1825368 F 2706195 602310 232465 369845 0 0 0 0 -256532 -256532 113313 344503 0 0 0 0 0 344503 0 257807 257807 602310 231190 0 0 0 0 0 231190 0 1275 1275 232465 SchD_P05_S00_L04 Schedule D, Part V, Line 4 The intended use of the organization's endowment funds is to hold the principal in perpetuity and use the interest for the general operations of the organization. SchD_P11_S00_L08 Schedule D, Part XI, Line 8 Restricted income of $476,454 less Net Assets released from restriction of $219,922 equals $256,532. SchD_P12_S00_L04b Schedule D, Part XII, Line 4b Add noncash donations of $1,275 and restricted income of $476,454 less net assets released from restriction of $219,922 equals $257,807 SchD_P13_S00_L04b Schedule D, Part XIII, Line 4b Noncash donations of $1,275 of food and prizes included for Form 990. Hospice 5K 28463 0 28463 500 1525 0 571 350 5243 0 0 28463 0 28463 500 1525 0 571 350 5243 8189 20274 1 Alliance Community Hospital 200 E State Street Alliance OH 44601 340714581 501(c)(3) 199493 0 medical equipment and building improvements 1 0 Indigent Patient Care 49 14104 0 SchI_P01_S00_L02 Schedule I, Part I, Line 2 Alliance Community Hospital Foundation was created to benefit Alliance Community Hospital's (ACH) mission which is to provide care to all, regardless of ability to pay. Funds given to ACH are used to purchase medical equipment, contribute to hospital building improvements, and provide for patients needs. Alliance Community Hospital Foundation has not provided grants to organizations outside its control. It worked in conjunction with other community,non-profit organizations to raise funds on their behalf. As such, these organizations such as the local YMCA, Economic Development Foundation, Interagency Council on Homelessness and Neighborhood Center, are fully engaged and a participant in the fund raising process. As such, ACHF relies on their participation and funding reports to verify use of the funds. Should ACHF provide grants outside those listed above, then ACHF will rely on the policy of lump sum funding preceeded by a grant application, approval from the Board, and then followed by a 6-month and annual evaluation of the project if needed. 0 0 0 0 0 0 0 0 0 Dale Wells 0 163215 0 0 0 0 0 8393 0 12925 0 184533 Stan Jonas 0 363177 0 0 0 16500 0 16351 0 17557 0 413585 SchJ_P01_S00_L03 Schedule J, Part I, Line 3 Alliance Community Hospital Foundation's Schedule J lists Dale Wells and Stan Jonas, employees of Alliance Community Hospital, a related organization. Their compensation is determined using all six methods listed in Part I, line 3. F990_P06_S0B_L11a Form 990, Part VI, Section B, Line 11a The Form 990 is reviewed by the CFO of Alliance Community Hospital, a related organization. Prior to filing, the 990 is also distributed to the Board of Trustees for their review and comments. It is then discussed as part of the financial report at the next Board meeting where any questions/concerns can be addressed. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c Members of the Board of Trustees are required to annually review and sign a conflict of interest policy. Under that policy, the Board member (i) has a duty to disclose any conflict, and (ii) must recuse themselves from a vote and or decision when such conflict arises. If this policy is violated, then the Board shall take appropriate action which may include an investigation and disciplinary action. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 No compensation is paid directly by Alliance Community Hospital Foundation; however, certain officers and top officials of this organization are compensated by Alliance Community Hospital, a related organization. That compensation is determined by an independent (noncompensated) committee from the Board of Trustees. This committee annually reviews compensation by obtaining market surveys of the positions. F990_P06_S0C_L17 Form 990, Part VI, Section C, Line 17 Ohio does not require the Form 990 to be filed with the Ohio Attorney General's Office. Instead, a "Verification of Filing with the Internal Revenue Service" form is completed stating that we did file Form 990 by the required due date. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The organization makes its governing documents available to the public via the Ohio Secretary of State's website. Financial statements are available in the NRMSIR filing database at www.emma.msrb.org. The conflict of interest policy is available upon request. F990_P07_S0A_L01a Form 990, Part VII, Section A, Line 1a Estimated hours per week devoted to a related organization for compensation reported in col. (E) or (F). Name: Dale Wells; Related Organization: Alliance Community Hospital; Estimated Hours devoted to Related Organization:40 hrs. Name:Stan Jonas; Related Organization: Alliance Community Hospital; Estimated Hours devoted to Related Organization:40 hrs F990_P11_S00_L05 Form 990, Part XI, Line 5 Change in unrealized gains and losses on other than trading securities, $1,752. Alliance Citizens' Health Association 200 E State St Alliance OH 44601 341531815 Manage Health Facil OH 501(C)(3) Sch A, 11b, II N/A Alliance Community Hospital 200 E State St Alliance OH 44601 340714581 Community Hospital OH 501(C)(3) Sch A, Ln 3 N/A Alliance Comm Hospital Auxiliary 200 E State St Alliance OH 44601 340777659 Volunteer Services OH 501(C)(3) Sch A, 11c, III-FI N/A Alliance Health Institute 200 E State St Alliance OH 44601 341932972 Support ACH OH 501(C)(3) Sch A, 11a, I N/A Caring Hands 885 Sawburg Rd Alliance OH 44601 341505340 Private Duty Nursing OH 501(C)(3) Sch A, 11c, III-FI N/A Alliance Health Partners 200 E State St Alliance OH 44601 341884059 PHO OH N/A C Alliance Hospitalist Group 200 E State St Alliance OH 44601 203188585 Dr Offices OH N/A C Alliance Community Radiologists Inc 200 E State St Alliance OH 44601 205698786 Dr Offices OH N/A C Alliance Medical Associates Inc 200 E State St Alliance OH 44601 911889215 Dr Offices OH N/A C Alliance Obstetrics Physicians Inc 200 E State St Alliance OH 44601 203095412 Dr Offices OH N/A C Alliance Pulmonary Associates Inc 200 E State St Alliance OH 44601 204083441 Dr Offices OH N/A C Health Alliance Inc 200 E State St Alliance OH 44601 341531993 Urgent Care OH N/A C NEO Surgical Associates Inc 200 E State St Alliance OH 44601 200760723 Dr Offices OH N/A C 0 1 1 0 0 0 0 0 0 0 1 0 1 1 1 0 0 0