2011-02-05T08:41:25-06:00 2010-06-30 Arnett & Foster PLLC P O Box 2629 Charleston WV 25329 990 2009-07-01 311045101 Appalachian Community Visiting Nurse Association Hospice and Health Services APPA 7405948226 30 Herrold Avenue Athens OH 457012326 Deborah Sechkar 7405948226 2011-01-19 1 Harry C Harless 3043460441 2009 2016-02-24 21:20:13Z Deborah Sechkar 30 Herrold Avenue Athens OH 457012326 4134130 0 X www.acvna.org X 1982 OH We are dedicated to providing cost effective, high quality home health services to the people in our Appalachian Community. We provide services to Medicaid clients through Ohio Home Care programs as well as for clients with Workers' Compensation, Veteran's Administration, Medicare and other payor sources. 10 10 124 40 0 0 153022 230286 3524933 3901744 2425 2100 15504 0 3695884 4134130 0 0 2434107 2347628 0 1198 1078136 1275923 3512243 3623551 183641 510579 721340 872521 925882 555073 -204542 317448 We are Southeastern Ohio's primary source for quality home care, striving to identfy and fulfill the healthcare needs of our Appalachian community. 0 0 3259570 3901744 The organization provides care to home bound, indigent, and terminaly-ill patients in the community. To accomplish its charitable purpose, the organization provided 10,042 days of hospice care, 24,656 hours of health services and 12,001 home health visits. The organization provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. 3259570 1 1 0 0 0 0 0 0 1 1 0 1 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 1 0 0 0 1 7 0 1 124 1 0 0 0 0 0 0 0 10 10 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X Chad Collins 7405929205 55 Hospital Drive Athens OH 45701 Larry Corrigan 1.00 X 0 0 0 Tracy Marx 1.00 X 0 0 0 Ray Stephens 1.00 X 0 0 0 Ron Strickmaker 1.00 X 0 0 0 David Stroh 1.00 X 0 0 0 Michael Turner 1.00 X 0 0 0 Kathy Tarantelli 1.00 X 0 0 0 Ruth Ann Althaus 1.00 X 0 0 0 Doreen Ireton 1.00 X 0 0 0 Sandra Shirey 1.00 X 0 0 0 Deborah Sechkar 40.00 X 62362 0 877 Thomas Campbell 40.00 X 127940 0 0 190302 0 877 1 0 0 0 0 15041 215245 230286 Patient services 621610 3901744 3901744 3901744 2100 2100 4134130 3901744 0 2100 71834 63753 8081 1921240 1705101 216139 1245 1105 140 193803 172000 21803 159506 141562 17944 5996 5996 119846 106363 13483 14826 13158 1668 325467 288852 36615 3396 3014 382 84540 75029 9511 157708 139966 17742 6940 6159 781 67 67 27157 24102 3055 32008 28407 3601 Hospice room & board 396571 396571 Repairs and maintenance 38596 34254 4342 Emergency response syst 26039 26039 Bad debts 21806 21806 Training & continuing e 6660 5911 749 8300 6418 684 1198 3623551 3259570 362783 1198 214331 238984 353272 519337 13713 11069 22223 16892 834548 817815 51390 16733 14262 4772 52149 64734 721340 872521 298695 265845 627187 289228 925882 555073 X -206799 315192 2257 2256 -204542 317448 721340 872521 X 0 1 1 X 0 X 137407 259800 269104 153016 230286 1049613 3082241 3512978 3468287 3524933 3901744 17490183 3219648 3772778 3737391 3677949 4132030 18539796 0 0 0 18539796 1522 3438 2180 2425 2100 11665 1522 3438 2180 2425 2100 11665 4205 15504 19709 3225375 3776216 3739571 3695878 4134130 18571170 0.99830 0.99770 0.00060 0.00060 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2257 2 2259 2251 6 2257 1.00000 0 0 834548 817815 16733 16733 CD - Internally designated for hospice services 64734 C 64734 Due to related party 265000 Advances from third party payors 24228 289228 4134130 3623551 510579 11411 11411 521990 Form 990, Part VI, Section B, line 11 The President/CEO reviews the Form 990 prior to signing and submitting to the IRS. Form 990, Part VI, Section B, line 12c Whenever a trustee feels that a conflict of interest situation is or may be involved, the trustee is to promptly and fully disclose the facts related to the conflict. Trustees are required to disclose possible conflicts of interest to the full Board of Trustees. Whenever conflicts are disclosed to the full Board, the Board discusses the possible conflict and decides on a course of action. Conflict of interest statements for board members are signed yearly. The President/CEO is reviewed annually by an evaluation committee appointed by the board and the compensation is negotiated during this review. Form 990, Part VI, Section C, line 19 If requests are made from the public to view the organization's governing documents, conflict of interest policy or financial statements, the organization seeks legal counsel to ensure compliance with organization guidelines. A written request must be submitted to the organization asking to view these documents. FORM 990, PART XI, LINE 2C CLARIFICATION OF ITEM MARKED YES The audit is overseen by a committee for the Sheltering Arms Foundation and this has not changed since last year. Sheltering Arms Hospital Foundation 55 Hospital Drive Athens OH 45701 314446959 Patient Care OH 3 Hospital N/A 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0