2011-05-16T18:14:01-05:00 2010-06-30 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2009-07-01 200934451 GALION HEALTH FOUNDATION GALI 4194684841 269 PORTLAND WAY SOUTH GALION OH 448332399 D ERIC DRAIME 4194684841 2011-05-16 1 Bernie Ostrowski 6148493000 2009 2016-02-24 21:20:13Z GALION COMMUNITY HOSPITAL FOUNDATION D ERIC DRAIME 269 PORTLAND WAY SOUTH GALION OH 448332399 28986 0 X N/A X 2004 OH INSPIRE PHILANTHROPY AND PROVIDE FINANCIAL SUPPORT TO GALION COMMUNITY HOSPITAL IN WAYS THAT HAVE A POSITIVE IMPACT ON PATIENTS, EMPLOYEES, AND THE COMMUNITY. 5 5 0 12 0 0 17383 7389 0 -114541 21597 4786 0 -92372 28986 48840 0 8036 3041 0 2775 3842 16675 11878 68556 -104250 -39570 336537 297928 7285 19059 329252 278869 INSPIRE PHILANTHROPY AND PROVIDE FINANCIAL SUPPORT TO GALION COMMUNITY HOSPITAL IN WAYS THAT HAVE A POSITIVE IMPACT ON PATIENTS, EMPLOYEES, AND THE COMMUNITY.THE PROCEEDS OF ALL FUNDRAISERS BY THE FOUNDATION ARE USED TO PROVIDE FINANCIAL SUPPORT TO GALION COMMUNITY HOSPITAL FOR EQUIPMENT AND SERVICES THAT WOULD HAVE A POSITIVE IMPACT ON THE PATIENTS, EMPLOYEES, AND THE COMMUNITY. 0 0 63748 SUPPORT GALION COMMUNITY HOSPITAL AND SUBSIDIARY ORGANIZATIONS THAT PROMOTE HEALTH CARE IN CRAWFORD COUNTY, OHIO AND SURROUNDING COUNTIES. 63748 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0 1 1 0 1 0 0 0 0 1 1 1 1 1 1 0 0 OH X ERIC DRAIME 4194685501 269 PORTLAND WAY SOUTH GALION OH 44833 X BOYD EPPERSON 0.20 X X 0 0 0 ERIC GEYER 0.20 X 0 0 0 REX CRAMER 0.20 X 0 0 0 MARGARET CAGLE 0.20 X 0 0 0 KENNETH DAVIS 0.20 X 0 0 0 JERRY MORASKO 0.20 X 0 109416 16535 D ERIC DRAIME 0.20 X 0 0 0 CHARLES WALKER 0.20 X 0 0 0 ROBERT MELARAGNO 0.20 X 0 159399 16500 0 268815 33035 0 0 1 0 0 7389 7389 166 166 21431 21431 21431 21431 28986 0 0 21597 48840 48840 2825 2486 339 216 190 26 13900 12232 1668 1000 1000 1331 1331 444 444 68556 63748 2033 2775 190992 216415 145545 81513 336537 297928 7285 19059 7285 19059 X 104878 102175 224374 176694 329252 278869 336537 297928 X 0 1 0 X 0 X 30526 482130 280870 17383 16104 827013 30526 482130 280870 17383 16104 827013 244312 582701 10966 894 7 6 11873 10314 10314 849200 0.68620 0.96220 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 28986 68556 -39570 -11813 1000 -10813 -50383 Part XI, Line 8 - Other Adjustments: NET ASSETS RELEASED FROM RESTRICTION: 1000. 1 GALION COMMUNITY HOSPITAL 269 PORTLAND WAY SOUTH GALION OH 44833 344451872 501(C)(3) 48840 HOSPITAL RENOVATION GRANT 1 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: ORGANIZATION MAY MAKE GRANTS TO RELATED EXEMPT ORGANIZATIONS TO FURTHER THEIR EXEMPT PURPOSES. 1 0 0 0 0 0 0 0 0 0 ROBERT MELARAGNO 0 159141 0 0 0 258 0 16500 0 0 0 175899 0 0 Supplemental Information Part III PART I, LINE 3: GALION HEALTH FOUNDATION RELIED ON A RELATED ORGANIZATION (GALION COMMUNITY HOSPITAL) THAT USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: -WRITTEN EMPLOYMENT CONTRACT -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE Form 990, Part VI, Section A, line 6 THE SOLE MEMBER OF THE CORPORATION SHALL, AT ALL TIMES, BE GALION COMMUNITY HOSPITAL. Form 990, Part VI, Section A, line 7a MEMBERS OR DIRECTORS SHALL HAVE THE APPROVAL OF THE BOARD OF DIRECTORS OF GALION COMMUNITY HOSPITAL. Form 990, Part VI, Section A, line 8b THE ORGANIZATION DOES NOT HAVE SUB-COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. Form 990, Part VI, Section B, line 11 THE FORM 990 WILL BE SENT TO THE EXECUTIVE COMMITTEE BOARD FOR THEIR REVIEW. THE BOARD EXECUTIVE COMMITTEE APPROVES THE FORM 990 FOLLOWING REVIEW, AS AUTHORIZED BY THE FULL GOVERNING BODY. Form 990, Part VI, Section B, line 12c GALION COMMUNITY HOSPITAL HAS A CONFLICT OF INTEREST POLICY THAT COVERS ALL BOARD OF DIRECTORS AND OFFICERS OF THE CORPORATION. CONFLICT OF INTEREST SURVEYS ARE REVIEWED BY BOARD CHAIRMAN AND THE CEO TO ENSURE COMPLIANCE. VARIOUS RESTRICTIONS ARE IMPOSED ON INDIVIDUALS WITH POTENTIAL CONFLICTS OF INTEREST (I.E. INABILITY TO VOTE) UNTIL DECISION HAS BEEN MADE ON POTENTIAL CONFLICT. GALION HEALTH FOUNDATION HAS ADOPTED THIS POLICY. Form 990, Part VI, Section B, line 15a GALION COMMUNITY HOSPITAL'S PROCESS FOR DETERMINING COMPENSATION CONSISTED OF BOARD EXECUTIVE COMMITTEE REVIEW OF OHIO HOSPITAL ASSOCIATION COMPENSATION SURVEYS, AND THE COMMITTEE DETERMINES EXECUTIVE COMPENSATION BASED ON THIS COMPARABILITY DATA. CONTEMPORANEOUS MINUTES ARE KEPT OF MEETINGS HELD BY THE EXECUTIVE COMMITTEE REGARDING DECISIONS AND DELIBERATIONS OF THIS PROCESSS. THIS PROCESS WAS LAST COMPLETED IN 2010. Form 990, Part VI, Section C, line 18 FORM 990 AND FORM 1023 ARE MADE AVAILABLE UPON REQUEST. Form 990, Part VI, Section C, line 19 NO DOCUMENTS ARE AVAILABLE TO THE PUBLIC. FORM 990, PART VII ESTIMATE OF OFFICERS' ALLOCATION OF HOURS WORKED FOR GALION COMMUNITY HOSPITAL RELATED ENTITIES: GALION COMMUNITY HOSPITAL -JERRY MORASKO: 39.4 -ROBERT MELARAGNO: 40 -D. ERIC DRAIME: 39.4 -ANDREW DANIELS: 0 COMMUNITY HEALTH ASSOCIATES, INC.: -JERRY MORASKO: .2 -ROBERT MELARAGNO: .2 -D. ERIC DRAIME: .2 -ANDREW DANIELS: .2 NORTH CENTRAL OHIO FAMILY CARE CENTER: -JERRY MORASKO: .2 -ROBERT MELARAGNO: .2 -D. ERIC DRAIME: .2 -ANDREW DANIELS: .2 FORM 990, PART XI, LINE 2C THE ORGANIZATION HAS A FINANCE COMMITTEE WHICH OVERSEES THE AUDIT OF THE FINANCIAL STATEMENTS, BUT IS NOT INVOLVED IN THE SELECTION OF THE INDEPENDENT ACCOUNTANT WHICH COMPLETES THE AUDIT. GALION COMMUNITY HOSPITAL 269 PORTLAND WAY SOUTH GALION OH 44833 344451872 HOSPITAL SERVICES OH 501(C)(3) Line 3 N/A COMMUNITY HEALTH ASSOCIATES INC 955 BUCYRUS ROAD GALION OH 44833 341784017 PHYSICIAN OFFICE OH 501(C)(3) Line 11a, I GALION COMMUNITY HOSPITAL NORTH CENTRAL OHIO FAMILY CARE CENTER INC 269 PORTLAND WAY SOUTH GALION OH 44833 341807906 PHYSICIAN OFFICE OH 501(C)(3) Line 11a, I GALION COMMUNITY HOSPITAL GALION COMMUNITY PAIN MANAGEMENT LLC 269 PORTLAND WAY SOUTH GALION OH 44833 300602607 HOSPITAL SUPPORT OH GALION COMMUNITY HOSPITAL 0 0 GALION COMMUNITY VASCULAR SERVICES LLC 269 PORTLAND WAY SOUTH GALION OH 44833 611613817 HOSPITAL SUPPORT OH GALION COMMUNITY HOSPITAL 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 GALION COMMUNITY HOSPITAL B 48840