2011-08-15T13:39:36-07:00 2010-12-31 990 2010-01-01 340714771 UNION HOSPITAL ASSOCIATION UNIO 3303433311 659 Boulevard Dover OH 44622 Eugene A Thorn III 3303640805 2011-08-15 2010 2016-02-24 21:20:13Z Union Hospital Eugene A Thorn II 659 Boulevard Dover OH 44622 110136384 0 X www.unionhospital.org X 1906 OH To provide excellent quality health care to the community at a competitive price through highly competent people and an integrated provider network. 17 16 1084 25 95677 15123 413522 374856 86338965 86019026 5942984 2478243 9679636 10863949 102375107 99736074 0 0 0 0 51444403 49673234 0 0 25375 49736465 48221706 101180868 97894940 1194239 1841134 146344526 149951538 39525950 40072679 106818576 109878859 Patient Care: Union Hospital Association provides quality medical health care regardless of race, creed, sex, national origin, handicap, age or ability to pay. 0 0 77384029 0 85923349 Union Hospital provided quality medical health care regardless of race, creed, age, sex, national origin, handicap, or the ability to pay. Hospital medical services provided 5,949 inpatients a total of 24,014 patient days and 242,970 outpatient visits a total of 346,990 procedures. (248919) 463805 42140 Patient and Family support programs, general and other: Union Hospital prepared 35,593 meals during 2010 for community residents who were unable to prepare meals for themselves due to a medical condition. These meals are provided at cost and are delivered by a volunteer group, Mobile Meals. During the year, 113 volunteers served 18,230 hours toward the common purpose of servicing the health care needs of the community. The value of these hours is $145,840 which is returned to the community through lower cost of patient services. The Hospital and the Kiwanis club of New Philadelphia co sponsors an annual program that provides laboratory tests and blood pressures for the residents of the community. These services are provided at or below cost. For 2010, over 48% of the medical services provided were to Medicare and Medicaid patients. The Hospital also provided services through a charity care program to include reductions for patients unable to pay for their services; the amount qualified and deducted for this adjustment was $5,610,625. Included in this number are charges written off for patients who participate in a local program called Rainbow Connection. This is a non profit health charity dedicated to meeting the needs of disadvantaged and disabled residents of Tuscarawas county. WE have agreed to write off 50% of all charges for those patients and the program pays the remaining 50%. We also have a contract with the local Hospice agency to write off specified charges for inviduals under this program; for 2010, we had 131 Hospice patients totaling $139,437. We also continue to sponsor a Helpline porgram which enables elderly and disabled to remain in their homes and feel safe in that setting, we had 738 subscribers for the year. The Hospital provides to Community Professional services, a mental health non for profit organization, space at $1.80 per square foot, well below the fair market value. The Hospital doesn't provide mental health care services as part of its normal operations therefore leases this space to help the community. Assuming a market rate of $10/sq ft the value of this is $70,400. Thus the rental rate and relating in kind support provided by the Hosptial are justified as a continuance of the hospital's mission. We also provide funding for eligible students in the radiology technician field increase the health care workforce, we provide a 35ft mobile medical vehicle that provides screenings to areas that would have been underserved. An Outreach sports medicine program that provides training to various schools to promote healthy athletes and physcials at a fraction of the cost and treatment of sports injuries. The hospital hosts and supports various medical related groups to the area such as Down syndrome, RSD, arthritis, pain management, cancer supports groups,etc. We provide babysitting, CPR, and AARP driving courses to the community. We also sent out 54,000 biannual healthy living newsletters to the community and surrounding areas. 0 0 0 77847834 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 1 109 0 1 1084 1 1 1 0 0 0 0 0 0 0 0 0 X 17 16 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OH X X Eugene A Thorn III 3303640805 659 Boulevard Dover OH 44622 John R Herzig 8 X 0 0 0 James E Knisely 8 X 0 0 0 James J Pringle 8 X 0 0 0 Gary A Petricola 8 X 0 0 0 Michael B Hovan 8 X 0 0 0 Agnes K Swigart 8 X 0 0 0 Mark N Kubina MD 8 X 0 0 0 Michael McCombs DO 8 X 0 0 0 Robert A Horn 8 X 0 0 0 Connie L Karlowicz 8 X 0 0 0 Lois E Andreas 8 X 0 0 0 Robert E Moore Jr 8 X 0 0 0 C Jason Deeds 8 X 0 0 0 John E Dooling 8 X 0 0 0 Perry L Hershberger 8 X 0 0 0 Dr Andrew J Wherley MD 8 X 0 0 0 R Bruce James 40 X X 250978 0 30081 Darwin K Smith 40 X 111061 0 13050 Thomas J Kelly Jr DO MPH 40 X 224088 0 28647 Eugene A Thorn III 40 X 159131 0 16641 Diana L Boyd 40 X 131802 0 14600 Robert J Craig 40 X 142000 0 22514 Sarah Barber 40 X 258399 0 0 Dr Terri Shilling 40 X 165017 0 0 Dr Ramon Daoud 40 X 176230 0 0 Jabr Hadid 40 X 225127 0 0 Mary Nipper 40 X 154294 0 0 1998127 0 125533 19 0 1 0 Emergimed Inc 659 Boulevard Dover OH 44622 Emergency services 4494783 Seneca Medical PO BOX 712361 Cincinnati OH 45271 Seller of medical equipment 2462948 Cardinal Health 5490 Collections Center Drive Chicago IL 60693 Seller of medical drugs 5056383 Schauer Insurance Services 200 Market Avenue N Suite 100 Canton OH 44702 Insurance agents 880754 Laboratory Corp of AM Holdings PO Box 12140 Burlington NC 27216 Laboratory services provider 815170 139 0 980 0 0 0 373876 0 374856 Net Patient Revenue 622000 85923349 85923349 0 0 Laboratory Services 621500 95677 0 95677 0 0 0 0 0 86019026 2474063 2474063 0 0 0 0 0 0 0 0 0 0 870828 0 597097 0 273731 0 273731 0 0 273731 0 4180 0 0 0 4180 4180 4180 0 0 0 19774260 9803213 9971047 9971047 0 0 Health Promotion 900099 59019 59019 0 0 Helpline Income 900099 130399 130399 0 0 Athletic training 900099 73240 73240 0 0 356513 356513 0 0 619171 99736074 98991810 95677 273731 0 0 0 0 0 0 0 0 1019060 0 1019060 0 0 0 0 0 37937955 32715882 5216476 5597 1997503 1737827 259676 0 5723571 4979507 744064 2995145 2552354 442383 408 175770 175770 113610 113610 17026461 13184108 3842215 138 335212 54361 267333 13518 10027330 8973772 1052764 794 1063935 1063935 1696726 1446593 250133 152232 81324 70908 25159 6117 18971 71 1595872 1055113 540759 6019882 3879760 2140062 60 983712 6621 977091 Bad debt expense 6960191 6960191 0 0 Dues 120932 10652 110259 21 Meals 53337 5423 47914 0 Education expense 89359 7103 82256 0 Miscellanous 1781986 191126 1586092 4768 97894940 77847834 20021731 25375 4196796 981906 3106310 3635732 11145197 12913506 0 0 0 0 0 0 1898389 2233630 1090922 1119068 122983424 68758163 56776771 54225261 47755154 50263544 2060723 2394880 2009690 2009690 16304574 20174321 146344526 149951538 6359181 6551536 27515000 27100000 0 0 4021092 3679814 0 1630677 2741329 39525950 40072679 X 97161980 99298397 205912 304769 9450684 10275693 106818576 109878859 146344526 149951538 X 1841134 1219149 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1105252 1105252 0 55384435 20896330 34488105 0 2589504 2006189 583315 0 63666337 45855644 17810693 0 237896 0 237896 54225261 Assets whose use is limited donor specification 908574 Assets whose use is limited indenture agreement 271824 Trust agreements 10275693 Other receivables 6359191 Deferred financing costs 464007 Notes receivable 107406 Interest in TVRCC 1787626 20174321 0 Interest payable 52485 Workers compensation payable 355486 Interest rate swap agreement 1216023 Accrued payroll withholdings 765286 Other payables 352049 2741329 SchD_P10_S00_L02 Schedule D, Part X, Line 2 The hospital is a not for profit corporation exempt from federal income taxes under Section 501c3 of the Internal Revenue Code. Therefore no provision has been made for federal income taxes in the accompanying financial statements. In addition the IRS has determined that the Hospital is not a "private foundation" within the meaning of section 509(a) of the code. 1 1 1 X 1 X 1 1 0 1 1 2859590 0 2859590 0.0314 12566656 5862119 6704537 0.0737 0 0 0 0 0 0 15426246 5862119 9564127 0.1051 400978 42140 358838 0.0039 62827 0 62827 0.001 0 0 463805 42140 421665 0.0049 0 0 15890051 5904259 9985792 0.1100 59627 0 59627 3200 3200 0 0 62827 0 62827 0 0 6960191 428584 29495027 22856679 6638348 X 1 1 Tuscarawas Ambulatory Surgery Center Amulatory surgery center 0.7 0 0.3 1 1 Union Hospital Association

659 Boulevard Dover OH 44622

X X X Union Hospital Association 1 5 Tuscarawas Ambulatory Surgery Center

320 Oxford St Dover OH 44622

Ambulatory Surgery Center Tuscarawas Valley Regional Cancer Center

659 Boulevard Dover OH 44622

Physician oncology center Union Physician Services

300 Medical Park Drive Suite 101C Dover OH 44622

Physician practices Union Hospital Medical Services

659 Boulevard Dover OH 44622

Physician offices DASCO UH Home Medical Equipment LLC

375 North West Street Westerville OH 43082

Home medical equipment sales. SchH_P01_S00_L07 Schedule H, Part I, Line 7 Used the ratio of patient cost to charges from worksheet 2 to calculate charity care reported. SchH_P01_S00_L072f Schedule H, Part I, Line 7, Column f $6,960,191 SchH_P02_S00_L00 Schedule H, Part II The Hospital has numerous community building activities. Project Search welcomes mentally handicapped youth into the workforce, the Hospital provides space and internships postions for these young adults to help them learn workforce traits and skills and to be more socially interactive. Many of our interns have secured positions from this program. We provide clinical rotations for numerous nursing and technical programs related to healthcare. These programs secure the youth to the area. We also host and offer numerous support groups. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 Patient accounts receivable are due in full when billed. Accounts are considered delinquent and subsequently written off as bad debt based on individual credit evaluation adn specific circumstances of the account. Line 2 represents 3.6% of gross patient revenue as seen as being uncollectible by self pay patients which is based upon historical valuations. A bad debt expense footnote is not presented in the notes to the financial statements. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 Amounts are generated by the Medicare cost report which utilizes a department cost to charge methodology. SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b The Hospital will refund any monies paid on an account deemed charity care or that qualifies for financial assistance once that assessment has been deteremined. The account is then written off to such classification and any or all collections will cease after the determination has been made. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 Our Community Wellness department is committed to addressing the health assessments of our community. The department compiled data gathered by utilizing secondary resoucers such as CDC and Ohio Obesity prevention. We have indentified six areas that are of high concern in our community, they are, cancer, diabetes, heart disease and strokes, physical activity and fitness, tobacco use, and the overall education of the community on health issues. In response to the areas of concern, the Hospital offers blood pressure screening, cholesterol screenings, fasting blood sugar tests, and vascular screening at reduced costs or free to members of the community on a monthly basis. We also have a cancer prevention day which includes pap smears, mammograms and skin cancer exams at a free or reduced cost. In response to the obesity and physical activity risks the hospital initiated a walking program and trail ,the fit youth initiative and Run for Home marathon training sessions. For the general health of the community we also teach classes on bicycle helmet safety, AARP driver safety course, babysitting basic classes, CPR for families and friends and smoking cessation. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 Inpatients are given an informational booklet upon admission to the hospital, this booklet contains information regarding contact with patient accounts, insurances accepted by the hospital, and other options of payment for the uninsured or under insured. The Hospital also employees a patient financial specialist who meets with patients/family to discuss family size, income and other information to see what if they would qualify for any programs. Financial assistance information is not provided at discharge but provided with the initial statement. The Hospital also discusses with the patients and family the availability of state and federal programs for medical care. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 Tuscarawas county is one of the 88 counties of the Sate of Ohio. The county has a population of about 91,000 residents with 25% under the age of 25 and 25% between the ages of 45 and 62. It is predominantly a caucasion county in a rural setting with 7.2% below the poverty level. 30% of adults smoke and 31% are obese or overweight. Heart disease and strokes are the prevalant health issues of the county. To help counteract these issues, the Hospital provides numerous blood pressure, cholesterol and blood sugar screenings throughout the year; the Hospital also offers a smoking cessation program. To help slow the obesity epidemic, the Hospital sponsors a fit youth initiative, a marathon and offers bicycle safety for our youth. The Hospital also supports a clinic for the uninsured. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 The Hospital provides many low cost clinics for blood pressure, cholesterol screenings, cancer screenings, and diabetes clinics to the area to help the community stay healthy and prevent diseases. The board is made up of individuals representing the community, there is an open medical staff and all surplus funds are used to make the Hospital a better organization for the community. We also offer health fairs and promote health speakers on various health and safety issues to the community at no charge. SchH_P06_S00_L07 Schedule H, Part VI, Line 7 Community benefit report is not filed with any state. X X 0 0 0 0 0 0 0 0 0 Darwin K Smith 111061 0 0 0 0 0 6664 0 6386 0 124111 0 0 Thomas J Kelly Jr DO MPH 224088 0 0 0 0 0 13445 0 15202 0 252735 0 0 0 Eugene A Thorn III 159131 0 0 0 0 0 9547 0 7094 0 175772 0 0 0 Robert J Craig 142000 0 0 0 0 0 8520 0 13994 0 164514 0 0 0 Diana L Boyd 131802 0 0 0 0 0 7908 0 6692 0 146402 0 0 0 R Bruce James 250978 0 0 0 0 0 14700 0 15381 0 281059 0 0 0 Sarah Barber 258399 0 0 0 0 0 0 0 8185 0 266584 0 0 0 Dr Terri Shilling 165017 0 0 0 0 0 9901 0 6914 0 181832 0 0 0 Dr Ramon Daoud 176230 0 0 0 0 0 10574 0 7151 0 193955 0 0 0 Jabr Hadid 225127 0 0 0 0 0 908 0 3064 0 229099 0 0 0 Mary Nipper 154294 0 0 0 0 0 0 0 9044 0 163338 0 0 0 Tuscarawas County Ohio 346002853 90069baa2 2009-10-15 27515000 Re issue of 1993 and 2001 bonds 1 1 0 0 0 0 0 0 0 484184 0 0 2090519 0 878551 2009 1 0 1 1 0 0 0 0 0 0 0 0 1 0 1 1 RBS Citizens NA 20.5 0 0 0 0 0 F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 The Hospital has a 17 member board of trustees who oversee the manangement of the Hospital. All monthly financial reporting is presented to the board of trustees. The trustees also oversee the hiring of any upper manangement and the approval of all capital and operatign budgets. F990_P06_S0A_L07a Form 990, Part VI, Section A, Line 7a The board of trustees elects the finance committee. F990_P06_S0B_L11a Form 990, Part VI, Section B, Line 11a The 990 is prepared internally by the Hospital's staff accountant. The general ledger is reconciled to the appropriate schedules on the form and to the audited financial statements. After this review it is then forwarded to the Vice President of Finance who reviews it for completeness and accuracy. After his review it is then submitted to the Finance Committee made up of Board of Trustee members. After the Finance Committee reviews the form it is then submitted to the Board of Trustees for review. The return is also reviewed by an independent accounting firm. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c Officers and board members are required to annually review the conflict of interest policy and make known any conflicts that may or have arose or any other discloseable event. If any notable event is disclosed it is reported to the Hospital CEO and Chairman of the Board of Trustees. Additionally, all financial transactions are reviewed through the Hospital's accounting systems. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 Compensation amounts are established based upon the appropriate healthcare industry standards and related surveys. Compensation amounts for key management is reviewed by the Executive Committee of the Board of Trustees. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The public at anytime may inquire at the administrative office in the main hospital building and ask for a copy of the Form 990. The general public may also go to the Hospital's website to view the annual report and our Community Benefit Report. F990_P11_S00_L05 Form 990, Part XI, Line 5 change in market value of temporarily and permanently restricted net assets $923,866 change in donor intent ($63,796) Net Assets assumed in total buy out of related party (TOM) 359079 Union Hospital Medical Services 659 Boulevard Dover OH 44622 Physcian offices OH 1151892 828479 N/A Union Physcian Services 659 Boulevard Dover OH 44622 Physcian office OH 3634975 680095 N/A Tuscarawas Valley Regional Cancer Center 659 Boulevard Dover OH 44622 340000100 Physician and Hospital Organization OH 501c3 3 N/A 0 Union Hospital Auxillary 659 Boulevard Dover OH 44622 341204928 supports hospital through fundraising public relations OH 501c3 11-III-FI N/A 0 Tuscarawas Ambulatory Surgery Center 320 Oxford St Dover OH 44622 311525875 ambulatory surgery center OH N/A Related 1043556 1850266 0 0 0.7 Dasco Union Hospital Home Medical Equipment LLC 375 N West St Westerville OH 43082 270495743 Durable medical equipment sales OH N/A Unrelated 16031 39150 0 0 0.5 Valley Healthcare Inc 659 Boulevard Dover OH 44622 341654921 Not operational OH N/A C 0 0 1 Union Care Corporation 659 Boulevard Dover OH 44622 341556177 Not operational OH N/A C 0 0 1 Union Pharmaceutical Care 659 Boulevard Dover OH 44622 043588229 retail pharmacy sales OH N/A C -570 2378 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 Tuscarawas Ambulatory Surgery Center a-iv 400505 Fair market of space as determined by lease agreement. Dasco Union Hospital Home Medical Equipment LLC a-iv 13600 fair market value of space as determined by lease agreement Tuscarawas Ambulatory Surgery Center i 400505 lease of building as determined by lease agreement.