ASHTABULA COUNTY MEDICAL CENTER: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
ASHTABULA COUNTY MEDICAL CENTER (EIN 34-0726081)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-15
IRS object ID
201143199349304524
Schema version
2010v3.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-11-15T11:47:53-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1S R SNODGRASS ACBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14134 PARK AVENUEAddressLine1
CityASHTABULACity
StateOHState
ZIP Code44004ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN340726081EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ASHTABULA COUNTY MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlASHTNameControl
Phone4409972262Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12420 LAKE AVENUEAddressLine1
CityASHTABULACity
StateOHState
ZIP Code44004ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameALANNA DAMESName
TitleCONTROLLERTitle
Phone4409976553Phone
Date Signed2011-11-15DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameRICHARD VANEKName
Phone4409932142Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonKEVIN MILLERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12420 LAKE AVENUEAddressLine1
CityASHTABULACity
StateOHState
ZIP Code44004ZIPCode
FieldValueIRS element (for citing)
Gross Receipts97342156GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.ACMCHEALTH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1902YearFormation
State Legal DomicileOHStateLegalDomicile
Activity Or Mission DescriptionOPERATION OF HOSPITALActivityOrMissionDescription
Nbr Voting Members Governing Body18NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees1070TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI289050TotalGrossUBI
Net Unrelated Business Txbl Income-89690NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year63729ContributionsGrantsPriorYear
Contributions Grants Current Year330859ContributionsGrantsCurrentYear
Program Service Revenue Prior Year88547050ProgramServiceRevenuePriorYear
Program Service Revenue CY89954226ProgramServiceRevenueCY
Investment Income Prior Year415816InvestmentIncomePriorYear
Investment Income Current Year133617InvestmentIncomeCurrentYear
Other Revenue Prior Year549777OtherRevenuePriorYear
Other Revenue Current Year1011074OtherRevenueCurrentYear
Total Revenue Prior Year89576372TotalRevenuePriorYear
Total Revenue Current Year91429776TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year47206960SalariesEtcPriorYear
Salaries Etc Current Year48889551SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year38878803OtherExpensePriorYear
Other Expenses Current Year39952806OtherExpensesCurrentYear
Total Expenses Prior Year86085763TotalExpensesPriorYear
Total Expenses Current Year88842357TotalExpensesCurrentYear
Revenues Less Expenses Prior Year3490609RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2587419RevenuesLessExpensesCY
Total Assets BOY67911679TotalAssetsBOY
Total Assets EOY72037415TotalAssetsEOY
Total Liabilities BOY32610700TotalLiabilitiesBOY
Total Liabilities EOY34747560TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY35300979NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY37289855NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE THE BEST POSSIBLE MEDICAL CARE THROUGH ALL PHASES OF LIFE TO THOSE SEEKING HELP. THE ACMC HEALTH CARE TEAM IS COMMITTED TO PRESERVING THE HUMAN RIGHTS AND DIGNITY OF THOSE WHO RECEIVE OUR CARE AND THOSE WHO PROVIDE IT.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense72850733Expense
Revenue90586204Revenue
DescriptionASHTABULA COUNTY MEDICAL CENTER IS A PRIVATE, NOT-FOR-PROFIT COMMUNITY ORIENTED MEDICAL CENTER THAT PROVIDES THE BEST POSSIBLE MEDICAL CARE THROUGH ALL PHASES OF LIFE TO THOSE SEEKING HELP. IN 2010 WE MET OUR MISSION OF MEETING OUR COMMUNITY'S HEALTH CARE NEEDS AS EVIDENCED BY APPROXIMATELY 33,842 EMERGENCY DEPARTMENT VISITS, 6,294 INPATIENT DISCHARGES, 1,755 INPATIENT SURGERIES, 7,201 OUTPATIENT SURGERIES, 497 BIRTHS, AND 73,484 RADIOLOGY PROCEDURES. IN 2010, ACMC PROVIDED CHARITY HEALTH CARE SERVICES TO PEOPLE UNABLE TO PAY IN THE AMOUNT OF $6,354,652.Description
Total Program Service Expense72850733TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached0FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109663NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees1070NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members18NbrVotingGoverningBodyMembers
Number Independent Voting Members14NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledOHStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1ALANNA DAMESBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4409976553TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12420 LAKE AVENUEAddressLine1
CityASHTABULACity
StateOHState
ZIP Code44004ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (34 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
REV NEROY CARTER
CHAIRMAN0.30X000
RICHARD MOLE
VICE-CHAIRMAN0.30X000
JOE GIANGOLA
SECT/TREAS0.30X000
MARTY COLE
BOARD MEMBER0.30X000
BILL DINGLEDINE
BOARD MEMBER0.30X000
ELEANOR JAMMAL
BOARD MEMBER0.30X000
SUSAN STOCKER PHD
BOARD MEMBER0.30X000
JOE VENDEL
BOARD MEMBER0.30X000
STEVE WALLING
BOARD MEMBER0.30X000
FRED DEGRANDIS
BOARD MEMBER/CCF REP0.30X000
IAN GLASS MD
BOARD MEMBER/CCF REP0.30X000
JASON HERGENROEDER
BOARD MEMBER/CCF REP0.30X000
SUK K CHOI MD
BOARD MEMBER/PHYSICIAN REP60.00X51075200X
ASHOK V KONDRU MD
BOARD MEMBER/PHYSICIAN REP0.30X000
NAFISA KONDRU MD
BOARD MEMBER/PHYSICIAN REP0.30X000
TIM O'BRIEN MD
BOARD MEMBER/PHYSICIAN REP60.00X25227000X
DAVID L PARKER MD
BOARD MEMBER/PHYSICIAN REP60.00X26218500X
SHIRLEY VIALL
EX-OFFICIO BOARD MEMBER0.30X000
KEVIN MILLER
BOARD MEMBER/PRESIDENT/CEO40.00X000X
ROGER CORLETT
EX-OFFICIO BOARD MEMBER0.30X000
PHILIP PAWLOWSKI
CFO40.00000X
DAVE MORONY
VP-ASHTABULA CLINIC40.0012316700X
MERILEE REBERA
VP PATIENT CARE SERVICES40.0012790600X
LEW HUTCHISON
VP QUALITY40.00000X
ROBERT SINCICH
VP HUMAN RESOURCES40.00000X
TINA STASIEWSKI
VP BUSINESS DEVELOPMENT40.007752400X
KERRY GERKEN
CEO-ASHTABULA REGIONAL40.00000X
PAT WESTON-HALL
EXEC DIR-GLENBEIGH40.0002083710X
KATHY CRAWFORD
COO40.00000X
MOUHAMAD S KABBANI
PHYSICIAN60.0063411300X
JAMES CHILLCOTT
PHYSICIAN60.0054160100X
ALEXANDER TAICH
PHYSICIAN60.0050635700X
MARK A CABELIN
PHYSICIAN60.0045518000X
LAXMAN R CINGIREDDI
PHYSICIAN60.0041218000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3903235TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs208371TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K36NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
AVI FOODSYSTEMS INC
2590 ELM ROAD NEWARRENOH44483CAFETERIA AND DIETARY SERVICES1794749
HMP OF ASHTABULA COUNTY LTD
4535 DRESSLER ROADCANTONOH44718HOSPITALIST MED/PROF SERVICES926604
CLEVELAND CLINIC REF LAB
9500 EUCLID AVECLEVELANDOH44106LABORATORY TESTING913259
SS&G HEALTHCARE SERVICE
32125 SOLON ROADCLEVELANDOH44139PHYSICIAN BILLING SERVICE770109
CLEVELAND CLINIC FOUNDATION
PO BOX 70060CLEVELANDOH44193ADMINISTRATIVE SERVICES719484
FieldValueIRS element (for citing)
Number Of Contractors GT100 K8NumberOfContractorsGT100K
Government Grants250000GovernmentGrants
All Other Contributions80859AllOtherContributions
Total Contributions330859TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT REVENUEDescription
Business Code622110BusinessCode
Total Revenue Column89954226TotalRevenueColumn
Related Or Exempt Function Income89954226RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue89954226TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column223663TotalRevenueColumn
Exclusion$223,663ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities5822334Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities5912205Securities
Other175Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-89871Securities
Other-175Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-90046TotalRevenueColumn
Related Or Exempt Function Income-90046RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
REBATES & REFUNDS900099330454330454
PREMIER FITNESS713940289050289050
MISC OPERATING REV900099194046194046

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column197524TotalRevenueColumn
Related Or Exempt Function Income197524RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue1011074TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column91429776TotalRevenueColumn
Related Or Exempt Function Income90586204RelatedOrExemptFunctionIncome
Unrelated Business Revenue289050UnrelatedBusinessRevenue
Exclusion$223,663ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1515938Total
Program Services1243071ProgramServices
Management And General272867ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total37202887Total
Program Services30506367ProgramServices
Management And General6696520ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1580751Total
Program Services1296216ProgramServices
Management And General284535ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total5844636Total
Program Services4792602ProgramServices
Management And General1052034ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2745339Total
Program Services2251178ProgramServices
Management And General494161ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total153378Total
Program Services125770ProgramServices
Management And General27608ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total74651Total
Program Services61214ProgramServices
Management And General13437ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1713737Total
Program Services1405264ProgramServices
Management And General308473ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total112235Total
Program Services92033ProgramServices
Management And General20202ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total20473Total
Program Services16788ProgramServices
Management And General3685ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total3205429Total
Program Services2628452ProgramServices
Management And General576977ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
SUPPLIES13625455111728732452582
MEDICAL SERVICES & FEES799349965546691438830
EQUIPMENT RENTAL/MAINTE39516403240345711295
PURCHASED ADMINISTRATIV28350852324770510315
INSURANCE21023421723920378422

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total4164882Total
Program Services3415201ProgramServices
Management And General749681ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total88842357Total
Program Services72850733ProgramServices
Management And General15991624ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1677BOY
EOY1680EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY14511802BOY
EOY17678045EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY10827690BOY
EOY11490263EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY894310BOY
EOY727246EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY639910BOY
EOY897419EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis82992286LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec62836032LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY20811304BOY
EOY20156254EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY14272802BOY
EOY14591088EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY5952184BOY
EOY6495420EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY67911679BOY
EOY72037415EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY13497996BOY
EOY14556794EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY1891629BOY
EOY1896081EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1781894BOY
EOY1364894EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY15439181BOY
EOY16929791EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY32610700BOY
EOY34747560EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY33741707BOY
EOY35476912EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1559272BOY
EOY1812943EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY35300979BOY
EOY37289855EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY67911679BOY
EOY72037415EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses2587419ReconcilationRevenueExpenses
Reconcilation Other Changes-598543ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1900568OtherCostOrOtherBasis
Book Value1900568BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis25810311OtherCostOrOtherBasis
Depreciation18181361Depreciation
Book Value7628950BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1883288OtherCostOrOtherBasis
Depreciation1598784Depreciation
Book Value284504BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis52078173OtherCostOrOtherBasis
Depreciation43055887Depreciation
Book Value9022286BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1319946OtherCostOrOtherBasis
Book Value1319946BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings20156254TotalOfBookValueLandBuildings

Other Securities OtherSecurities (4 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
INVESTMENTS IN SUBSIDIARIES2319775F
OTHER INVETSMENTS779F
INVESTMENT - DEF COMP PLAN1886586F
EQUITIES10383948F
FieldValueIRS element (for citing)
Total Of Book Value Securities14591088TotalOfBookValueSecurities

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
SELF-INSURANCE INVESTMENTS5523283
OTHER RECEIVABLES-NET882456
DUE FROM AFFILIATES61608
OTHER ASSETS28073
FieldValueIRS element (for citing)
Total Book Value Other Assets6495420TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
SELF INSURANCE$8,805,499
PENSION LIABILITY$8,124,292
FieldValueIRS element (for citing)
Total Of Amounts16929791TotalOfAmounts

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To Most HospitalsXPolicyAppliedToMostHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care0FPGReferenceDiscountedCare
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report0AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense2058907TotalCommunityBenefitExpense
Net Community Benefit Expense2058907NetCommunityBenefitExpense
Percent Of Total Expense0.02320PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense2058907TotalCommunityBenefitExpense
Net Community Benefit Expense2058907NetCommunityBenefitExpense
Percent Of Total Expense0.02320PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense2058907TotalCommunityBenefitExpense
Net Community Benefit Expense2058907NetCommunityBenefitExpense
Percent Of Total Expense0.02320PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$2,381,267BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care0ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1ASHTABULA COUNTY MEDICAL CENTERBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line12420 LAKE AVENUEAddressLine1
CityASHTABULACity
StateOHState
ZIP Code44004ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NOT REQUIREDBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained0EligibilityCriteriaExplained
Uses FPG Free0UsesFPGFree
Uses FPG Discounted0UsesFPGDiscounted
Explains Basis0ExplainsBasis
Explains Application Method0ExplainsApplicationMethod
Includes Publicity Measures0IncludesPublicityMeasures
Actions On Nonpayment0ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy0NondiscrimEmergencyCarePolicy
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
SUK K CHOI MD
510752000000000510752000
TIM O'BRIEN MD
252270000000000252270000
DAVID L PARKER MD
262185000000000262185000
PAT WESTON-HALL
020837100000000020837100
MOUHAMAD S KABBANI
634113000000000634113000
JAMES CHILLCOTT
541601000000000541601000
ALEXANDER TAICH
506357000000000506357000
MARK A CABELIN
455180000000000455180000
LAXMAN R CINGIREDDI
412180000000000412180000

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonKIMBERLY GIANGOLANamePerson
FieldValueIRS element (for citing)
RelationshipWIFERelationship
Amount Of Transaction18541AmountOfTransaction
Description Of TransactionEMPLOYMENT AGREEMENT WITH ACMCDescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 3THE CLEVELAND CLINIC HOLDS AND EXERCISES A MANAGEMENT AGREEMENT WITH ACMC.
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 REPORT IS E-MAILED TO THE CHAIRMAN OF THE FINANCE COMMITTEE WHEN IT IS RECEIVED FROM THE PREPARER. AFTER REVIEW AND APPROVAL BY THE COMMITTEE, THE FORM 990 IS THEN PRESENTED TO THE BOARD FOR FINAL APPROVAL BEFORE FILING.
ALL OFFICERS, TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO ANNUALLY REVIEW AND SIGN A CONFLICT OF INTEREST POLICY ACKNOWLEDGEMENT FORM.FORM 990, PART VI, SECTION B, LINE 12C
SALARIES ARE REVIEWED AT A MINIMUM OF EVERY TWO YEARS. THEY ARE COMPARED TO LOCAL, REGIONAL,AND NATIONAL MARKET RATES AND IN CONJUNCTION WITH THE CEO AND CFO TO DETERMINE COMPENSATION. WHEN OPENINGS FOR KEY POSITIONS BECOME AVAILABLE, THE HR DEPARTMENT EXAMINES THE MARKET RATES TO DETERMINE A STARTING SALARY. EVERY YEAR THE TYPICAL SALARY HAS A 3% MERIT RATE INCREASE.FORM 990, PART VI, SECTION B, LINE 15
ALL REQUESTS ARE SENT TO THE CEO FOR DISTRIBUTION.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 405,122. INTERCOMPANY TRANFER FROM ACMC FOUNDATION 31,106. DIVIDENDS TO CLEVELAND CLINIC -1,646,000. EQUITY IN AFFILIATES 611,229. TOTAL TO FORM 990, PART XI, LINE 5: -598,543.FORM 990, PART XI, LINE 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusControlled OrgControlledOrg
ACMC FOUNDATION
2420 LAKE AVENUEASHTABULAOH44004341392784SUPPORTS THE ASHTABULA COUNTY MEDICAL CENTEROH501(C)(3)ACTIVE0
ROCK CREEK MEDICAL CENTER DBA GLENBEIGH HEALTH SOURCES
RT 45 RIVERDALE ROADROCK CREEKOH44084341789783OPERATE AND MAINTAIN A HOSPITAL AND OUTPATIENT CENTERSOH501(C)(3)ACTIVE0
ASHTABULA REGIONAL HOME HEALTH SERVICES
3949 JEFFERSON ROADASHTABULAOH44004341143158HOME HEALTH SERVICESOH501(C)(3)ACTIVE0
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (6 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
ROCK CREEK MEDICAL CENTER DBA GLENBEIGH HEALTH SERVICES
D12634LOAN RECORDS
ACMC FOUNDATION
D38236LOAN RECORDS
ASHTABULA REGIONAL HOME HEALTH SERVICES
D10738LOAN RECORDS
ROCK CREEK MEDICAL CENTER DBA GLENBEIGH HEALTH SERVICES
P58138CASH RECEIVED
ACMC FOUNDATION
P101716CASH RECEIVED
ACMC FOUNDATION
R31106CASH RECIEVED

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