2023-11-14T13:35:39-06:00 2022-12-31 410746749 CLIFTONLARSONALLEN LLP 1785 INDIAN WOOD CIRCLE MAUMEE OH 43537 990 2022-01-01 341116795 HOSPITAL COUNCIL OF NORTHWEST OHIO HOSP 4198420800 3231 CENTRAL PARK WEST 200 TOLEDO OH 43617 KIM TEMPLE PRESIDENT 4198420800 2023-11-13 1 KIM TEMPLE 999009999 0 CAITLIN BAINTER P01985124 4197942000 2023-11-13 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z PAM JENSEN 3231 CENTRAL PARK WEST 200 TOLEDO OH 43617 7641585 0 X WWW.HCNO.ORG X 1973 OH THE HOSPITAL COUNCIL OF NORTHWEST OHIO IS A MEMBER DRIVEN ORGANIZATION THAT REPRESENTS AND ADVOCATES ON BEHALF OF ITS MEMBER HOSPITALS AND HEALTH SYSTEMS AND PROVIDES COLLABORATIVE OPPORTUNITIES TO ENHANCE THE HEALTH STATUS OF THE CITIZENS OF NORTHWEST OHIO. THE HOSPITAL COUNCIL IS DEDICATED TO: -BRINGING TOGETHER NORTHWEST OHIO'S HEALTH CARE LEADERS. -PROVIDING COLLABORATIVE OPPORTUNITIES TO ADDRESS HEALTHCARE PROVIDERS' SHARED CONCERNS. -DEVELOPING CREATIVE HEALTH-RELATED INITIATIVES TO IMPROVE THE REGION'S HEALTH STATUS. -PROVIDING EDUCATIONAL PROGRAMS FOR THE HEALTHCARE SECTOR. 26 25 58 42 0 0 3796111 4684751 3486490 2882179 11749 11674 50925 62981 7345275 7641585 2458746 2694501 0 0 3438236 3442681 0 0 0 995111 1168060 6892093 7305242 453182 336343 6991547 7102177 1423788 1198075 5567759 5904102 X THE HOSPITAL COUNCIL OF NORTHWEST OHIO IS A MEMBER DRIVEN ORGANIZATION THAT REPRESENTS AND ADVOCATES ON BEHALF OF ITS MEMBER HOSPITALS AND HEALTH SYSTEMS AND PROVIDES COLLABORATIVE OPPORTUNITIES TO ENHANCE THE HEALTH STATUS OF THE CITIZENS OF NORTHWEST OHIO. SEE SCHEDULE O THE HOSPITAL COUNCIL IS DEDICATED TO: -BRINGING TOGETHER NORTHWEST OHIO'S HEALTH CARE LEADERS. -PROVIDING COLLABORATIVE OPPORTUNITIES TO ADDRESS HEALTHCARE PROVIDERS' SHARED CONCERNS. -DEVELOPING CREATIVE HEALTH-RELATED INITIATIVES TO IMPROVE THE REGION'S HEALTH STATUS. -PROVIDING EDUCATIONAL PROGRAMS FOR THE HEALTHCARE SECTOR. 0 0 7066836 2694501 2945160 -PROVIDING COLLABORATIVE OPPORTUNITIES TO ADDRESS HEALTHCARE PROVIDERS' SHARED CONCERNS.-DEVELOPING, IMPLEMENTING, AND SECURING FUNDING FOR CREATIVE HEALTH-RELATED INITIATIVES TO IMPROVE THE REGION'S HEALTH STATUS.-PROVIDING EDUCATIONAL PROGRAMS FOR THE HEALTHCARE SECTOR. 7066836 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 59 0 1 58 1 0 0 0 0 0 0 0 0 0 0 0 0 X 26 25 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X KIM TEMPLE 4198420800 3231 CENTRAL PARK WEST TOLEDO OH 43617 W SCOTT FRY PRESIDENT & CEO UNTIL JUNE 2022 35.00 5.00 X X 372293 0 33846 DANIEL BARBEE TREASURER 1.00 0.00 X X 0 0 0 JEFFREY DEMPSEY CHAIRMAN 1.00 0.00 X X 0 0 0 NICK MARSICO SECRETARY 1.00 0.00 X X 0 0 0 BRENT BURKEY CHAIRMAN ELECT 1.00 0.00 X X 0 0 0 PATRICIA FINN IMMEDIATE PAST CHAIR 1.00 0.00 X X 0 0 0 MYRON LEWIS TRUSTEE 1.00 0.00 X 0 0 0 CHAD TINKEL TRUSTEE 1.00 0.00 X 0 0 0 JEREMY NORMINGTON - SLAY DPT TRUSTEE 1.00 0.00 X 0 0 0 KRISTI BRAND TRUSTEE 1.00 0.00 X 0 0 0 JENNIFER MONTGOMERY TRUSTEE 1.00 0.00 X 0 0 0 SONJA SELHORST TRUSTEE 1.00 0.00 X 0 0 0 CRAIG ALBERS TRUSTEE 1.00 0.00 X 0 0 0 RON GOEDDE TRUSTEE 1.00 0.00 X 0 0 0 THADIUS WADSWORTH TRUSTEE 1.00 0.00 X 0 0 0 KEITH BURMEISTER TRUSTEE 1.00 0.00 X 0 0 0 DARRELL WACHOWIAK TRUSTEE 1.00 0.00 X 0 0 0 JODI RUCKER TRUSTEE 1.00 0.00 X 0 0 0 DAWN BUSKEY TRUSTEE 1.00 0.00 X 0 0 0 TIM BUIT TRUSTEE 1.00 0.00 X 0 0 0 RICHARD SWAINE TRUSTEE 1.00 0.00 X 0 0 0 STANLEY KORDUCKI TRUSTEE 1.00 0.00 X 0 0 0 TY SHAULL TRUSTEE 1.00 0.00 X 0 0 0 ANDREA GWYN TRUSTEE 1.00 0.00 X 0 0 0 ANDREW MORGAN TRUSTEE 1.00 0.00 X 0 0 0 BRADLEY BERTKE TRUSTEE UNTIL FEBRUARY 2022 1.00 0.00 X 0 0 0 KIMBERLY TEMPLE CONTROLLER & FISCAL OFFICER 40.00 0.00 X 155495 0 77384 PAM JENSEN INTERIM PRESIDENT & CEO 40.00 0.00 X 0 0 0 CARLY SALAMONE SENIOR DIRECTOR 40.00 0.00 X 102379 0 46862 CAROLYN TRUMBULL NOSS PROGRAM & SERVICES DIRECTOR 40.00 0.00 X 112300 0 62229 742467 0 220321 4 0 1 0 MAIL IT 380 S ERIE STREET TOLEDO OH 43604 PRINTING 128829 1 91865 2601679 1991207 4684751 CONTRACT INCOME 900099 2278224 2278224 MEMBERSHIP DUES 900099 603955 603955 2882179 11674 11674 62981 62981 62981 7641585 2945160 0 11674 2645569 2645569 48932 48932 639016 617149 21867 1922351 1856568 65783 162104 154851 7253 526303 503017 23286 192907 184543 8364 2765 2765 24224 24224 260044 232129 27915 18368 18368 185474 160818 24656 132159 115832 16327 90624 84949 5675 28253 26760 1493 17912 11840 6072 871 871 27314 26346 968 PROGRAM EXPENSE 202805 202805 BAD DEBT EXPENSE 163522 163522 TRAINING 8914 8873 41 ORG DUES AND MEMBERSHIP 3505 2605 900 1306 489 817 7305242 7066836 238406 0 5744620 6106599 560792 642162 611072 187031 10187 10653 130960 89710 871 41250 64005 114482 6991547 7102177 337059 481544 409870 348354 57319 89325 619540 0 0 278852 1423788 1198075 X 4849973 5195191 717786 708911 5567759 5904102 6991547 7102177 336343 0 X X 0 1 X 1 1 1 X 3267063 3100552 4087393 3796111 4684751 18935870 3267063 3100552 4087393 3796111 4684751 18935870 18935870 21138 51351 38861 11749 11674 134773 34195 22668 34206 50925 62981 204975 19275618 18006000 0.98240 0.98350 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: REIMBURSEMENT INCOME - 2018 AMOUNT: $ 33,077. 2019 AMOUNT: $ 22,512. 2020 AMOUNT: $ 15,629. 2021 AMOUNT: $ 50,925. 2022 AMOUNT: $ 62,981. REFUNDS REBATES - 2020 AMOUNT: $ 18,577. MISCELLANEOUS - 2018 AMOUNT: $ 1,118. 2019 AMOUNT: $ 156. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 107954 66704 41250 23006 23006 0 41250 CONTRACT LIABILITIES 254405 OPERATING LEASE 24447 278852 X 7801585 160000 160000 7641585 0 7641585 7465242 160000 160000 7305242 0 7305242 PART IV, LINE 2B: DURING NOVEMBER 2019, THE ORGANIZATION BECAME THE COORDINATING ORGANIZATION, FISCAL AGENT, AND COMMUNICATIONS COORDINATOR FOR HEALTHY LUCAS COUNTY. AS FISCAL AGENT, THE ORGANIZATION PROVIDES CASH MANAGEMENT FUNCTIONS AND HOLDS FUNDS ON BEHALF OF HEALTHY LUCAS COUNTY. FUNDS HELD ON BEHALF OF HEALTHY LUCAS COUNTY WERE $89,325 AND $57,319 AT DECEMBER 31, 2022 AND 2021, RESPECTIVELY. PART X, LINE 2: MANAGEMENT OF THE ORGANIZATION IS REQUIRED TO DETERMINE WHETHER A TAX POSITION OF THE ORGANIZATION IS MORE LIKELY THAN NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPLICABLE TAXING AUTHORITY, INCLUDING RESOLUTION OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS OF THE POSITION. MANAGEMENT OF THE ORGANIZATION IS NOT AWARE OF ANY TAX POSITIONS FOR WHICH IT IS REASONABLY POSSIBLE THAT THE TOTAL AMOUNTS OF UNRECOGNIZED TAX BENEFITS WILL SIGNIFICANTLY CHANGE IN THE NEXT TWELVE MONTHS. HOWEVER, MANAGEMENT'S CONCLUSIONS MAY BE SUBJECT TO REVIEW AND ADJUSTMENT AT A LATER DATE BASED ON FACTORS INCLUDING, BUT NOT LIMITED TO, NEW TAX LAWS, REGULATIONS, AND ADMINISTRATIVE INTERPRETATIONS (INCLUDING RELEVANT COURT DECISIONS). THE ORGANIZATION'S FEDERAL TAX RETURNS FOR THE PRIOR THREE YEARS REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. NO INTEREST OR PENALTIES WERE INCURRED OR RECOGNIZED IN 2022 OR 2021. PART XI, LINE 2D - OTHER ADJUSTMENTS: FOSTERING TRANSFERS FROM HLC TO HCNO 160,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: FOSTERING TRANSFERS FROM HCNO TO HLC 160,000. 1 BABY UNIVERSITY 860 ORCHARD STREET TOLEDO OH 43609 474336051 501(C)(3) 325525 0 SUPPORT BIOMEDICAL DEVICES INTL INC 17171 DAIMLER ST IRVINE CA 92614 5439 0 SUPPORT BLANCHARD VALLEY HEALTH SYSTEM 1900 SOUTH MAIN STREET FINDLAY OH 45840 341369963 501(C)(3) 12200 0 SUPPORT CATHOLIC CHARITIES DIOCESE OF TOLEDO 1933 SPIELBUSCH AVENUE TOLEDO OH 43604 344428254 501(C)(3) 37815 0 SUPPORT COMMUNITY HOSPITALS AND WELLNESS CENTERS 433 W HIGH STREET BRYAN OH 43506 341048666 501(C)(3) 10639 0 SUPPORT COMMUNITY MEMORIAL HOSPITAL 208 N COLUMBUS STREET HICKSVILLE OH 43526 346401873 6100 0 SUPPORT COMPASSION HEALTH TOLEDO 1638 BROADWAY TOLEDO OH 436093240 473197108 501(C)(3) 189645 0 SUPPORT CONCORDANCE HEALTHCARE SOLUTIONS 85 SHAFFER PARK DRIVE TIFFIN OH 44883 383986849 12960 0 SUPPORT EAST TOLEDO FAMILY CENTER 1020 VARLAND AVENUE TOLEDO OH 43605 344429426 501(C)(3) 305355 0 SUPPORT ERIE COUNTY GENERAL HEALTH DISTRICT 420 SUPERIOR ST SANDUSKY OH 44870 20603 0 SUPPORT FIRELANDS REGIONAL MEDICAL CENTER 1111 HAYES AVE SANDUSKY OH 44870 344428218 501(C)(3) 6100 0 SUPPORT FISHER - TITUS MEDICAL CENTER 272 BENEDICT AVE NORWALK OH 44857 344430716 501(C)(3) 6100 0 SUPPORT FISHER & PAYKEL HEALTHCARE INC 17400 LAGUAN CANYON RD SUITE 300 IRVINE CA 92618 7076 0 SUPPORT FULTON COUNTY HEALTH CENTER 725 SOUTH SHOOP AVENUE WAUSEON OH 43567 344428214 501(C)(3) 6100 0 SUPPORT GREGORY LOCHER 8827 BLUESTONE BAY CT SHERRILLS FORD NC 28673 286521770 12520 0 SUPPORT HENRY COUNTY HEALTH DEPARTMENT 1843 OAKWOOD AVE NAPOLEON OH 43545 346400633 95540 0 SUPPORT HENRY COUNTY HOSPITAL 1600 EAST RIVERVIEW AVENUE NAPOLEON OH 43545 344477047 6100 0 SUPPORT LUCAS COUNTY REGIONAL HEALTH DISTRICT 635 N ERIE STREET TOLEDO OH 43604 346400806 30695 0 SUPPORT MAGRUDER HOSPITAL 615 FULTON STREET PORT CLINTON OH 43452 344441792 501(C)(3) 6100 0 SUPPORT MERCER HEALTH 800 W MAIN STREET COLDWATER OH 45828 341101385 501(C)(3) 6100 0 SUPPORT MERCY FOUNDATION 2525 CHERRY STREET TOLEDO OH 43608 201072726 501(C)(3) 454075 0 SUPPORT NORTH CENTRAL EMS 12513 US 295 N MILAN OH 44846 30001 0 SUPPORT PATHWAYS COMMUNITY HUB INSTITUTE INC ONE MARION AVE SUITE 306 MANSFIELD OH 44903 813738049 501(C)(3) 16100 0 SUPPORT PAULDING COMMUNITY HOSPITAL 1035 W WAYNE STREET PAULDING OH 45879 346405718 6100 0 SUPPORT PROMEDICA HEALTH SYSTEM 100 MADISON AVE TOLEDO OH 43604 341517671 501(C)(3) 5285 0 SUPPORT PROMEDICA PHYSICIANS 2142 N COVE BLVD 5SW TOLEDO OH 43606 21240 0 SUPPORT PROMEDICA TOLEDO HOSPITAL 2142 NORTH COVE BLVD TOLEDO OH 43606 344428256 501(C)(3) 357344 0 SUPPORT PROMEDICA TRANSPORTATION NETWORK 7140 PORT SYLVANIA DRIVE STE 150 TOLEDO OH 43617 344428256 501(C)(3) 10000 0 SUPPORT SALEM LUTHERAN CHURCH 1127 N HURON ST TOLEDO OH 43604 344474606 501(C)(3) 32085 0 SUPPORT THE BELLEVUE HOSPITAL 1400 W MAIN ST BELLEVUE OH 44811 344428205 501(C)(3) 6100 0 SUPPORT THE UNIVERSITY CHURCH 4747 HILL AVENUE TOLEDO OH 43615 352484010 501(C)(3) 42613 0 SUPPORT TOLEDO-LUCAS COUNTY CARENET INC 3231 CENTRAL PARK WEST DR ROOM/SUITE 200 TOLEDO OH 43617 431986672 501(C)(3) 277626 0 SUPPORT UNIVERSITY OF TOLEDO GRANTS ACCOUNTING 2801 W BANCROFT ST TOLEDO OH 43606 346401483 501(C)(3) 25000 0 SUPPORT VAN WERT COUNTY HOSPITAL 1250 SOUTH WASHINGTON STREET VAN WERT OH 45891 344429514 501(C)(3) 6100 0 SUPPORT WOOD COUNTY HOSPITAL 950 W WOOSTER STREET BOWLING GREEN OH 43402 344440884 501(C)(3) 20100 0 SUPPORT YWCA OF NORTHWEST OHIO 1018 JEFFERSON AVE TOLEDO OH 43604 344428265 501(C)(3) 70750 0 SUPPORT 24 12 GIFT CARDS 654 9360 0 SURVEY INCENTIVES 19786 39572 0 PART I, LINE 2: THE PROGRAM STAFF WORK CLOSELY WITH EACH SUB GRANTEE REGARDING PAPERWORK NEEDED. ALL SUB GRANTEES MUST SUBMIT DOCUMENTATION FOR REIMBURSEMENT OF ALL EXPENDITURES. WHEN NECESSARY, THE ASSISTANT CONTROLLER TRACKS EXPENDITURES TO ENSURE ADHERENCE TO THE BUDGET; IN ADDITION, THE PROGRAM DIRECTOR WORKS WITH FINANCE TO OVERSEE THE GRANT AND MANTAIN COMPLIANCE WITH APPLICABLE MANDATES. EACH SUB-GRANTEE MUST SUBMIT A BUDGET SPENDING PLAN FOR APPROVAL, PRIOR TO RECEIVING THEIR FIRST PAYMENT. THE SPENDING PLANS GIVE AN ESTIMATE "DATE TO BE SPENT" FOR EACH LINE ITEM. SUB GRANTEES TURN IN QUARTERLY REPORTS, AND THE PROGRAM DIRECTOR AND SPECIALIST REVIEW THEIR SPENT FUNDS TO DATE. SUB GRANTEES MUST SUBMIT RECEIPTS FOR EXPENSES, AT WHICH TIME A CHECK FOR REIMBURSEMENT WILL BE DISBURSED. X X X 0 0 0 0 0 0 0 1 0 W SCOTT FRY PRESIDENT & CEO UNTIL JUNE 2022 163558 0 0 0 208735 0 13723 0 20123 0 406139 0 0 0 KIMBERLY TEMPLE CONTROLLER & FISCAL OFFICER 153894 0 0 0 1601 0 19507 0 57877 0 232879 0 0 0 CAROLYN TRUMBULL NOSS PROGRAM & SERVICES DIRECTOR 111125 0 0 0 1175 0 13625 0 48604 0 174529 0 0 0 PART I, LINE 7 THE ORGANIZATION ISSUED A 1099 TO THE ESTATE OF SCOTT FRY DURING 2022 FOR $201,213. SCOTT FRY WAS THE PRESIDENT/CEO OF THE ORGANIZATION AND PASSED AWAY UNEXPECTEDLY IN JUNE 2022. THIS 1099 REPRESENTS THE WAGE AND VACATION PAYOUT OF $48,194 AND DEFERRED COMPENSATION PAYOUT OF $153,019 TO SCOTT FRY'S ESTATE. FORM 990, PART VI, SECTION A, LINE 6 AREA HOSPITALS COMPRISE THE MEMBERSHIP OF HOSPITAL COUNCIL OF NORTHWEST OHIO. FORM 990, PART VI, SECTION A, LINE 7A THESE MEMBER HOSPITALS MAY ELECT ONE OR MORE MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S SIGNING OFFICER SCANS THE FORM 990 FOR COMPLETENESS PRIOR TO SIGNATURE, IN ADDITION TO RELYING UPON THE INDEPENDENT ACCOUNTANT FOR ACCURACY. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE GOVERNING BODY USES A PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO OR TOP MANAGEMENT OFFICIALS WHICH INCLUDES A COMPARISON TO OTHER ORGANIZATIONS, SALARY SURVEYS, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION ON AN ANNUAL BASIS. THE ORGANIZATION USES A PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S OFFICERS OR KEY EMPLOYEES WHICH INCLUDES A REVIEW AND APPROVAL BY THE CEO, USE OF MANAGEMENT SURVEYS, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES REPSONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. NORTHWEST OHIO SHARED SERVICES 3231 CENTRAL PARK WEST DR TOLEDO OH 43617 341388279 PURCHASE CORPORATION OH N/A C 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0