2024-11-11T16:26:53-06:00 2023-12-31 410746749 CLIFTONLARSONALLEN LLP 4334 MUNSON STREET SUITE 200 CANTON OH 44718 990 2023-01-01 341392784 ASHTABULA COUNTY MEDICAL CENTER FOUNDATION ASHT 4409972262 2420 LAKE AVENUE ASHTABULA OH 44004 LEONARD STEPP PRESIDENT & CEO 4409972262 2024-11-08 1 1 JENNIFER COLEMAN P00743188 3304972000 2023 2024-10-15 13:58:12Z LEONARD STEPP 2420 LAKE AVENUE ASHTABULA OH 44004 2977726 0 X WWW.ACMCHEALTH.ORG/FOUNDATION X 1983 OH RAISE AND ADMINISTER CHARITABLE GIFTS THAT SUPPORT THE MISSION OF ASHTABULA COUNTY MEDICAL CENTER. 11 7 0 28 0 0 63225 2400135 0 0 165227 224336 35202 34085 263654 2658556 0 0 0 0 0 0 0 0 0 363047 275557 363047 275557 -99393 2382999 6404775 9118315 596138 519726 5808637 8598589 X THE ACMC FOUNDATION IS A NOT-FOR-PROFIT 501(C)(3) ORGANIZATION ESTABLISHED TO RAISE, RECEIVE AND ADMINISTER CHARITABLE GIFTS IN SUPPORT OF ASHTABULA COUNTY MEDICAL CENTER. TO DO THIS, THE FOUNDATION HOLDS SPECIAL EVENTS, CULTIVATES AND SOLICITS INDIVIDUAL DONORS AND CORPORATE DONORS, AND SECURES GRANT FUNDING; AND ALIGNS ITS WORK WITH THE INITIATIVES AND PRIORITIES OF ACMC. 0 0 155758 0 ASHTABULA COUNTY MEDICAL CENTER (ACMC) IS A NON-PROFIT COMMUNITY HOSPITAL, THE ONLY FULL-SERVICE HOSPITAL IN ASHTABULA COUNTY, AND IS THE COUNTY'S LARGEST EMPLOYER. THE ACMC FOUNDATION HELPS TO ENSURE THAT THE HIGH-QUALITY CARE ALL PATIENTS DESERVE IS AVAILABLE WHEN THE COMMUNITY NEEDS IT.ACMC FOUNDATION SUPPORTS THE HOSPITAL BY FUNDING CAPITAL AND EQUIPMENT PURCHASES, FACILITY RENOVATIONS, STAFF SUPPORT AND EDUCATION AND OTHER PROGRAM SUPPORT. WITH MORE THAN A DOZEN DESIGNATED-USE AND UNRESTRICTED FUNDS, ACMC FOUNDATION ADMINISTERS CONTRIBUTIONS THAT ALIGN WITH DONORS' INTERESTS AND THE PRIORITIES AND NEEDS OF ACMC. EXAMPLES OF RECENT CAPITAL SUPPORT INCLUDE IMAGING EQUIPMENT, PATIENT MONITORS, INTENSIVE CARE UNIT EQUIPMENT AND TECHNOLOGY, INFRARED VEIN FINDERS, AND VARIOUS BUILDING AND FACILITY RENOVATIONS. ACMC FOUNDATION SUPPORTS ACMC THROUGH VARIOUS PROGRAMS. ACMC FOUNDATION ADMINISTERS AND FUNDS THE ACMC ACADEMY PROGRAM, A SUMMER INTERNSHIP AND SCHOLARSHIP PROGRAM FOR HIGH SCHOOL STUDENTS INTERESTED IN HEALTHCARE CAREERS. THE FOUNDATION FUNDS PROGRAMS TO PROVIDE ITEMS OF COMFORT TO PEDIATRIC PATIENTS IN OUTPATIENT LABS AND EMERGENCY DEPARTMENT, AND ASSISTANCE TO PATIENTS TO HELP MEET TEMPORARY URGENT NEEDS THAT HAVE A DIRECT IMPACT ON PATIENTS' HEALTH OUTCOMES, SUCH AS MEDICAL SUPPLIES NOT COVERED BY INSURANCE, TRANSPORTATION EXPENSES RELATED TO MEDICAL CARE, AND SHORT TERM MEDICATIONS. 155758 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 11 7 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 OH X MICHAEL HABOWSKI PRESIDENT & CEO 4409972262 2420 LAKE AVENUE ASHTABULA OH 44004 SANDI KANICKI CHAIR 0.30 0.00 X X 0 0 0 DR CATHERINE BISHOP VICE CHAIR/PHYSICIAN 0.30 40.00 X X 0 168505 19423 LEONARD STEPP SECRETARY/TREASURER 0.30 40.30 X X 0 0 0 TINA STASIEWSKI INTERIM EXECUTIVE DIRECTOR 0.30 40.30 X X 0 119871 4603 BRET CIMORELL TRUSTEE 0.30 0.00 X 0 0 0 MIKE FEDLER TRUSTEE 0.30 0.00 X 0 0 0 TODD GRAY TRUSTEE 0.30 0.00 X 0 0 0 GARY SEECH TERM OCT 2023 TRUSTEE; CEO GLENBEIGH 0.30 40.00 X 0 174939 18621 NANCY KISTER TRUSTEE 0.30 0.00 X 0 0 0 CATHY MAYLISH TRUSTEE 0.30 0.00 X 0 0 0 PAUL MECHLING DVM TRUSTEE 0.30 0.00 X 0 0 0 LISA NEWSOME TRUSTEE 0.30 0.00 X 0 0 0 ALANNA DAMES MAY 2023 START VP FINANCE/CFO 0.30 40.30 X 0 0 0 0 463315 42647 0 0 1 0 0 84289 2315846 13696 2400135 141630 141630 349294 266588 82706 82706 82706 29911 84289 50379 -20468 -20468 2717 2203 514 514 OTHER INCOME 900099 54039 54039 54039 2658556 0 0 258421 111147 111147 1500 1500 7152 7152 21578 21578 32452 32452 87 87 MISCELLANEOUS 79355 79355 PROGRAM COSTS 17461 17461 EQUIPMENT MAINTENANCE 4550 4550 DUES AND SUBSCRIPTIONS 275 275 275557 155758 119799 0 51008 54608 1021291 1485563 6358 4756 5326118 7573388 6404775 9118315 118111 2390 478027 517336 596138 519726 X 4852171 7269903 956466 1328686 5808637 8598589 6404775 9118315 2382999 406953 0 X 0 1 X 1 0 X X 1 ASHTABULA COUNTY MEDICAL CENTER 340726081 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 874022 91481 5735 959768 1027977 77810 98075 322636 7204 874022 956162 71815 1027977 871622 84540 956162 758632 112990 871622 0.00000 1.00000 0.00000 1 0 0 DUE TO AFFILIATES 517336 517336 X PART X, LINE 2: WHEN TAX RETURNS ARE FILED, IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD BE ULTIMATELY SUSTAINED. IN ACCORDANCE WITH THE INCOME TAXES TOPIC OF THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION, THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. TAX POSITIONS TAKEN ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY OF BEING REALIZED UPON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. GOLF CLASSIC OUTING 61530 51788 9742 800 5159 4583 16831 SAWRUK GOLF OUTING 20988 15825 5163 5163 1037 1 31682 16676 15006 8764 8042 114200 84289 29911 9564 5159 9746 25910 50379 -20468 0 0 0 0 0 0 0 0 0 GARY SEECH TERM OCT 2023 TRUSTEE; CEO GLENBEIGH 0 173166 0 0 0 1773 0 6093 0 12528 0 193560 0 0 DR CATHERINE BISHOP VICE CHAIR/PHYSICIAN 0 167416 0 0 0 1089 0 6791 0 12632 0 187928 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE CLEVELAND CLINIC FOUNDATION HOLDS AND EXERCISES A MANAGEMENT AGREEMENT WITH THE ACMC HEALTHCARE SYSTEM. FORM 990, PART VI, SECTION A, LINE 6 ASHTABULA COUNTY MEDICAL CENTER (ACMC) IS THE SOLE MEMBER OF THE FOUNDATION. ACMC APPROVES THE APPOINTING OF FOUNDATION TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7A SEE FORM 990, PART VI, SECTION A, LINE 6 EXPLANATION FORM 990, PART VI, SECTION A, LINE 7B SEE FORM 990, PART VI, SECTION A, LINE 6 EXPLANATION FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 REPORT IS PUBLISHED TO THE WEBSITE OF THE BOARD OF DIRECTORS OF THE ASHTABULA COUNTY MEDICAL CENTER, THE FOUNDATION'S SOLE MEMBER. FORM 990, PART VI, SECTION B, LINE 12C EACH TRUSTEE, PRINCIPAL OFFICER, MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS, AND KEY EMPLOYEE SHALL ANNUALLY SIGN A STATEMENT, WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE CORPORATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IF A PERSON COVERED BY THE CONFLICT OF INTEREST POLICY BELIEVES HE OR SHE HAS A POTENTIAL CONFLICT OF INTEREST, THAT PERSON IS TO DISCLOSE THE CONFLICT TO THE BOARD. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE OR SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. THE DISCLOSING PERSON MAY MAKE A PRESENTATION REGARDING THE PROPOSED TRANSACTION/POTENTIAL CONFLICT OF INTEREST AT THE BOARD OR COMMITTEE MEETING, BUT AFTER SUCH PRESENTATION, HE OR SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE PROPOSED TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE CONFLICT OF INTEREST. THE CHAIRPERSON OF THE BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE CORPORATION CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THE BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED TRUSTEES WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTEREST AND FOR ITS OWN BENEFIT AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO THE CORPORATION AND SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE MEMBER AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT THE MEMBER HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 NO COMPENSATION IS PAID BY ACMC FOUNDATION. FOR RELATED TAX-EXEMPT ORGANIZATIONS, SALARIES ARE REVIEWED APPROXIMATELY EVERY TWO YEARS. SALARIES ARE COMPARED TO LOCAL, REGIONAL, AND NATIONAL MARKET RATES AND IN CONJUNCTION WITH THE CEO AND CFO OF ASHTABULA COUNTY MEDICAL CENTER TO DETERMINE COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 ALL REQUESTS ARE SENT TO THE CEO FOR DISTRIBUTION. FORM 990, PART VII, SECTION A: THE FOLLOWING OFFICERS WORKING FULL-TIME FOR ACMC ARE EMPLOYED BY THE CLEVELAND CLINIC AND ARE COMPENSATED THROUGH EMPLOYMENT AGREEMENTS WITH THE CLEVELAND CLINIC: TINA STASIEWSKI, INTERIM EXECUTIVE DIRECTOR, ALANNA DAMES, VP FINANCE/CFO, AND LEONARD STEPP. ASHTABULA COUNTY MEDICAL CENTER 2420 LAKE AVENUE ASHTABULA OH 44004 340726081 OPERATION OF HOSPITAL OH 501(C)(3) LINE 3 N/A 0 ROCK CREEK MEDICAL CENTER (DBA GLENBEIGH HEALTH SOURCES) 2863 STATE ROUTE 45 ROCK CREEK OH 44084 341789783 OPERATE AND MAINTAIN A HOSPITAL AND OUTPATIENT CENTERS OH 501(C)(3) LINE 3 ASHTABULA COUNTY MEDICAL CENTER 0 ASHTABULA REGIONAL HOME HEALTH SERVICES 3949 JEFFERSON ROAD ASHTABULA OH 44004 341143158 HOME HEALTH SERVICES OH 501(C)(3) LINE 11 ASHTABULA COUNTY MEDICAL CENTER 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0