Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
MARY RUTAN HOSPITAL
Employer identification number
34-1407259
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
MARY RUTAN HOSPITAL
Employer identification number
34-1407259
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 6
THE SOLE MEMBER OF THIS ORGANIZATION IS MARY RUTAN HEALTH ASSOCIATION OF LOGAN COUNTY, AN OHIO NONPROFIT CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7A
THE SOLE MEMBER, MARY RUTAN HEALTH ASSOCIATION OF LOGAN COUNTY MAY PARTICIPATE IN THE ELECTION OF THE ORGANIZATION'S TRUSTEES. THE MEMBER SHALL EXERCISE ITS RIGHT TO VOTE AT ANY MEETING OR TO CONSENT TO ANY ACTION WITHOUT A MEETING THROUGH ITS CHAIRMAN, VICE CHAIRMAN, TREASURER, SECRETARY OR PRESIDENT UNLESS BEFORE SUCH VOTE IS TAKEN OR CONSENT IS GIVEN THE BOARD OF TRUSTEES OF THE MEMBER PROVIDES A CERTIFIED COPY OF A RESOLUTION STATING THAT SUCH AUTHORITY IS VESTED ON SOME OTHER OFFICER OR PERSON.
FORM 990, PART VI, SECTION A, LINE 7B
THE MEMBER SHALL EXERCISE ITS RIGHT TO VOTE AT ANY MEETING OR TO CONSENT TO ANY ACTION WITHOUT A MEETING THROUGH ITS CHAIRMAN, VICE CHAIRMAN, TREASURER, SECRETARY OR PRESIDENT UNLESS BEFORE SUCH VOTE IS TAKEN OR CONSENT IS GIVEN THE BOARD OF TRUSTEES OF THE MEMBER PROVIDES A CERTIFIED COPY OF A RESOLUTION STATING THAT SUCH AUTHORITY IS VESTED ON SOME OTHER OFFICER OF PERSON. AN ANNUAL MEETING OF THE MEMBER IS HELD FOR THE ELECTION OF TRUSTEES, FOR THE CONSIDERATION OF REPORTS AND FOR SUCH OTHER BUSINESS. IN ADDITION, THE FOLLOWING MATTERS ARE AUTHORIZED ONLY AFTER AUTHORIZATION BY THE BOARD OF TRUSTEES AND UPON APPROVAL BY THE MEMBER: 1. REMOVAL OF TRUSTEE; 2. AMENDMENT OF THE CORPORATE REGULATIONS; 3. THE PURCHASE, SALE OR ENCUMBRANCE OF REAL PROPERTY, OR OF SUBSTANTIALLY ALL OF THE PERSONAL PROPERTY, OF THE CORPORATION; 4. MERGER OR CONSOLIDATION WITH ANY OTHER CORPORATION OR LEGAL ENTITY; 5. ANY CHANGES TO THE ARTICLES OF INCORPORATION; 6. ADOPTION OF THE CORPORATION'S ANNUAL OPERATING AND CAPITAL BUDGET; 7. EXPENDITURES FOR (A) NON-BUDGETED ITEMS IN EXCESS OF $250,000; (B) ITEMS WHICH ARE INCUDED IN THE CORPORATION'S ANNUAL BUDGET BUT EXCEED THE BUDGETED AMOUNT BY $250,000 OR MORE, AND (C) EXECUTIVE COMPENSATION; 8. EXECUTION OF ANY CONTRACT WITH A TERM IN EXCESS OF ONE YEAR AND REPRESENTING AN EXPENDITURE OF MORE THAN $500,000; 9. APPROVE THE SELECTION OF THE CEO OF THE CORPORATION; 10. APPOINTMENT OF THE CORPORATION'S AUDITORS; 11. ADOPTION OF THE CORPORATION'S LONG RANGE PLANS AND MANAGEMENT OBJECTIVES; 12. ADOPTION OF THE MEDICAL STAFF BY-LAWS; 13. ANY OTHER MATTERS REQUIRED BY LAW TO BE SUBMITTED TO THE MEMBER OR WHICH THE BOARD DETERMINES BY RESOLUTION TO SUBMIT.
FORM 990, PART VI, SECTION B, LINE 11
FORM 990 IS REVIEWED BY THE CFO, CEO, AND MEMBERS OF THE AUDIT COMMITTEE PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C
DIRECTORS AND OFFICERS OF THE CORPORATION SHALL DISCLOSE TO THE BOARD ANY SITUATION WHEREIN THE DIRECTOR OR OFFICER HAS A CONFLICTING INTEREST OR DUALITY OF INTEREST THAT COULD POSSIBLY CAUSE THAT PERSON TO ACT IN OTHER THAN THE BEST INTEREST OF THE CORPORATION. OFFICERS AND DIRECTORS MUST COMPLETE AN ANNUAL STATEMENT OF CONFLICTS OF INTEREST. THE RESPONSES TO THE CONFLICT OF INTEREST ARE REVIEWED AND DETERMINED IF ADDITIONAL DISCLOSURE IS NECESSARY OR IF THE ANSWERS NEED TO BE REVIEWED BY LEGAL COUNSEL. ANY MEMBER OF THE BOARD HAVING A KNOWN DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER SHOULD MAKE A DISCLOSURE OF SUCH CONFLICT TO THE OTHER TRUSTEES. SUCH PERSON SHALL NOT VOTE OR USE HIS OR HER PERSONAL INFLUENCE ON THE MATTER, BUT SUCH PERSON MAY BE COUNTED IN DETERMINING THE QUORUM FOR THE MEETING. THE MINUTES OF THE MEETING SHOULD REFLECT THE MAKING OF THE DISCLOSURE, AND ABSTENTION FROM VOTING AND THE QUORUM SITUATION. IN ADDITION, ANY OFFICER OF THE CORPORATION HAVING A KNOWN DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER BEFORE SUCH OFFICER FOR ADMINISTRATIVE ACTION SHALL REPORT THE CONFLICT TO THE PRESIDENT OR, IN THE CASE OF THE PRESIDENT, TO THE CHAIR. SUCH OFFICER SHALL ABSTAIN FROM TAKING ANY ADMINISTRATIVE ACTION ON SUCH MATTER.
FORM 990, PART VI, SECTION B, LINE 15
MARY RUTAN HOSPITAL'S EXECUTIVE COMPENSATION PHILOSOPHY COVERS THE FOLLOWING GROUPS OF EXECUTIVES: PRESIDENT AND CHIEF EXECUTIVE OFFICER; CHIEF FINANCIAL OFFICER; ASSOCIATION, HOSPITAL, AND SELECT SUBSIDIARY VICE PRESIDENTS AND ADMINISTRATORS. IN DETERMINING THE APPROPRIATE LEVEL OF COMPENSATION WITHIN THE OVERALL STRATEGY, MARY RUTAN WILL CONSIDER SUCH FACTORS AS: TOTAL INCUMBENT RESPONSIBILITIES AND SCOPE OF THE POSITION HELD BY THE INDIVIDUAL; INCUMBENT'S LENGTH OF SERVICE IN THE INDUSTRY, LENGTH OF SERVICE WITH THE HOSPITAL, AND YEARS IN CURRENT POSITION; THE HOSPITAL'S FINANCIAL AND NON-FINANCIAL PERFORMANCE OVER A RELEVANT TIME PERIOD; AND ADDITIONAL ACTIVITIES PERFORMED BY THE INCUMBENT FROM THE POSITION RESPONSIBILITIES IDENTIFIED, BUT HAVING A DIRECT OR INDIRECT IMPACT ON BUSINESS (MULTIPLE JOB RESPONSIBILITIES, SPECIAL PROJECTS, SPECIFIC INDUSTRY EXPERTISE/EXPERIENCE, ETC.). THE REVIEW INCLUDES USE OF AN INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION STUDIES AND SURVEYS, AND APPROVAL BY THE COMPENSATION COMMITTEE AND BOARD. VOTING MEMBERS OF ANY COMMITTEE WHOSE JURISDICTION INCLUDES COMPENSATION MATTERS AND WHO RECEIVES COMPENSATION, DIRECTLY OR INDIRECTLY, FROM THE CORPORATION FOR SERVICES IS PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION. THE COMPENSATION REVIEW FOR THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES WAS LAST CONDUCTED IN 2010.
FORM 990, PART VI, SECTION C, LINE 18
FORM 1023 AND FORM 990 ARE MADE AVAILABLE UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19
THE DOCUMENTS ARE ONLY MADE AVAILABLE AT THE WRITTEN REQUEST OF THE INTERESTED PARTY.
FORM 990, PAGE 7
BREAKDOWN OF OFFICER COMPENSATION BETWEEN RELATED ENTITIES: AMANDA GOBLE- MARY RUTAN FOUNDATION: .5 HOUR MARY RUTAN HEALTH ASSOCIATION: 1.5 HOURS LOGAN VIEW INC.: 1.5 HOURS LOGAN COUNTY CANCER SOCIETY: .5 HOUR RONALD CARMIN- MARY RUTAN FOUNDATION: .5 HOUR MARY RUTAN HEALTH ASSOCIATION: 1.5 HOURS LOGAN VIEW INC.: 1.5 HOURS LOGAN COUNTY CANCER SOCIETY: .5 HOUR
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
NET UNREALIZED GAINS ON INVESTMENTS: 1,214,104. INVESTMENT IN CANCER NETWORK OF WEST CENTRAL OHIO -70,000. REVERSE WCORHA K-1 LOSS NOT RECORDED IN FINANCIAL STATEMENTS 5,455. NET ASSETS RELEASED FROM RESTRICTION 6,334. TOTAL TO FORM 990, PART XI, LINE 5: 1,155,893.
FORM 990, PART XI, LINE 2C:
THE AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
FORM 990, PART I, LINE 1 AND PART III, LINE 1:
THOSE DIRECTING MARY RUTAN HOSPITAL, A NOT-FOR-PROFIT, NON-GOVERNMENTAL HOSPITAL, ACCEPT RESPONSIBILITY FOR MEETING HEALTH CARE NEEDS OF THE COMMUNITY AND INSURING: A. THE DELIVERY OF SAFE, EFFICIENT AND ECONOMICAL HEALTH CARE WITHIN THE BOUNDS OF SOUND FINANCIAL AND DEBT SERVICE MANAGEMENT; B. A STRONG COMPETITIVE POSTURE WITHIN ITS SELECTED AREAS OF HEALTH SERVICES THROUGH EFFECTIVE BUDGETING, FORECASTING, AND MANAGEMENT; C. FIRM ESTABLISHMENT OF MARY RUTAN HOSPITAL AS A LEADER IN HEALTH CARE, SERVING RESIDENTS OF LOGAN COUNTY, OHIO, AND SURROUNDING AREAS WITH HIGH QUALITY ACUTE CARE, EMERGENCY CARE, AMBULATORY CARE AND CONSUMER HEALTH EDUCATION CONSISTENT WITH COMMUNITY NEEDS AND STAFF UTILIZATION; D. THAT THE HOSPITAL'S POSITION IN THE COMMUNITY WILL BE ENHANCED THROUGH STRONG INTERNAL MANAGEMENT, WELL-TRAINED HEALTH PROFESSIONALS WHO MAINTAIN CURRENT STANDARDS OF PRACTICE AND AGGRESSIVE AND CREATIVE EVALUATION OF SERVICES, TRENDS AND COMMUNITY NEEDS. E. THAT PATIENT EDUCATION IS PLANNED AND PROVIDED TO PROMOTE AND MAINTAIN HEALTH.
CONTINUATION OF SCHEDULE K
PART I, LINE F, DESCRIPTION OF PURPOSE: $5,066,114 OF THE BOND PROCEEDS IS CURRENTLY BEING USED TO REFUND ALL OF THE PREVIOUSLY OUTSTANDING CITY OF BELLEFONTAINE, OHIO HOSPITAL FACILITIES REVENUE AND REFUNDING BONDS, AND SERIES 1993 (MARY RUTAN HEALTH ASSOCIATION OF LOGAN COUNTY) ISSUED JULY 8, 1993. $9,640,708 OF THE BOND PROCEEDS WAS USED TO ACQUIRE, CONSTRUCT AND EQUIP HOSPITAL FACILITIES. PART II, LINE 3, TOTAL PROCEEDS OF ISSUE: THE TOTAL PROCEEDS ARE NOT EQUAL TO THE ISSUE PRICE LISTED IN PART I A(E) DUE TO $628,526 OF CUMULATIVE INVESTMENT EARNINGS ON THE PROJECT FUND. *BOND COUNSEL HAS REVIEWED MANAGEMENT CONTRACTS RELATING TO THE FINANCED PROPERTY PRIOR TO THE SUBMISSION OF SCHEDULE K.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.