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
AKRON GENERAL HEALTH SYSTEM
Employer identification number
34-1546466
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)
No
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
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
(1)
AKRON GENERAL MEDICAL CENTER
340714478
3
Yes
Yes
Yes
13,934,520
(2)
AKRON GENERAL DEVELOPMENT FDN
341127047
7
Yes
Yes
Yes
30,065
(3)
LODI COMMUNITY HOSPITAL
340718390
3
No
Yes
Yes
616,758
(4)
ROSE LANE INC
341527202
9
No
Yes
Yes
27,299
(5)
VISITING NURSE SERVICE INC
340714779
9
No
Yes
Yes
582,629
(6)
PARTNERS PHYSICIAN GROUP
341843403
9
No
Yes
Yes
1,260,324
(7)
AKRON GENERAL PARTNERS
201801493
11A
No
Yes
Yes
855,153
Total
17,306,748
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
AKRON GENERAL HEALTH SYSTEM
Employer identification number
34-1546466
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION B, LINE 11
LINE 11B - AKRON GENERAL HEALTH SYSTEM PREPARES ITS FORM 990 INTERNALLY. THE RETURN IS SUBJECT TO FINANCIAL REVIEW BY THE VICE PRESIDENT OF ACCOUNTING AND FINANCE/INTERIM CHIEF FINANCIAL OFFICER OF AKRON GENERAL HEALTH SYSTEM AND REVIEWED FOR COMPLIANCE WITH THE REPORTING REQUIREMENTS OF FORM 990 BY THE DIRECTOR OF CORPORATE TAX FOR AKRON GENERAL HEALTH SYSTEM. AN OVERALL REVIEW IS PERFORMED BY THE CHIEF FINANCIAL OFFICER AND THE GOVERNANCE COMMITTEE OF THE AKRON GENERAL HEALTH SYSTEM BOARD. THE FORM 990 IS THEN REVIEWED BY ERNST & YOUNG, WHICH SIGNS AS PREPARER.
FORM 990, PART VI, SECTION B, LINE 12C
AKRON GENERAL HEALTH SYSTEM IS THE PARENT ORGANIZATION OF THE SYSTEM AND AS SUCH IT DETERMINES CERTAIN POLICIES AND PROCEDURES APPLICABLE TO ALL MEMBER ORGANIZATIONS. IN THE CASE OF CONFLICT OF INTEREST REPORTING, AKRON GENERAL HEALTH SYSTEM NOT ONLY DETERMINES THE POLICY AND THE PROCEDURE, IT CARRIES OUT THE PROCEDURE FOR ALL SYSTEM ORGANIZATIONS ITSELF. A CONFLICT OF INTEREST QUESTIONNAIRE IS DISTRIBUTED TO ALL BOARD MEMBERS, MANAGEMENT PERSONNEL, EMPLOYED PHYSICIANS AND ANY OTHER PERSONNEL THAT HAVE BEEN DESIGNATED BY MANAGEMENT. THE DISTRIBUTION COVERS ALL SYSTEM ORGANIZATIONS. ALL RESPONSES THAT INDICATE A PERCEIVED CONFLICT OF INTEREST ARE TURNED OVER TO THE GOVERNANCE AND COMPLIANCE COMMITTEE (THE COMMITTEE) OF AKRON GENERAL HEALTH SYSTEM FOR REVIEW. THE COMMITTEE MAKES A DETERMINATION AS TO WHETHER THE PERCEIVED CONFLICT IS LIKELY TO BE AN ACTUAL CONFLICT, THE MATERIALITY OF ANY ACTUAL CONFLICTS AND THE EXTENT OF SAFEGUARDS REQUIRED FOR ANY ACTUAL CONFLICTS. SAFEGUARDS INCLUDE, BUT ARE NOT LIMITED TO, REQUIRING, IN THE CASE OF A BOARD MEMBER, THAT THE PERSON RECUSE HIMSELF OR HERSELF FROM ANY DISCUSSIONS OR VOTING THAT MAY BE AFFECTED BY THE CONFLICT, REQUIRING THE PERSON TO DISENGAGE FROM THE CONDUCT CREATING THE CONFLICT OR REQUIRING THE PERSON TO RESIGN FROM THE POSITION AFFECTED BY THE CONFLICT. THIS PROCESS IS CONDUCTED BY AKRON GENERAL HEALTH SYSTEM'S LEGAL DEPARTMENT ANNUALLY IN JANUARY. THE CONFLICT OF INTEREST LETTER PUTS THE RECIPIENT ON NOTICE THAT HE OR SHE IS UNDER AN ONGOING DUTY TO REPORT ANY POTENTIAL CONFLICTS THAT MAY ARISE SUBSEQUENT TO THIS FORMAL PROCESS. SUBSEQUENT EVENT REPORTING IS MONITORED BY AKRON GENERAL HEALTH SYSTEM'S LEGAL DEPARTMENT. ANY SUBSEQUENT REPORTED ITEMS ARE SUBJECT TO THE AFOREMENTIONED REVIEW PROCESS BY AKRON GENERAL HEALTH SYSTEM'S GOVERNANACE AND COMPLIANCE COMMITTEE.
FORM 990, PART VI, SECTION B, LINE 15
THE REPORTING ORGANIZATION FOLLOWS A PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO AND OTHER TOP MANAGEMENT PERSONNEL THAT IS MODELED AFTER THE REQUIREMENTS FOUND IN INTERNAL REVENUE CODE SECTION 4958 FOR ESTABLISHING THE PRESUMPTION OF REASONABLE COMPENSATION. THEREFORE, THE PROCESS CALLS FOR RECOMMENDATIONS - DEVELOPED BY AN INDEPENDENT COMPENSATION CONSULTANT, BASED ON COMPARABLE MARKET DATA FROM PUBLISHED SURVEYS AND THE FORMS 990 OF COMPARABLE ORGANIZATIONS - THAT ARE WITHIN THE RANGE OF THE COMPENSATION OF SIMILARLY SITUATED PERSONS AT SIMILARLY SITUATED ORGANIZATIONS. THESE RECOMMENDATIONS ARE REVIEWED BY THE COMPENSATION COMMITTEE OF THE REPORTING ORGANIZATION'S BOARD OF DIRECTORS. THE COMPENSATION COMMITTEE IS COMPRISED OF INDEPENDENT PERSONS AND THE DELIBERATIONS ARE DOCUMENTED, CONTEMPORANEOUSLY, IN THE COMMITTEE'S MINUTES. WITH THE EXCEPTION OF THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER, THE COMPENSATION FOR ALL TOP MANAGEMENT WAS REVIEWED FOR REASONABLENESS USING THIS PROCESS IN 2008. IN 2010, THE REPORTING ORGANIZATION RECRUITED A NEW CHIEF EXECUTIVE OFFICER. THE PROCESS FOR DETERMINING THAT INDIVIDUAL'S INITIAL COMPENSATION AS WELL AS THAT FOR DETERMINING THAT INDIVIDUAL'S BASE COMPENSATION FOR FUTURE YEARS WAS ESSENTIALLY IDENTICAL TO THE ABOVE DESCRIBED PROCESS AND TOOK PLACE IN 2010 AS PART OF THE RECRUITMENT PROCESS.
FORM 990, PART VI, SECTION C, LINE 19
CURRENTLY, AKRON GENERAL HEALTH SYSTEM DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR ITS FINANCIAL STATEMENTS GENERALLY AVAILABLE TO THE PUBLIC. AKRON GENERAL HEALTH SYSTEM DOES MAKE THESE DOCUMENTS AVAILABLE ON A CASE BY CASE BASIS.
FORM 990, PART VII, SECTION A, LINE 1A, COLUMN (A)
VINCENT J. MCCORKLE, FACHE - CEO AND MEMBER EX-OFFICIO OF THE BOARD OF DIRECTORS FOR THE REPORTING ORGANIZATION. MR. MCCORKLE ALSO SERVED AS MEMBER EX-OFFICIO OF THE BOARD OF DIRECTORS OF AKRON GENERAL MEDICAL CENTER - .77 HOURS AVERAGE PER WEEK, MEMBER EX-OFFICIO OF THE BOARD OF DIRECTORS OF AKRON GENERAL PARTNERS - .23 HOURS AVERAGE PER WEEK, MEMBER EX-OFFICIO OF THE BOARD OF DIRECTORS OF COMMNUITY HEALTH VENTURES, INC. - .23 HOURS AVERAGE PER WEEK, MEMBER EX-OFFICIO OF THE BOARD OF DIRECTORS OF LODI COMMUNITY HOSPITAL - .69 HOURS AVERAGE PER WEEK, MEMBER EX-OFFICIO OF THE BOARD OF DIRECTORS OF AKRON GENERAL DEVELOPMENT FOUNDATION - .23 HOURS AVERAGE PER WEEK. MR. MCCORKLE ASSUMED EACH OF THE PRECEDING ROLES ON JULY 1, 2010. DEBBIE GORBACH - INTERIM TREASURER FOR THE REPORTING ORGANIZATION. MRS. GORBACH ALSO SERVED AS V.P. ACCOUNTING AND FINANCE AND INTERIM TREASURER FOR AKRON GENERAL HEALTH SYSTEM - 61.5 HOURS AVERAGE PER WEEK, INTERIM TREASURER FOR AKRON GENERAL PARTNERS - .25 HOURS AVERAGE PER WEEK, INTERIM TREASURER FOR PARTNERS PHYSICIAN GROUP - .25 HOURS AVERAGE PER WEEK, INTERIM TREASURER FOR NHV PHYSICIANS PROFESSIONAL CORPORATION - .25 HOURS AVERAGE PER WEEK, AND INTERIM TREASURER FOR AKRON GENERAL DEVELOPMENT FOUNDATION - .50 HOURS AVERAGE PER WEEK. CRAIG BABBITT - MR. BABBITT SERVED AS SR. V.P. LEGAL SERVICES & GENERAL COUNSEL AND SECRETARY FOR THE REPORTING ORGANIZATION - 55.5 HOURS AVERAGE PER WEEK. MR. BABBITT ALSO SERVED AS SECRETARY FOR AKRON GENERAL PARTNERS - .25 HOURS AVERAGE PER WEEK, SECRETARY FOR AKRON GENERAL MEDICAL CENTER - .25 HOURS AVERAGE PER WEEK, SECRETARY FOR PARTNERS PHYSICIAN GROUP - .25 HOURS AVERAGE PER WEEK, SECRETARY FOR NHV PHYSICIANS PROFESSIONAL CORPORATION - .25 HOURS AVERAGE PER WEEK, AND SECRETARY FOR AKRON GENERAL DEVELOPMENT FOUNDATION - .25 HOURS AVERAGE PER WEEK. MICHAEL RINDLER - FORMER INTERIM CHIEF EXECUTIVE OFFICER AND DIRECTOR EX OFFICIO OF THE REPORTING ORGANIZATION. MR. RINDLER ALSO SERVED AS DIECTOR EX OFFICIO OF AKRON GENERAL MEDICAL CENTER - 2 HOURS AVERAGE PER WEEK, DIRECTOR EX OFFICIO OF AKRON GENERAL PARTNERS - 2 HOURS AVERAGE PER WEEK, DIRECTOR EX OFFICIO OF COMMUNITY HEALTH VENTURES - 1 HOUR AVERAGE PER WEEK, AND DIRECTOR EX OFFICIO OF LODI COMMUNITY HOSPITAL - 1 HOUR AVERAGE PER WEEK. MR. RINDLER HELD THESE ROLES THROUGH 6/30/2010. ALAN J. BLEYER - FORMER DIRECTOR EX OFFICIO OF THE REPORTING ORGANIZATION. MR. BLEYER ALSO SERVED AS CHIEF EXECUTIVE OFFICER OF AKRON GENERAL HEALTH SYSTEM. MR. BLEYER SEPARATED FROM SERVICE IN 2009 AND THE COMPENSATION SHOWN IS PAID BY AKRON GENERAL HEALTH SYSTEM IN ACCORDANCE WITH MR. BLEYER'S SEVERANCE AGREEMENT. DANIEL J. CUNNINGHAM - FORMER SECRETARY AND SR. V.P. OF LEGAL SERVICES FOR THE REPORTING ORGANIZATION. MR. CUNNINGHAM BEGAN MEDICAL LEAVE IN 2009. THE COMPENSATION REPORTED IS A COMBINATION OF ACCRUED TIME OFF AND SHORT TERM DISABILITY PAID BY AKRON GENERAL HEALTH SYSTEM IN ACCORDANCE WITH MR. CUNNINGHAM'S SEVERANCE AGREEMENT. PAUL LECAT, M.D. - DIRECTOR FOR THE REPORTING ORGANIZATION. DR. LECAT ALSO SERVED AS CHAIRMAN OF MEDICAL EDUCATION FOR AKRON GENERAL MEDICAL CENTER (AGMC), A RELATED ORGANIZATION - 50 HOURS AVERAGE PER WEEK, DIRECTOR FOR AKRON GENERAL PARTNERS - 1 HOUR AVERAGE PER WEEK, DIRECTOR FOR LODI COMMUNITY HOSPITAL - .2 HOURS AVERAGE PER WEEK, AND DIRECTOR FOR PARTNERS PHYSICIAN GROUP - .2 HOURS AVERAGE PER WEEK. THOMAS STOVER, M.D. - PRESIDENT OF OUTPATIENT SERVICES FOR THE REPORTING AGENCY. DR. STOVER ALSO SERVED AS DIRECTOR FOR AKRON GENERAL PARTNERS - .9 HOURS AVERAGE PER WEEK, DIRECTOR FOR PARTNERS PHYSICIAN GROUP - .2 HOURS AVERAGE PER WEEK, AND DIRECTOR FOR NHV PHYSICIANS PROFESSIONAL CORPORATION - .2 HOURS AVERAGE PER WEEK. MARK LERNER - DIRECTOR OF THE REPORTING ORGANIZATION. MR. LERNER ALSO SERVES AS DIRECTOR OF PARTNERS PHYSICIAN GROUP - .25 HOURS AVERAGE PER WEEK AND DIRECTOR OF AKRON GENERAL PARTNERS - 2 HOURS AVERAGE PER WEEK.
FORM 990, PART X, COLUMN (A)
SOME BEGINNING BALANCES HAVE BEEN RECLASSIFIED FOR PRESENTATION PURPOSES ONLY.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
NET UNREALIZED GAINS ON INVESTMENTS: 837,560. CONTRIBUTED CAPITAL FROM AFFILIATED ORGANIZATIONS 24,473,749. TRANSFERS FROM/(TO) AFFILIATED ORGANIZATIONS -6,940,000. BOOK/TAX DIFFERENCE ON PARTNERSHIPS -348. TOTAL TO FORM 990, PART XI, LINE 5: 18,370,961.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.