-
TIN:
SCHEDULE A
(Form 990 or 990EZ)
Department of the Treasury
Internal Revenue Service
(Form 990 or 990EZ)
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. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Inspection
Name of the organization
University Hospitals Health System Inc
Group Return
Group Return
Employer identification number
90-0059117
90-0059117
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
6
7
8
9
10
11
a
b
c
d
e
f
Enter the number of supported organizations
..............
g
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 (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2015
Schedule A (Form 990 or 990-EZ) 2015
Page 2
Part II
Support Schedule for Organizations Described in Sections 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.)
(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.)
| Calendar year (or fiscal year beginning in) |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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. | ||||||
| Calendar year
(or fiscal year beginning in) |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10. | ||||||
12
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here........................................
Section C. Computation of Public Support Percentage
14
14
15
15
16a
b
17a
b
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 .....................................................
instructions .....................................................
Schedule A (Form 990 or 990-EZ) 2015
Schedule A (Form 990 or 990-EZ) 2015
Page 3
Part III
Support Schedule for Organizations Described in Section 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.)
(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.)
| Calendar year (or fiscal year beginning in) |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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.) | ||||||
| Calendar year (or fiscal year beginning in) |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
14
Section C. Computation of Public Support Percentage
15
15
16
16
Section D. Computation of Investment Income Percentage
17
17
18
18
19a
b
20
Schedule A (Form 990 or 990-EZ) 2015
Schedule A (Form 990 or 990-EZ) 2015
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B.
If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
Yes
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was
described in section 509(a)(1) or (2).
2
No
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)?
If "Yes," answer (b) and (c) below.
3a
No
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the
public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the
determination.
3b
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes?
If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
4a
Was any supported organization not organized in the United States ("foreign supported organization")?
If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.
4a
No
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported
organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or
supervised by or in connection with its supported organizations.
4b
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections
501(c)(3) and 509(a)(1) or (2)?
If “Yes,” explain in Part VI what controls the organization used to ensure that all support to
the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
5a
Did the organization add, substitute, or remove any supported organizations during the tax year?
If “Yes,” answer (b) and
(c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported
organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the
organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by
amendment to the organizing document).
5a
No
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the
organization's organizing document?
5b
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other
than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its
supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing
organization’s supported organizations?
If “Yes,” provide detail in Part VI.
6
No
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in
section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a
substantial contributor?
If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .
7
No
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7?
If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).
8
No
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as
defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))?
If “Yes,” provide detail in Part VI.
9a
No
b
Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting
organization had an interest?
If “Yes,” provide detail in Part VI.
9b
No
c
Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets
in which the supporting organization also had an interest?
If “Yes,” provide detail in Part VI.
9c
No
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain
Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)?
If “Yes,” answer line 10b below.
10a
No
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine
whether the organization had excess business holdings).
10b
Schedule A (Form 990 or 990-EZ) 2015
Schedule A (Form 990 or 990-EZ) 2015
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
No
b
A family member of a person described in (a) above?
11b
No
c
A 35% controlled entity of a person described in (a) or (b) above?
If “Yes” to a, b, or c, provide detail in Part VI.
11c
No
Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or
elect at least a majority of the organization’s directors or trustees at all times during the tax year?
If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or
trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such
powers during the tax year.
1
Yes
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that
operated, supervised, or controlled the supporting organization?
If “Yes,” explain in Part VI how providing such benefit
carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting
organization.
2
No
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of
each of the organization’s supported organization(s)?
If “No,” describe in Part VI how control or management of the
supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
No
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s
tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the
Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing
documents in effect on the date of notification, to the extent not previously provided?
1
No
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s)
or (ii) serving on the governing body of a supported organization?
If "No," explain in Part VI how the organization
maintained a close and continuous working relationship with the supported organization(s).
2
No
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the
organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax
year?
If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
No
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported
organization(s) to which the organization was responsive?
If "Yes," then in Part VI identify those supported
organizations and explain how these activities directly furthered their exempt purposes, how the organization was
responsive to those supported organizations, and how the organization determined that these activities constituted
substantially all of its activities.
2a
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the
organization’s supported organization(s) would have been engaged in?
If "Yes," explain in Part VI the reasons for the
organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s
involvement.
2b
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of
the supported organizations?
Provide details in Part VI.
3a
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its
supported organizations?
If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
Schedule A (Form 990 or 990-EZ) 2015
Schedule A (Form 990 or 990-EZ) 2015
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | 0 | |||
| 2 | Recoveries of prior-year distributions | 2 | 0 | |||
| 3 | Other gross income (see instructions) | 3 | 0 | |||
| 4 | Add lines 1 through 3 | 4 | 0 | |||
| 5 | Depreciation and depletion | 5 | 0 | |||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | 0 | |||
| 7 | Other expenses (see instructions) | 7 | 0 | |||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | 0 | |||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | 0 | |||
| b | Average monthly cash balances | 1b | 0 | |||
| c | Fair market value of other non-exempt-use assets | 1c | 0 | |||
| d | Total (add lines 1a, 1b, and 1c) | 1d | 0 | |||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): 0 |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | 0 | |||
| 3 | Subtract line 2 from line 1d | 3 | 0 | |||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | 0 | |||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | 0 | |||
| 6 | Multiply line 5 by .035 | 6 | 0 | |||
| 7 | Recoveries of prior-year distributions | 7 | 0 | |||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | 0 | |||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | 0 | |||
| 2 | Enter 85% of line 1 | 2 | 0 | |||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | 0 | |||
| 4 | Enter greater of line 2 or line 3 | 4 | 0 | |||
| 5 | Income tax imposed in prior year | 5 | 0 | |||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | 0 | |||
7
Schedule A (Form 990 or 990-EZ) 2015
Schedule A (Form 990 or 990-EZ) 2015
Page 7
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 0 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
0 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 0 | |
| 4 Amounts paid to acquire exempt-use assets | 0 | |
| 5 Qualified set-aside amounts (prior IRS approval required) | 0 | |
| 6 Other distributions (describe in Part VI). See instructions | 0 | |
| 7Total annual distributions. Add lines 1 through 6. | 0 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
0 | |
| 9 Distributable amount for 2015 from Section C, line 6 | 0 | |
| 10 Line 8 amount divided by Line 9 amount | 0 % | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
0 | |||
|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
0 | |||
| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013.......0 | ||||
| e From 2014.......0 | ||||
| fTotal of lines 3a through e | 0 | |||
| g Applied to underdistributions of prior years | 0 | |||
| h Applied to 2015 distributable amount | 0 | |||
|
i
Carryover from 2010 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | 0 | |||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ 0 | ||||
| a Applied to underdistributions of prior years | 0 | |||
| b Applied to 2015 distributable amount | 0 | |||
| c Remainder. Subtract lines 4a and 4b from 4. | 0 | |||
|
5
Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
0 | |||
|
6
Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
0 | |||
|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
0 | |||
| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013.......0 | ||||
| d From 2014.......0 | ||||
| e From 2015.......0 | ||||
Schedule A (Form 990 or 990-EZ) (2015)
Schedule A (Form 990 or 990-EZ) 2015
Page 8
Part VI
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Schedule A Supplemental Information | SOFTWARE LIMITATION WOULD NOT ALLOW COMPLETION OF SCHEDULE A. PUBLIC CHARITY CLASSIFICATION OF EACH GROUP MEMBER IS SHOWN BELOW: AMHERST HOSPITAL ASSOCIATION, INC. - 34-0067060 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD MSC 9155 SHAKER HEIGHTS, OH 44122 EMH REGIONAL MEDICAL CENTER - 34-0714612 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD MSC 9155 SHAKER HEIGHTS, OH 44122 PARMA COMMUNITY GENERAL HOSPITAL - 34-0827442 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD MSC 9155 SHAKER HEIGHTS, OH 44122 ROBINSON HEALTH SYSTEM, INC. - 46-1382538 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD MSC 9155 SHAKER HEIGHTS, OH 44122 SAMARITAN REGIONAL HOSPITAL - 34-0714535 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD MSC 9155 SHAKER HEIGHTS, OH 44122 UHHS - HEATHER HILL REHABILITATION HOSPITAL INC. (UHECC) - 34-1465745 DBA UNIVERSITY HOSPITALS EXTENDED CARE CAMPUS 170(B)(1)(A)(III) 12340 BASS LAKE ROAD CHARDON, OH 44024 UNIVERSITY HOSPITALS AHUJA MEDICAL CENTER - 26-4827222 170(B)(1)(A)(III) 3999 RICHMOND ROAD BEACHWOOD, OH 44122 UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER (UHCMC) - 34-1567805 170(B)(1)(A)(III) 11100 EUCLID AVE CLEVELAND, OH 44106 UNIVERSITY HOSPITALS CONNEAUT MEDICAL CENTER (CMC) - 34-0714550 170(B)(1)(A)(III) 158 WEST MAIN ROAD CONNEAUT, OH 44030 UNIVERSITY HOSPITALS GEAUGA MEDICAL CENTER (GMC) - 34-0816492 170(B)(1)(A)(III) 13207 RAVENNA ROAD CHARDON, OH 44024 UNIVERSITY HOSPITALS GENEVA MEDICAL CENTER (UHGMC) - 34-0714461 170(B)(1)(A)(III) 870 WEST MAIN STREET GENEVA, OH 44041 UH REGIONAL HOSPITALS - 34-1924226 170(B)(1)(A)(III) 27100 CHARDON ROAD RICHMOND HEIGHTS, OH 44143 UNIVERSITY HOSPITALS ST. JOHN MEDICAL CENTER - 34-1260978 170(B)(1)(A)(III) 3605 WARRENSVILLE CENTER RD MSC 9155 SHAKER HEIGHTS, OH 44122 ROYALTON SENIOR LIVING, INC. - 56-2314071 509(A)(2) 3605 WARRENSVILLE CENTER RD MSC 9155 SHAKER HEIGHTS, OH 44122 UNIVERSITY HOSPITALS ACCOUNTABLE CARE ORGANIZATION INC. - 27-3970270 509(A)(2) 3605 WARRENSVILLE CENTER RD MSC 9155 SHAKER HEIGHTS, OH 44122 UNIVERSITY HOSPITALS COORDINATED CARE ORGANIZATION - 90-0794903 509(A)(2) 3605 WARRENSVILLE CENTER RD. - MSC 9155 SHAKER HEIGHTS, OH 44122 UNIVERSITY HOSPITALS RAINBOW CARE CONNECTION INC. - 46-1074672 509(A)(2) 3605 WARRENSVILLE CENTER RD MSC 9155 SHAKER HEIGHTS, OH 44122 BMH PROFESSIONAL CORPORATION (BMHPC) - 34-1749966 509(A)(3) - TYPE I ORGANIZATION 158 WEST MAIN ROAD CONNEAUT, OH 44030 PART I LINE 11G (I) NAME OF SUPPORTED ORGANIZATION: UNIVERSITY HOSPITALS CONNEAUT MEDICAL CENTER (II) EIN OF SUPPORTED ORGANIZATION: 34-0714550 (III) TYPE OF ORG. (DESCRIBED ON LINES 1-9 ABOVE OR IRC SECTION): 170 (B)(1)(A)(III) (IV) IS THE SUPPORTED ORG. LISTED IN YOUR GOVERNING DOCUMENTS?: YES (V) AMOUNT OF MONETARY SUPPORT: $0 MEMORIAL HOSPITAL HEALTH FOUNDATION - 34-1810018 509(A)(3) - TYPE I ORGANIZATION 11100 EUCLID AVENUE CLEVELAND, OH 44106 PART I LINE 11G (I) NAME OF SUPPORTED ORGANIZATION: UNIVERSITY HOSPITALS GENEVA MEDICAL CENTER (II) EIN OF SUPPORTED ORGANIZATION: 34-0714461 (III) TYPE OF ORG. (DESCRIBED ON LINES 1-9 ABOVE OR IRC SECTION): 170(B) (1)(A)(III) (IV) IS THE SUPPORTED ORG. LISTED IN YOUR GOVERNING DOCUMENTS?: YES (V) AMOUNT OF MONETARY SUPPORT: $0 ROBINSON HEALTH AFFILIATES 34-1499719 509(A)(3) - TYPE I ORGANIZATION 3605 WARRENSVILLE CENTER RD MSC 9155 SHAKER HEIGHTSTS, OH 44122 PART I LINE 11G (I) NAME OF SUPPORTED ORGANIZATION: ROBINSON HEALTH SYSTEM, INC. (II) EIN OF SUPPORTED ORGANIZATION: 46-1382538 (III) TYPE OF ORG. (DESCRIBED ON LINES 1-9 ABOVE OR IRC SECTION): 170(B) (1)(A)(III) (IV) IS THE SUPPORTED ORG. LISTED IN YOUR GOVERNING DOCUMENTS?: YES (V) AMOUNT OF MONETARY SUPPORT: $0 UNIVERSITY MEDNET (UMI) - 34-0750341 509(A)(3) - TYPE I ORGANIZATION 23001 EUCLID AVENUE CLEVELAND, OH 44117 PART I LINE 11G (I) NAME OF SUPPORTED ORGANIZATION: UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. (II) EIN OF SUPPORTED ORGANIZATION: 34-0714775 (III) TYPE OF ORG. (DESCRIBED ON LINES 1-9 ABOVE OR IRC SECTION): 509(A)(3) - TYPE II ORGANIZATION (IV) IS THE SUPPORTED ORG. LISTED IN YOUR GOVERNING DOCUMENTS?: YES (V) AMOUNT OF MONETARY SUPPORT: $0 UNIVERSITY HOSPITALS HOME CARE SERVICES, INC. (HCS) - 34-1527536 509(A)(3) - TYPE I ORGANIZATION 4901 GALAXY PARKWAY WARRENSVILLE HEIGHTS, OH 44128 PART I LINE 11G (I) NAME OF SUPPORTED ORGANIZATION: UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. (II) EIN OF SUPPORTED ORGANIZATION: 34-0714775 (III) TYPE OF ORG. (DESCRIBED ON LINES 1-9 ABOVE OR IRC SECTION): 509(A)(3) - TYPE II ORGANIZATION (IV) IS THE SUPPORTED ORG. LISTED IN YOUR GOVERNING DOCUMENTS?: YES (V) AMOUNT OF MONETARY SUPPORT: $0 COMPREHENSIVE HEALTH CARE OF OHIO, INC. - 34-1492733 509(A)(3) - TYPE II ORGANIZATION 3605 WARRENSVILLE CENTER RD MSC 9155 SHAKER HEIGHTS, OH 44122 PART I LINE 11G (I) NAME OF SUPPORTED ORGANIZATION: EMH REGIONAL MEDICAL CENTER (II) EIN OF SUPPORTED ORGANIZATION: 34-0714612 (III) TYPE OF ORG. (DESCRIBED ON LINES 1-9 ABOVE OR IRC SECTION): 170(B) (1)(A)(III) (IV) IS THE SUPPORTED ORG. LISTED IN YOUR GOVERNING DOCUMENTS?: YES (V) AMOUNT OF MONETARY SUPPORT: $0 SAMARITAN HOSPITAL HOSPITALITY SHOP 34-0808574 509(A)(3) - TYPE II ORGANIZATION 3605 WARRENSVILLE CENTER RD MSC 9155 SHAKER HEIGHTS, OH 44122 PART I LINE 11G (I) NAME OF SUPPORTED ORGANIZATION: SAMARITAN REGIONAL HEALTH SYSTEM (II) EIN OF SUPPORTED ORGANIZATION: 34-0714535 (III) TYPE OF ORG. (DESCRIBED ON LINES 1-9 ABOVE OR IRC SECTION): 170(B) (1)(A)(III) (IV) IS THE SUPPORTED ORG. LISTED IN YOUR GOVERNING DOCUMENTS?: YES (V) AMOUNT OF MONETARY SUPPORT: $19,739 UHHS HEATHER HILL INC. (HHI)- 34-0771884 509(A)(3) - TYPE II ORGANIZATION 12340 BASS LAKE ROAD CHARDON, OH 44024 PART I LINE 11G (I) NAME OF SUPPORTED ORGANIZATION: UHHS - HEATHER HILL REHABILITATION HOSPITAL INC. DBA UNIVERSITY HOSPITALS EXTENDED CARE CAMPUS (II) EIN OF SUPPORTED ORGANIZATION: 34-1465745 (III) TYPE OF ORG. (DESCRIBED ON LINES 1-9 ABOVE OR IRC SECTION): 170(B) (1)(A)(III) (IV) IS THE SUPPORTED ORG. LISTED IN YOUR GOVERNING DOCUMENTS?: YES (V) AMOUNT OF MONETARY SUPPORT: $0 UNIVERSITY HOSPITALS LABORATORY SERVICES FOUNDATION (UHLSF) - 34-1720429 509(A)(3) - TYPE II ORGANIZATION 11100 EUCLID AVENUE CLEVELAND, OH 44106 PART I LINE 11G (I) NAME OF SUPPORTED ORGANIZATION: UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER (II) EIN OF SUPPORTED ORGANIZATION: 34-1567805 (III) TYPE OF ORG. (DESCRIBED ON LINES 1-9 ABOVE OR IRC SECTION): 170(B) (1)(A)(III) (IV) IS THE SUPPORTED ORG. LISTED IN YOUR GOVERNING DOCUMENTS?: YES (V) AMOUNT OF MONETARY SUPPORT: $1,698,000 UNIVERSITY HOSPITALS MEDICAL GROUP, INC. (UHMG) - 20-4881619 509(A)(3) - TYPE II ORGANIZATION 11100 EUCLID AVENUE CLEVELAND, OH 44106 PART I LINE 11G (I) NAME OF SUPPORTED ORGANIZATION: UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. CARE ORGANIZATION (II) EIN OF SUPPORTED ORGANIZATION: 34-0714775 (III) TYPE OF ORG. (DESCRIBED ON LINES 1-9 ABOVE OR IRC SECTION): 509(A)(3) - TYPE II ORGANIZATION (IV) IS THE SUPPORTED ORG. LISTED IN YOUR GOVERNING DOCUMENTS?: YES (V) AMOUNT OF MONETARY SUPPORT: $0 Schedule A, Part III, Section A-C 2011 2012 2013 2014 2015 Total Line 1 $1,996,502 $1,995,195 $2,045,868 $2,275,000 - $8,312,565 Line 2 - - - - - - Line 3 - - - - - - Line 4 - - - - - - Line 5 - - - - - - Line 6 $1,996,502 $1,995,195 $2,045,868 $2,275,000 - $8,312,565 Line 7a - - - - - - Line 7b - - - - - - Line 7c - - - - - - Line 8 - - - - - $8,312,565 Line 9 $1,996,502 $1,995,195 $2,045,868 $2,275,000 - $8,312,565 Line 10a - - - - - - Line 10b - - - - - - Line 10c - - - - - - Line 11 - - - - - - Line 12 $39,444 $32,762 $33,290 - $9,000 $114,496 Line 13$2,035,946 $2,027,957 $2,079,158 $2,275,000 $9,000 $8,427,061 Line 15: 99% Line 16: 99% SCHEDULE A, PART IV, SECTION B, TYPE I SUPPORTING ORGANIZATIONS LINE 1: YES LINE 2: YES THE FOLLOWING GROUP SUBORDINATES RESPONDED YES: -UNIVERSITY HOSPITALS HOME CARE SERVICES, INC. UNIVERSITY HOSPITALS HOME CARE SERVICES, INC. ("UH HOME CARE") IS ORGANIZED AS A SUPPORTING ORGANIZATION OF UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. ("UHHS"). BY SUPPORTING UHHS, UH HOME CARE INDIRECTLY SUPPORTS ALL HEALTH CARE DELIVERING ENTITIES THROUGHOUT THE HEALTH SYSTEM. THE FOLLOWING GROUP SUBORDINATES RESPONDED NO: - UNIVERSITY MEDNET: THIS ENTITY IS CURRENTLY INACTIVE. - BMH PROFESSIONAL CORPORATION: THIS ENTITY IS CURRENTLY INACTIVE. - MEMORIAL HOSPITAL HEALTH FOUNDATION: THIS ENTITY IS CURRENTLY INACTIVE. -ROBINSON HEALTH AFFILIATES, INC. SCHEDULE A, PART IV, SECTION C, TYPE II SUPPORTING ORGANIZATIONS LINE 1: YES THE FOLLOWING GROUP SUBORDINATES RESPONDED YES: - HEATHER HILL, INC. THE FOLLOWING GROUP SUBORDINATES RESPONDED NO: - COMPREHENSIVE HEALTH CARE OF OHIO COMPREHENSIVE HEALTH CARE OF OHIO ("CHCO") IS A SUPPORTING ORGANIZATION OF EMH REGIONAL MEDICAL CENTER AS STATED IN ITS ARTICLES. UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. ("UHHS") IS THE SOLE MEMBER OF CHCO. CHCO IS SUPERVISED, DIRECTED AND CONTROLLED BY UHHS. -SAMARITAN HOSPITAL HOSPITALITY SHOP SAMARITAN HOSPITAL HOSPITALITY SHOP ("SHHS") IS A SUPPORTING ORGANIZATION OF SAMARITAN REGIONAL HEALTH SYSTE |
Schedule A (Form 990 or 990-EZ) 2015
Additional Data
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Attach to Form 990 or 990-EZ.