Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 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 |
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Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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 | ||||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 1,757,441 | 307,141 | 2,827,146 | 6,000 | 4,897,728 | |
| 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 | 14,059,412 | 14,499,981 | 16,587,718 | 15,702,985 | 14,138,089 | 74,988,185 |
| 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 | 14,059,412 | 16,257,422 | 16,894,859 | 18,530,131 | 14,144,089 | 79,885,913 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | |||||
| 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. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 79,885,913 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 14,059,412 | 16,257,422 | 16,894,859 | 18,530,131 | 14,144,089 | 79,885,913 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 16,148 | 16,148 | ||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 16,148 | 16,148 | ||||
| 11 | Net income from unrelated business activities not included on 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.) .. | 1,535,056 | 46,566 | 86,117 | 117,987 | 39,198 | 1,824,924 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 15,594,468 | 16,303,988 | 16,980,976 | 18,648,118 | 14,199,435 | 81,726,985 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 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 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 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 | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2024 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2024 |
(iii) Distributable Amount for 2024 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2024 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2024 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2024: | ||||
| a From 2019....... | ||||
| b From 2020....... | ||||
| c From 2021....... | ||||
| d From 2022....... | ||||
| e From 2023....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2024 distributable amount | ||||
|
i
Carryover from 2019 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2024 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2024 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2024, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2024. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2025. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2020..... | ||||
| b Excess from 2021..... | ||||
| c Excess from 2022..... | ||||
| d Excess from 2023..... | ||||
| e Excess from 2024..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
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| FORM 990, ITEM B | THIS AMENDED FORM 990 FOR THE TAX YEAR ENDED DECEMBER 31, 2024, IS BEING FILED TO REFLECT FINANCIAL STATEMENT ADJUSTMENTS BASED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS, WHICH WERE NOT COMPLETE AT THE TIME THE ORIGINAL RETURN WAS FILED. AS A RESULT OF FINAL AUDIT ADJUSTMENTS: - FORM 990, PARTS I, III (LINE 4A), VIII, IX, X, AND XI HAVE BEEN UPDATED TO ALIGN TOTALS, PROGRAM EXPENSES, FUNCTIONAL EXPENSES, FINANCIAL POSITION, AND PRIOR PERIOD ADJUSTMENTS WITH THE AUDITED FINANCIAL STATEMENTS. - FORM 990, PART IV, LINE 12A IS NOW MARKED "YES" TO REFLECT THAT THE ORGANIZATION OBTAINED SEPARATE, INDEPENDENT AUDITED FINANCIAL STATEMENTS. - FORM 990, PART XII, LINES 2B AND 2C ARE NOW MARKED "YES" TO REFLECT THAT THE FINANCIAL STATEMENTS HAVE BEEN AUDITED. - SCHEDULE A, PART III AMOUNTS AND PERCENTAGES HAVE BEEN UPDATED TO REFLECT THE REVISED REVENUE FIGURES REPORTED ELSEWHERE ON THE FORM 990. - SCHEDULE D, PARTS VI, IX, AND X HAVE BEEN UPDATED TO CONFORM TO THE AUDITED FINANCIAL STATEMENTS. - SCHEDULE D, PARTS XI AND XII ARE NOW REQUIRED AND INCLUDED AS A RESULT OF THE COMPLETION OF THE AUDITED FINANCIAL STATEMENTS. NO OTHER MATERIAL CHANGES WERE MADE TO GOVERNANCE, PROGRAMS, OFFICERS, DIRECTORS, OR KEY EMPLOYEES AS A RESULT OF THESE AMENDMENTS. |
| FORM 990, PART VI, SECTION A, LINE 2 | THE MEMBERS OF THE CORPORATION CONSIST OF ASHTABULA COUNTY MEDICAL CENTER AND MEMORIAL HOSPITAL OF GENEVA |
| FORM 990, PART VI, SECTION A, LINE 3 | FITCH & ASSOCIATES - HAS A LONG-TERM MANAGEMENT CONTRACT WITH COMMUNITY CARE AMBULANCE NETWORK. |
| FORM 990, PART VI, SECTION A, LINE 6 | MEMBER CLASSES: THE MEMBERS OF THE CORPORATION SHALL HAVE SUCH RIGHTS AND POWERS AS ARE PROVIDED FOR IN THE ARTICLES OF INCORPORATION OF THE CORPORATION, THE BYLAWS, AND THE LAWS OF THE STATE OF OHIO. SUCH RIGHTS AND POWERS INCLUDE, BUT ARE NOT LIMITED TO, THE EXCLUSIVE POWER: A. TO ELECT OR APPOINT TRUSTEES OF THE CORPORATION AND TO REMOVE SUCH TRUSTEES FROM OFFICE; B. TO APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION OF THE CORPORATION; C. TO APPROVE THE ADMISSION OF NEW MEMBERS; AND D. TO APPROVE ANY MERGER, CONSOLIDATION, DISSOLUTION, OR SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION. A MEMBER MAY, WITH THE CONSENT OF THE OTHER MEMBERS, ASSIGN ITS MEMBERSHIP TO A SUBSIDIARY OF AFFILIATE OF THE MEMBER, AS LONG AS THE ASSIGNEE IS A NONPROFIT CORPORATION EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501 (C) (3) OF THE INTERNAL REVENUE CODE. EXCEPT AS SPECIFIED IN THE PRECEDING SENTENCE, MEMBERSHIP IN THE CORPORATION IS NOT TRANSFERABLE OR ASSIGNABLE. |
| FORM 990, PART VI, SECTION A, LINE 7A | MEMBERS WHO MAY ELECT MEMBERS: THE MEMBERS OF THE ORGANIZATION JOINTLY NOMINATED AND ELECT THE EIGHT MEMBER OF THE BOARD OF TRUSTEES TO A TWO YEAR TERM OF OFFICE. |
| FORM 990, PART VI, SECTION A, LINE 7B | GOVERNING BODY DECISION APPROVAL: THE BUSINESS, AFFAIRS, AND PROPERTY OF THE CORPORATION SHALL BE MANAGED BY THE BOARD OF TRUSTEES. THE BOARD OF TRUSTEES MAY ENGAGE AN EXECUTIVE DIRECTOR AND OTHER STAFF TO MANAGE THE DAY-TO-DAY ACTIVITIES OF THE CORPORATION, EXCEPT THAT THE BOARD OF TRUSTEES SHALL BE REQUIRED TO APPROVE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION AND ALL NONBUDGETED CAPITAL EXPENDITURES IN EXCESS OF $10,000. ANY TRUSTEE MAY RESIGN AT ANY TIME BY GIVING WRITTEN NOTICE TO THE BOARD OF TRUSTEE, THE PRESIDENT, OR THE SECRETARY-TREASURER OF THE CORPORATION. SUCH RESIGNATION SHALL TAKE EFFECT WHEN THE NOTICE IS RECEIVED UNLESS THE NOTICE SPECIFIES A LATER DATE. A TRUSTEE (OTHER THAN THE EXECUTIVE DIRECTOR) MAY BE REMOVED WITH OR WITHOUT CAUSE BY THE MEMBER WHICH APPOINTED THE TRUSTEE. ANY OF THE TRUSTEES OF THE CORPORATION MAY BE REMOVED WHENEVER IN ITS JUDGMENT THE BEST INTERESTS OF THE BOARD WILL BE SERVED THEREBY. ANY TRUSTEE INCURRING THREE (3) UNEXCUSED, CONSECUTIVE ABSENCES WITH RESPECT TO THE REGULAR MEETINGS OF THE BOARD OF TRUSTEES SHALL BE SUBJECT TO REMOVAL. EXCEPT FOR A VACANCY RESULTING FROM THE ABSENCE OF AN EXECUTIVE DIRECTOR, VACANCIES ON THE BOARD OF TRUSTEES SHALL BE FILLED BY THE MEMBER THAT APPOINTED THE TRUSTEE WHOSE POSITION HAS BECOME VACANT. |
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990 REVIEW PROCESS: THE DRAFT 990 IS PROVIDED TO THE BOARD PRIOR TO SUBMISSION FOR REVIEW EITHER AT A BOARD MEETING OR THROUGH ELECTRONIC BOARD COMMUNICATIONS. ELECTRONIC OR IN PERSON COMMENTS ARE REVIEWED AND ANY ACTIONS TAKEN AS WELL AS THE REVIEW PROCESS IS NOTED IN BOARD MINUTES. |
| FORM 990, PART VI, SECTION B, LINE 12C | MONITOR AND ENFORCE CONFLICT OF INTEREST POLICY: A SIGNED ANNUAL DISCLOSURE OF ANY CONFLICTS OF INTEREST IS REQUIRED OF ALL BOARD OF TRUSTEE MEMBERS |
| FORM 990, PART VI, SECTION B, LINE 15 | PROCESS FOR DETERMINING COMPENSATION: THE COMPENSATION FOR THE SENIOR MANAGEMENT TEAM IS ESTABLISHED THROUGH A COMPENSATION REVIEW OF COLLATED SURVEY DATA FROM THE SEVERAL SOURCES INCLUDING INDUSTRY AND GEOGRAPHIC SPECIFIC DATA. THE HR COMMITTEE COMPRISED OF THE EXECUTIVE COMMITTEE REVIEWED THE DATA AND ESTABLISHED COMPENSATION RANGES FOR EACH POSITION. THE EXECUTIVE DIRECTOR DETERMINED EACH SENIOR LEADERSHIP MEMBER'S COMPENSATION WITHIN THE RANGES ESTABLISHED FOR EACH POSITION. |
| FORM 990, PART VI, SECTION C, LINE 19 | DOCUMENTS AVAILABLE TO PUBLIC: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| Software ID: | |
| Software Version: |