Return ofOrganization ExemptFromIncomeTax 0MBNo.IUS-00990s.foundationcenter.org/990_pdf_archive/314/314394942/314394… · Return ofOrganization ExemptFromIncomeTax 0MBNo.IUS-00 form

Return of Organization Exempt From Income Tax 0MBNo.IUS-00form 990. Under section 501 (c), 527, or 4947( a)(1) of the Internal Revenue Code (except black lung 2003benefit trust or private foundation)Depart,neM of the Treasury x p A ^linternal re,ue Sege 0, The organization may have to use a copy of this return to satisfy state reporting requirements .

- 7 For the 2003 calendar year, or tax year beginning JUL 1 , 200 3 and ending JUN 30. 2004

Chem If _ plame, C Name of organization

° e use ERs

Dadgo W`'°` HIOHEALTH CORPORATION^^torED

NWW470, , Number and street (or P.O. box if mail Is not delivered to street address)see

Firet'T,,, spade 1087 DENNISON AVENUE 3RD FLOOR

r

I=r City or town, state or country, and ZIP + 4wed COLUMBUS , OH 43201rI^ on • Section 501 (c)(3 ) organizations and 4947(a)(1) nonexempt charitable trusts

must attach a completed Schedule A (Form 990 or 990-EZ).

G Websfte:)WWW. OHIOHEALTH . COMJ Organization type o onryone)►[ 501(c) ( 3 4 onsed no•) 0 4947(a)(1) or EJ 52

K Check here ►U If the organization's gross receipts are normally not more than $25,000. The

organization need not file a return with the IRS; but If the organization received a Form 990 PackageIn the mail, it should file a return without financial data. Some states require a complete return.

D Employer Identification number

31-4394942

Room/suite E Telephone number,614-566-5000

_ F ao ntro meaad cash ] A c d

H and I are not applicable to section 527 organizations.

H(a) Is this a group return for affiliates? El Yes ® No

H(b) If Yes, enter number of affiliates ►H(c) Are all affiliates Included? N/A EDYes 0 No

(If'No, attach a list.)H(d) Is this a separate return fled by an or-

ganization covered by a orouo ruling ? [] Yes F-1 No

M Check ►U If the organization is not required to attachL Gross rece ipts: Add lines 6b , 8b, 9b , and 10b to One 12 ► 1 , 17 4 715 8 5 9 . Sch. B (Form 990 , 990-EZ, or 990•PF).

:T?axirt Revenue. Expenses. and Chances in Net Assets or Fund Balances

C

1

a

b

Contributions , gifts, grants , and similar amounts received:

Direct public support .............................................................................. is

Indirect public support ........................................................................... 1 b 2 , 065 , 962. ^.wc Government contributions (grants ) .. ..... ..................................................... it

. 4 Tota (add tin sMe gS01*$- 300 , 000. noncash $ 1,76 5,962. ).. id 2 , 065 , 962.2 frog m êroice revenuêincludin er ant fees and contracts (from Part VII , line 93 ) ............. ....................... 2 10 2 6 3 094751 .

3 Me Whip dues and assessments .... .......................................................................... ....................... 3

_

4 Inte

(

s^ sa an^teiîpo zash1vestments ....................................................... ...... ....................... 4

5 DMd nds•and_interest from secu ritieSIX. ............................................................................ ....................... 5 14 , 907 , 887.

rip6 a Gros rents r-.;. .7•.........^^^

S,STATEMENT ... ..1 .-..... . .. .. . ... .. ........ . ...... .......... 6a 1 3 31 312 . 3-71"b Less :

y49nta1W*xpense ........................... ..SEE.-STATEMENT......... 6b 2 969 565.

f <

c Net rental income or (loss) (subtract line 6b from One 6a ) ....................................................... ....................... 6c <1 , 638 , 253.:nz

7 Other Investment Income (descnibe )- OTHER INVESTMENT INCOME 7 1 , 874 , 692.8 a Gross amount from sales of assets other (A) Securities B Other

than inventory ................................................ 17 , 129 , 917. 8a 961 , 625..b Less : cost or other basis and sales expenses .•....... 8b 253 , 981.

c Gain or (loss) (attach schedule ) ........................... 17 , 129 , 917. 8c 707 , 644.d Net gain or (loss ) (combine line ac, columns (A) and (B)) STMT 3 STMT - 4 ... 8d 17 , 837 , 561.

(,)

W

9

a

Special events and activities (attach schedule ). If any amount is from gaming , check here ►Gross revenue (not Including $ of contributions

reported on line 1a ) ...................................... ........... 9a

b Less : direct expenses other than fundraising expenses .................................... 9b

c Net Income or (loss ) from special events (subtract One 9b from One 9a) .............. ........................................... 9c10 a Gross sales of inventory , less returns and allowances .................................... 10a 7 , 793 , 422 ' , A.

b Less : cost of goods sold ........................................................................... 10b 4 137 52 4 .c Gross profit or (loss) from sales of inventory (attach schedule ) (subtract line 10b from fine 10a ) ....... 5...... TM......T.... ... . 10c 3 655 , 898.

11 Other revenue (from Part VII, fine 103 ) .................................................................................. ....................... 11 102 , 341 , 291.12 Total revenue (add lines 1d , 2 3 . 4 . 5 . 6c . 7 8d 9c , 10c and 11 ) .............................................. ....................... 12 1,167.354789.13 Program services (from One 44, column (B)) ......................................................................... ....................... 13 8 56 , 495 , 9 44.14 Management and general (from fine 44, column (C)) ................... ................... 14 198 , 195 , 680.

CL 15 Fundraising (from line 44, column (D)) 16

W 16 Payments to affiliates (attach schedule ) ................................................................... ............ ....................... 1617 Total exp enses add lines 16 and 44 , column A ....................................................................................... 17 1 5 4 6 9 6 2 4 .18 Excess or (deficit ) for the year (subtract line 17 from line 12) ..._.... 18 112 66 3 16 5 .

mq 19 Net assets or fund balances at beginning of year (from line 73, column (A)) ................................... ...................... 1g 538 , 590 , 182.Z 20 Other changes in net assets or fund balances (attach explanation ) S.-SENT. 6........ ........ ..... .. . ... .... .. . ..... .... .... 20 34 329 , 947.

21 Net assets or fund balances at end of year (combine lines 18 , 19, and 20 ) ...................................................... 21 685 , 583 , 294.

12-17-M LHA For Paperwork Reduction Act Notice, see the separate Instructions . Form 990 (2003)

OHIOHEALTH CORPORATION 31-4394942yl Statement of ganizations must complete column (A). Columns (B), (C, (D) are required for section 501(c)(3) Page 2

Functional Expenses aiw (4) organizations and section 4947(a)(1) nonexempt charltaoie trusts but notional for others-

r

r

Do noto6(8b9b

amountsor 1 t

on line (A) Total ( B) Programservices

( C) Managementand eneral (D) Fundralsing

22

23

24

Grants and allocations (attach schedule ) ............

cash S ooneesh S

Specific assistance to individuals (attach schedule)

Benefitspaidtoorformembers (attach schedule )

22

23

24

w ^x"• o-'

- r^ *r' ,^tryi

k

^'``

25 Compensation of officers, directors , tic . ............ 25 5 , 845 , 966. 4 , 747 , 403. 1 , 098 , 563 t 0.26 Other salaries and wages ................................. 26 373 , 270 , 381 . 303 , 126 , 108. 70 , 144 f

.273 .

27 Pension plan contributions .............................. 27 _ 15 , 721 , 326 . 12 , 767 , 004. 2 , 954 , 322.28 Other employee benefits ................................. 28 42 , 093 , 672 . 34 , 183 508. 7 , 910 , 164.29 Payroll taxes ................................................ 29 31 , 599 , 015 . 25 660 987. 5 , 938 , 028.30 Professional fundraising fees ........................... 3031 Accounting fees ................................ 31 380 , 915 . 309 , 334. 71 , 581.32 Legalfees ................................................... 32 4 , 355 , 734 . 3 , 537 , 213. 818 521.33 Supplies ...................................................... 33 09 282 540. 169 954 556. 39 , 327 , 984 .34 Telephone ................................................... 34

35 Postage and shipping .................................... 95 791 , 742 . 642 , 959. 148 , 783.36 Occupancy _ ................................................. 36 8 , 102 , 112 . 6 , 579 , 578. 1 , 522 r 534 .37 Equipment rental and maintenance .................. 37 23 , 820 , 746. 19 , 344 , 396. 4 , 476 , 350.38 Printing and publications .............................. 38 841 , 512 . 683 , 377. 158 , 135 .39 Travel ......................................................... 39 1 , 899 , 103. 1 , 542 , 227. 356 876.40 Conferences , conventions , and meetings ............ 40 669 , 137. 543 , 394. 125 , 743.41 Interest ...................................................... 41 6 , 607 , 184. 5 , 365 , 574. 1 , 241 , 610.42 Depredation , depletion , etc. (attach schedule ) ... 42 50 , 671 , 866. 41 , 149 , 704. 9 , 522 , 162.43

a

Other expenses not covered above (itemi ze):

43a

b 43b

c 43c

d 43de SEE STATEMENT 7 43e 78 738 673. 26 358 622. 52 380 051.

44 ° rAnfea w 13.15 44 1,054,691,624. 856 , 495 , 944. 198 , 195 , 680. 0.Joint Costs. Check ► l_j If you are following SOP 98-2.Are any joint costs from a combined educational campaign and fundraising solicitation reported In (B) Program services? ....If Yes, enter ( I) the aggregate amount of these joint costs $

........ [K] No; (II) the amount allocated to Program services $

011 11 the amount allocated to Management and general $ • and Iv the amount allocated to FundralsinStatement of Program Service Accomplishments

f(

What Is the organization 's primary exempt purpose? ► SEE STATEMENT 8Program Service

All organitatlons must describe theirexerript purpose achievements In a dear and concise rtwmer. State Vw mmtberotclients served, publications Issued, etc. Discussechlavartients that are not measurable. (section e01(c and (4) organizations and 4947W) normcempt charitable trust must also enter the amount of grants andallocations to others.)

UPenses

ors,44M. ))basis; butoptfaW torothersJ

a SEE STATEMENT 8

Grants and allocations 856 495 944.b

(Grants and allocationsC

(Grants and allocations

d

(Grants and allocations

e Other p rog ram services attach schedule (Grants and allocations $

f Total of Program Service Expenses (should equal line 44, column (8), Program services) .................................................... . . ► 856.495.944-323D1 112-17-03 Form 990 (2003)

form990(2003) OHIOHI jTH CORPORATION 31-4394942 Page3

Balance Sheets

fNote : Where requited, attached schedules and amounts within the description column (A) (B)

should be for end-of-year amounts only. Beginning of year End of year •

45 Cash - non-Interest-bearing .............................................................................. 45

46 Savings and temporary cash investments ............................................................ 25 f 9 9 9, 085. 46 58 , 13 0 2 8 7.

47 a Accounts receivable .......................................... 47a 186 , 366 , 066.

b Less : allowance for doubtful accounts .................. 47b 60 075 529. 123 993 663. 47c 126 290 537.

46 a Pledges receivable ......_. .................................. 48a

b Less : allowance for doubtful accounts .................. 48b 48c49 Grants receivable ............................................................................................. 49

50 Receivables from officers , directors , trustees,

and key employees .......................................................................................... 5051 a Other notes and loans receivable ........................ 51 a 2 9 0 2 7 696.

b Less : allowance for doubtful accounts .................. 1 51b 4 0 , 096 , 221. 31 c 29 027 696.52 Inventories for sale or use ................................................................................. 12 , 395 , 915. 52 14 , 078 , 951.53 Prepaid expenses and deferred charges ............................................................... 8 987 174 . 53 10 , 289 , 080.54 Investments - secur6les STMT. 9•...••STMT,..10. ► Cost 00 Fm 370 632 274. 54 501 705 839.55 a Investments - land, buildings, and

equipment basis ............................................. 55a

b Less : accumulated depreciation ........................... 55b 65c56 Investments - other .......................................&.F F ...1.1.... 15 , 443 , 011. 56 10 , 678 , 000.57 a Land , buildings, and equipment: basis .................. 57a 859859 , 366 , 206 .

b Less : accumulated depredation ........................... 57b 1 492 , 990 , 458. 335 ,020 ,166. 57c 366 , 375 , 748.58 Other assets (describe 10- SEE STATEMENT 12 ) 104 330 879. 58 81 882 891.

59 Total assets (add lines 45 throug h 58) must e qual line 74 ....................................... 1036-898388. 59 X19 8 4 59029.60 Accounts payable and accrued expenses ....................................... 94 , 218 ,- 858. 60 150 , 284 ,- 957.61 Grants payable ................................................................................................ 61

62 Deferred revenue ............................................................................................. 6263 Loans from officers , directors , trustees , and key employees .................................... 6364 a Tax-exem pt bond liabilities .......................... SEE $TATE11 EN T I 304 , 447 , 57 8. 64a 280 , 569 , 581.

b mortgages and other notes payable ................. Mfll NT._..l .......... 64b 12 , 965 , 497.65 Other liabilities (describe '. SEE STATEMENT 13 ) 109 , 641 , 770 . 65 69 , 055 , 700.

66 Total liabilities add fines 60 through 65 ............................ ................................ 498 , 308 , 206. 56 512 , 875 , 735.Organizations that follow SFAS 117, check here ► © and complete lines 67 through

69 and Ones 73 and 74.

67 Unrestricted ................................................................................................... 538 590 182. 67 685 583 294._à 68 Temporarily restricted ....................................................................................... 68m 69 Permanently restricted ....................................................................................... 69

Organizations that do not follow SFAS 117 , check here ► and complete lines 44

70 through 74.MMWE

° 70 Capital stock , trust principal , or current funds .............................

71 Paid-in or capital surplus , or land , building , and equipment fund ................................. 7172 Retained earnings, endowment, accumulated Income , or other funds ........................... 72

Z 73 Total net assets or fund balances (add lines 67 through 69 or lines 70 through 72;column (A) must equal One 19 ; column ( B) must equal line 21 ) ................................• 5 3 8 5 9 0 18 2 . 73 685 583 , 294.

74 Total lIabilities and net assets / fund balances (add lines 66 and 73 ) ................ .-•.•,_. 1036898 88. 74 1 .1 9 8,4 5 9. 0 2 9 -Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular organization. How the public

perceives an organization in such cases may be determined by the information presented on its return. Therefore, please make sure the return Is complete and accurateand fully describes, in Part III, the organization's programs and accomplishments.

32302112-17-03

Form 990 2003 OHIOHI TH CORPORATION 31-4394942 Page4ry Reconciliation of Revenue per Audited arr Reconciliation of Expenses per Audited

'Financial Statements with Revenue per Financial Statements with Expenses per

a Total revenue, gains, and other supportper audited financial statements ............... ►

b Amounts included on line a but not online 12 , Form 990:

{1) Net unrealized gains

on investments ......;

(2) Donated services

and use of facilities ... $

(3) Recoveries of prior

year grants ............ 5(4) Other (specify):

iAdd amounts on lines (1) through (4) ......... ►

c Line a minus line b ................................. ►d Amounts included on line 12, Form

990 but not on fine a:

(1) Investment expenses

not included on

fine 6b , Form 990 ..,;

(2) Other (specify):

SAdd amounts on lines (1) and (2) ............ ►

e Total revenue per line 12 , Form 990line c plus lined ................................. ►

1:VE List of Officers . Directors.'

M" ^^N/A

a Total expenses and losses per'..

$Sk^Naudited financial statements ..................... ► a

A . b Amounts Included on One a but not ona line 17, Form 990:

Y^h (1) Donated services v^

and use of facilities e

4 o ^. (2) Prior year adjustmentsf 4

reported on One 20,

'Form 990 5

v?...............

4v

(3) Losses reported on

fine 20, Form 990 ..; i^

ffi (4) Other (specify):$

Add amounts on fines (1) through (4) ...... ► b

c Line a minus line b ................................. ► c

d Amounts Included on line 17, Form990 but not on line a:

(1) Investment expenses

not included on '` h k

line 6b , Form 990 .. $

(2) Other (specify): 'a fix.

e

$Add amounts on lines (1) and (2) ............ ►Total expenses per line 17, Form 990

(line c plus line d) ................................. ►mees (List each one even if not comnensated.1

(A) Name and address(B) Title and average hours

per week devoted toosition

C) Compensation(If not pa id , enter

0.

(D c.nNwuons toberwitp,^sation

(E) Expenseaccount and

other allowances

SEE STATEMENT-15-----------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

---------------------------------

---------------------------------

75 Did any officer , director, trustee, or key employee receive aggregate compensation of more than $100,000 from your organization and all related STMT 15

organizations , of which more than $ 10,000 was provided by the related organizations? if 'Yes, attach schedule . ► [X Yes [J No

323031 12-17-03 Form 990 (2003)

Forrn 990 (2003) OH IOHI TH CORPORATION 31-4394942 Page 5Other Information Yes No

76 Djd the organization engage In any activity not previously reported to the IRS? If Yes, attach a detailed description of each activity ............ 76 X

77 Were any changes made in the organizing or governing documents but not reported to the IRS? ......................................................... 77 X

if Yes, attach a conformed copy of the changes. ME_=W78 a Did the organization have unrelated business gross income of $1,000 or more during the year covered by this return? .............................. 78a X

b If Yes; has it filed a tax return on Form 990-T for this year? ......................................................................................................... 78b X

79 Was there a liquidation , dissolution , termination, or substantial contraction during the year? ............................................................... 79 X

If 'Yes , attach a statement

80 a Is the organization related (other than by association with a statewide or nationwide organization ) through common membership,

governing bodies , trustees , officers , etc., to any other exempt or nonexempt organhahnn? .................................................................. 80a X

b If 'Yes; enter the name of the organization SEE STATEMENT 16and check whether it is [) exempt or tJ nonexempt.

81 a Enter direct or indirect political expenditures . See one 81 instructions ................... .......................... .81a 0.

b Did the organization fie Form 1120-POL for this year? .................................................................................................................. 81b X

82a Did the organization receive donated services or the use of materials , equipment , or facilities at no charge or at substantially less than

fair rental value? .................................................................................................................................................................. 82a X

b if Yes; you may Indicate the value of these items here . Do not Include this amount as revenue In Part I or as anexpense in Part II. (See Instructions in Part III.) ........................................................................... 82b

-83P Did the organization comply with the public inspection requirements for returns and exemption applications ? .......................................... 83a X

b Did the organization comply with the disclosure requirements relating to quid pro quo contributions ? ................................................... 83b X

84a Did the organization solicit any contributions or gifts that were not tax deductible ? .............................................................................. 848 X

b If Yes; did the organization include with every solicitation an express statement that such contributions or gifts were nottax deductible? ..................................................................................................................................................N/A.••...... 84b

85 501 (c)(4), (5), or(6) organizations . a Were substantially all dues nondeductible by members? ........................................ N/A......... 85a

b Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................................ N./A ........ 85b

If Yes' was answered to either 85a or 85b , do not complete 85c through 85h below unless the organization received a waiver for proxy taxowed for the prior year. v

c Dues , assessments , and similar amounts from members .............................................•................. 85c N/A^ A

d Section 162(e) lobbying and political expenditures 85d N/A

e Aggregate nondeductible amount of section 6033 (e)(1)(A) dues notices ..........................................

I Taxable amount of lobbying and political expenditures (line 85d less 85e) ......................................• 851 N/A

g Does the organization elect to pay the section 6033 (e) tax on the amount on One 85f? ..................................................... N/A............ 85h If section 6033 (e)(1)(A) dues notices were sent , does the organization agree to add the amount on line 85f to its reasonable estimate of dues

allocable to nondeductible lobbying and political expenditures for the following taxyear? .................................................. N/A.....•.. 85h

86 501 (c)(7) organizations. Enter a Initiation fees and capital contributions included on fine 12 ........• 86a N/A

b Gross receipts , included on line 12, for public use of dub fadOdes .................................................„ 86b N/A

87 501 (c)(12) organizations. Enter. a Gross Income from members or shareholders ..........................• 87a N/A

D Gross Income from other sources . ( Do not net amounts due or paid to other sources

against amounts due or received from them.) .............................................................................. 87b N/A

88 At any time during the year, did the organization own a 50% or greater Interest in a taxable corporation or partnership,or an entity disregarded as separate from the organization under Regulations sections 301 .7701-2 and 301 .7701-3?If Yes; complete Part IX ........................................................................................................ ................................................. 88 X

89 a 501 (c)(9) organizations. Enter. Amount of tax imposed on the organization during the year under. `

section 0 . ; section 4912 ► 0 . ; section 4955 ► 0 .

b 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess benefittransaction during the year or did it become aware of an excess benefit transaction from a prior year?If Yes; attach a statement explaining each transaction .................................................

c Enter. Amount of tax imposed on the organization managers or disqualified persons during the year undersections 4912 , 4955 , and 4958 ................................................................................................................................. ► 0.

d Enter. Amount of tax on One 89c, above , reimbursed by the organization ........................................................................... ► 0.

90 a List the states with which a copy of this return is fled ► NONE

b Number of employees employed in the pay period that Includes March 12 , 2003 ...................................................... glib 9,881

91 The books are In care of ► CRAIG BJERKE, CONTROLLER Telephone no. ► L4-9-(4- L{05Z

Located at ► oy ^, ^^'.. C^^YÎ:t?Ù mby i (^s^^Q __ ZIP+4 ► Q32-trD

92 Section 4947(e)(1) nonexempt charitable trusts firng Form 990 1n lieu of Form 1041 - Check here .................................................. .......... ►0and enter the amount of tax-exempt interest received or accrued during the tax year .......................................... ► 192 N/A

Mai-M

form 990 (2003)

Fomi990(2003 ) OHIOHEALTH CORPORATION 31-4394942 Page6

;;1d( Analysis of Income-Producing Activities ( See page 33 of the Instructions)

Note: E r ross amounts unless otherwiset Unrelated business income Excluded by seddon 512. 513 , or514gn eIndicated.

93 Program service revenue.

(A)Business

(B)Amount

RExdwlioncod e

(D)Amount

(E)

Related or exemptfunction income

a HEALTH AND MEDICALb SERVICES 1026309751.

Cd

ef Medicare/Medicaid payments

g Fees and contracts from government agencies

94 Membership dues and assessments ... . ...

95 Interest on savings and temporary cash investments

96 Dividends and interest from securities . . ... ... 9 0 0 0 0 3 217,326. 14 14,690,561.97 Net rental income or ( loss) from real estate • •

a debt-financed property

b not debt-financed property 16 <1 , 638 , 253. >. .96 Net rental Income or ( loss) from personal property

99 other investment Income 621500 63,395. 14 1 , 811 , 297.

100 Gain or (loss) from sales of assets

other than inventory ........ .. .. ...... 18 17,837,561.

101 Net income or (loss ) from special events

102 Gross profit or ( loss) from sales of inventory 03 3,655,898.

103 Other revenuea OTHER REVENUE 03 102,341 291.b

c

de

104 Subtotal (add columns (B),(D),and (E)) 280 721. 138 , 6 8355. 43090751.1 ,026columns ( B), (D), and (E))105 Total (add line 104 ► 116 2 8 82 7 .,

Note : Line 105 plus line 1d. Part 1. should eaual the amount on line 12. Part

yIU Relationship of Activities to the Accomplishment of Exempt Purposes ( See page 34 of the instructions)

Line No .V

Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment of the organization's

exempt purposes ( other than by providing funds for such purposes)

SEE STATEMENT 17

p }=' Information Regarding Taxable Subsidiaries and Disregarded Entities ( See page 34 of the instructions)

Name , address , and)EIN of corporation ,partnershi p, or disreg arded entity

Percentage ofownershi p interest

Nature off)activities Totalncome End off-yearassets

SEE STATEMENT 1 %

Part 3C Information Reaardina Transfers Associated with Personal Benefit Contracts (See page 34 of the Instructions)

(a) Did the organization , during the year, rece ive any funds , directly or indirectly, t

(b) Did the organization , during the year, pay premiums , directly or indirectly, on a

PleaseSignHere

Paid

Preparer's

Use Only

r

SCHEDULE A Orga..ization Exempt Under Sectic.. d 501 (c)(3)(Form 990 or .990-9A lExcept Private Foundation ) and Section 501(e), 501(1), 501(k),

501(n), or Section 4947(a)(1) Nonexempt Charitable Trust

p ,mt,tto TrOMM Supplementary Information-(See separate instructions.)rote r m Service ► MUST be completed by the above organizations and attached to their Form 990 or 990-EZ

OMB No.1eas.uo47

2003Name of the organization Employer Identification number

OHIOHEALTH CORPORATION 31;4394942

Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees

r

See page 1 of the instructions . List each one . If there are none , enter None.")

(a) Name and address of each employee paid

more than $50,000

( b) Tdle and average hoursper week devoted to

p osition(c) Compensation

(C1 conbibudorm tobeft5t

on

e) Expenseaccount and other

allowances

SEE-STATEMENT-19-------------------------------

1199038. 91 602. 173 901.

---------------------------------

---------------------------------

---------------------------------

---------------------------------

Total number of other employees paid

over $50000 .............. ........................................................................ 185

tea.+: y i. ,y\nw o-d v +'

^Ka, ^ytn . •

<; x{4x^^,,,{; ?^ '

Compensation of the Five Highest Paid Independent Contractors for Professional Services(See page 2 of the instructions . List each one (whether individuals or firms). If there are none, enter 'None.')

(a) Name and address of each Independent contractor paid more than $50,000 (b) Type of service (c) Compensation

MIDWEST PHYSICIAN ANESTHESIA--------------------------

1631 NW PROFESSIONAL PLAZA , STE. 101 , COLUMBUS MEDICAL SERVICES 561753.

CORPATH LTD--- ---- ------------ --------- ----- -- - --- -----

IAGNOSTIC LABP.O. BOX 21400 , COLUMBUS , OHIO 43211 SERVICES M880506.

BRICKER & ECKLER LLP--------------------------------------------

100 S. 3RD ST. , COLUMBUS , OH 43215 LEGAL SERVICES 1354404.

MID-OHIO CARDIOLOGY CONSULTANTS,-INC.-------------------------------------------

3705 OLENTANGY RIVER RD. , STE. 100 , COLUMBUS , OH MEDICAL SERVICES 1325750.

MEDCENTER MANAGEMENT SERVICES/ORTHOLINK--------------------------------------------

8001 RAVINES EDGE COURT , SUITE 201 , COLUMBUS , OH MEDICAL SERVICES 1 58333.Total number of others receiving over

L

• ''`t^z; z^NON-1 `^, h^^+`^k` ,^ ^4^ "` :.„A,•^z;^`

` `` ' °•$50,000 for professional services ............................................................ 72 a (y . - ; ,\^ 4rv ^Y^4 \vtSvr' ,`(y^

323101,12-os03 LHA For Paperwork Reduction Act Notice . see the Instructions for Form 990 and Form 990-EZ . Schedule A (Form 990 nr 900-Ei12009

Schedule A (Form 990or990-EZ)2003 OHIC ALTH CORPORATION 31-4394942

t ` °. Statements About Activities (See page 2 of the instructions.)

7 During the year , has the organization attempted to Influence national , state, or local legislation , Including any attempt to Influence

public opinion on a legislative matter or referendum? If 'Yes, enter the total expenses paid or incurred In connection with the

lobbying activities ► -$ $ 17 4 , 2 0 6 . (Must equal amounts on One 38 , Part VI-A,or line lot Part Vl-B.) VI-B, LINE I

Organizations that made an election under section 501 (h) by filing Form 5768 must complete Part VI-A. Other organizations checking'Yes, must complete Part VI-8 AND attach a statement giving a detailed description of the lobbying activities.

2 During the year, has the organization , either directly or Indirectly , engaged in any of the following acts with any substantial contributors,trustees, directors , officers , creators , key employees , or members of their families , or with any taxable organization with which any suchperson Is affiliated as an officer , director, trustee , majority owner, or principal beneficia ry? the answer to any question is 'Yes,'attach a detailed statement explaining the transactions.) SEE STATEMENT 20 ^^.

No

a Sale, exchange, or leasing of property? ...................................................................................................

It Lending of money or other extension of credit? ....................................................................... ................................ 2b X

c Furnishing of goods , services, or facilities? ............................................................................ ........................................................

RM 990d Payment of compensation (or payment or reimbursement of expenses if more than $1,000)? .- SEE ..PART... V,.. . . O ... ............... ... 2d X

e Transfer of any part of Its Income or assets? ........................................

3 a Do you make grants for scholarships , fellowships , student loans , etc.? (If 'Yes' attach an explanation of howyou determine that recipients qualify to receive payments .) ............................................................................................................... 9a X

b Do you have a section 403(b) annuity plan for your employees ? ......................................................................................................... Sb X

4 Did you maintain any separate account for participating donors where donors have the right to provide adviceon the use or distribution of funds? ............................................................................................................................................. 4 X``` ` ,- Reason for Non-Private Foundation Status (See pages 3 through 6 of the Instructions.)

The organization is not a private foundation because it is: (Please check only ONE applicable box.)

5 [] A church, convention of churches , or association of churches . Section 170(b)(1)(A)(I).

6 [J A school. Section 170(b)(1)(A)(Iii ). (Also complete Part V.)

7 © A hospital or a cooperative hospital service organization . Section 170(b)(1)(A)(fil).

8 0 A Federal, state, or local government or governmental unit. Section 170(b)(1)(A)(v).

9 0 A medical research organization operated In conjunction with a hospital. Section 170(b)(1)(A)(ili ). Enter the hospital's name, city,and state ►

10 0 An organization operated for the benefit of a college or university owned or operated by a governmental unit. Section 170(b)(1)(A)(iv).

(Also complete the Support Schedule In Part IV-A.)

11a El An organization that normally receives a substantial part of its support from a governmental unit or from the general public.

Section 170(b)( 1)(A)(vl). (Also complete the Support Schedule In Part N-A.)

11b [] A community trust. Section 170(b)(1)(A)(vi). (Also complete the Support Schedule In Part IV-A.)

12 0 An organ ization that normally receives : (1) more than 331/3% of its support from contributions , membership fees, and grossreceipts from activities related to Its charitable , etc., 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). (Also complete the Support Schedule in Part N-A.)

13 An organization that is not controlled by any disqualified persons ( other than foundation managers ) and supports organizations described In:

(1) lines 5 through 12 above ; or (2) section 501(c)(4), (5). or (6). if they meet the test of section 509(a)(2). (See section 509(a)(3).)Provide the following information about the supported organizations . (See page 5 of the Instructions.)

(a) Name (s) of supported organization(s)(b) Line number

fromabovebove

C14 0 An organization organized and operated to test for public safety. Section 509(a )(4). (See page 6 of the instructions.)

Schedule A (Form 990 or 990-EZ) 2003

32311112.05-03

Schedule A (Form 990 or 990-EZ) 2003 OHIC ALTH CORPORATION 31-4394 942 Page 3

Support Schedule (Complete only if you checked a box on line 10, 11 , or 12 .) Use cash method of accounting. N/A. Note: You may use the worksheet In the instructions for converting from the accrual to the cash method of accountinc.

CCalendar year ( or fiscal yearbe g in InIn) .............................. ► ( a ) 2002 ( b) 2001 ( c ) 2000 (d ) 1999 a Total15 Gifts grants , and contributions

rece(ved . ( Do not include unusualg rants . See line 28 .)

16 Membership fees received .........

17 Gross receipts from admissions,merchandise sold or servicesperformed , or furnishing offacilities In any activity that Isrelated to the organization'scharitable, etc., purpose ............

18 Gross Income from Interest,dividends, amounts received frompayments on securities loans (sec-tion 51 2 (a)(5)), rents, royalties, andunrelated business taxable Income(less section 511 taxes) frombusinesses acquired by theorganization after June 30, 1975

19 Net Income from unrelated business

activities not Included In line 18 ...20 Tax revenues levied for the

organization 's benefit and eitherpaid to it or expended on its behalf

21 The value of services or facilitiesfurnished to the organization by agovernmental unit without charge.Do not include the value of servicesor facilities generally furnished tothe public without charge .........

22 Other income . Attach a schedule.Do not Include gain or (loss) fromsale of ca pital assets ...............

23 Total of Ones 15 through 22 0. 0. 0. 0. 0.

24 Line 23 minus line 17 ...............

25 Enter 1 % of line 23 .............

26 Organizations described on Tines 10 or 11 : a Enter 2% of amount In column (e), line 24 ............................................. ► 26a N/Ab Prepare a list for your records to show the name of and amount contributed by each person (other than a governmental

`^ùnit or publicly supported organization) whose total gifts for 1999 through 2002 exceeded the amount shown In line 26a .Do not file this list with your return. Enter the total of all these excess amounts ......................................................... ► 26b N/A

c Total support for section 509(a )( 1) test : Enter line 24 , column (e) .............................................................................. 26c N/A

d Add : Amounts from column (e) for lines : 18 19 REMRWEREARIMM22 26b ......... ► 26d N/A

e Public support (line 26c minus One 26d total) ......................................................................................................... ► 26e N/AI

Public su pp ort p ercenta g e ( line 28e (numerator) divided line 26c (denominator )) ...... ......................................... 26f N/A %

27 Organizations described on line 12: a For amounts included in lines 15,16, and 17 that were received from a'disqualified person; prepare a listfor yourrecords to show the name of, and total amounts received in each year from, each 'disqualified person.' Do not file this list with your return. Enter the sum ofsuch amounts for each year.

(2002) .......... (2001) .......................................... (2000) ....................................... (1999) .......................................

b For any amount included In line 17 that was received from each person (other than 'disqualified persons'), prepare a list for your records to show the name of,

and amount received for each year, that was more than the larger of (1) the amount on fine 25 for the year or (2) $5,000. (Include in the list organizationsdescribed In lines 5 through 11, as well as individuals.) Do not file this list with your return . After computing the difference between the amount received andthe larger amount described in (1) or (2), enter the sum of these differences (the excess amounts) for each year.

(2002) ....................................... (2001) .......................................... (2000) ....................................... (1999) .......................................c Add: Amounts from column (e) for lines: 15 16

17

d Add: Line 27a total .._ and line 27b total .................

e Public support (line 27c total minus line 27d total) ............................................................

t Total support for section 509(a)(2) test: Enter amount on line 23, column (e) ........ ► 2711

g Public support percentage (line 27e (numerator) divided by line 27f (denominator))

20 21

N/A

N/AN/A

N/A %N/A %

28 Unusual Grants: For an organization described in line 10 , 11, or 12 that received any unusual grants during 1999 through 2002 , prepare a fist for your recordsto show, for each year, the name of the contributor , the date and amount of the grant , and a brief description of the nature of the grant . Do not file this list withyour return . Do not include these grants in line 15.

323121 12-05-03 Schedule A (Form 990 or 990-M 2003

Schedule A (Form 990 or 990-EZ) 2003 OH IC ALTH CORPORATION 31-4394942 Page 4Private School Questionnaire (See page 7 of the Instructions.) N/A(To be completed ONLY by schools that checked the box on line 6 in Part N)

Yes No29 Does the organization have a racially nondiscriminatory policy toward students by statement In its charter, bylaws, other governing

instrument, or in a resolution of its governing body? ..................................................................................................................... 29

30 Does the organization Include a statement of its racially nondiscriminatory policy toward students in all its brochures, catalogues,

and other written communications with the public dealing with student admissions, programs, and scholarships? .................................... 30

31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period of '^^

solicitation for students, or during the registration period if it has no solicitation program, in a way that makes the policy known

to all parts of the general community it serves? .................................................................. ........................................................ 81

"'Yes,' please describe; it'No; please explain. (If you need more space, attach a separate statement.)

32 Does the organization maintain the following:

a Records Ind icating the racial composition of the student body , faculty, and administrative staff? ..................................................... .......

b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory basis? ........................

c Copies of all catalogues , brochures , announcements , and other written communications to the public dealing with student

admissions , programs , and scholarships? ........................................................................ .........................................................

d Copies of all material used by the organization or on its behalf to solicit contributions ? ........................................................................

it you answered 'No'to any of the above , please explain . ( if you need more space , attach a separate statement.)

33 Does the organization discriminate by race in any way with respect to:

a Students' rights or privileges ? ......................................................... .......................................................................................

b Admissions policies? ............................................................................................................................................................

c Employment of faculty or administrative staff? ....................................................... ....................................................................

d Scholarships or other financial assistance? ...................... ... ......... ..............................................

e Educational policies ? ........................................................................................ ....................................................................

I Use of facilities? ........................................................................................... .......................................................................

g Athletic programs? ................................................................ ...............................................................................................

h Other extracurricular activities? ................................................................................................................... .............................

If you answered 'Yes'to any of the above , please explain . ( If you need more space , attach a separate statement.)

34 a Does the organization receive any financial aid or assistance from a governmental agency? ..................................................................

b Has the organization 's right to such aid ever been revoked or suspended ? .......................................................................................

If you answered 'Yes' to either 34a orb , please explain using an attached statement.

35 Does the organization certify that it has complied with the applicable requirements of sections 4.01 through 4.05 of Rev . Proc. 75-50,

1975-2C.8.587 , covering racial nondiscrimination ? If'No, attach an explanation -----------

Schedule A (Form 990 or 990-EZ) 2003

32313112-05-W

Schedule A (Form 990 or 990-EZ) 2003 OHIC ALTH CORPORATION 31-4394 942 Page 5

WiRail 3f Lobbying Expenditures by Electing Public Charities (See page 9 of the instructions.) N/A(To be completed ONLY by an eligible organization that filed Form 5768)

r

I

unecK ► a L i a me org anization Delon s to an affiliated rou . Check -- o Lj if ou cnecKea -a- ana iumnea conlro provisions apply.

(a) (b)Limits on Lobbying Expenditures Affiliated group To be completed for ALL

(The term 'expenditures' means amounts paid or Incurred.) totals electing organizations

N/A36 Total lobbying expenditures to influence public opinion {grassroots lobbying) ........................... 36

37 Total lobbying expenditures to influence a legislative body (direct lobbying) .............................. 37

38 Total lobbying expenditures (add lines 36 and 37 ) ............................................................... 36

39 Other exempt purpose expenditures ................................................................................. 39

40 Total exempt purpose expenditures (add lines 38 and 39) ................................................... 40

41 Lobbying nontaxable amount. Enterthe amount from the following table - `zN''`r

If the amount on line 40 Is - The lobby ing nontaxable amount Is - WSIkI.Not wa. $500,000 .................................... 20% or the amount on One 40 .................................

Over $500,000 but not over $1.000,000 .... $100,000 plus 15% of the excess over $500,000 wf , ` +'x \iw < •.' }`

Over $1,000,000 but not over $1.500,000 ......... 5175.000 plus 10% of the a over S1,OOa,0Oa ......... 41

Over $1,500.000 but not ova $17,000,000 ......... $225,000 pus 5% of the excess over$l,500,000 ......... }w: }^^$- ctt^.^^

M1

Y r ,

{

Ôvc$17,00a,000 .................................... $1.000.a0a...................................................... \v* ewe" i \ ^„ •

42 Grassroots nontaxable amount (enter 25% of line 41) ......................................................... 42

43 Subtract line 42 from line 36. Enter -0- Kline 42 Is more than fine 36 ....................................... 43

44 Subtract line 41 from line 38. Enter -0- Urine 41 Is more than line 38 -.....................................• 44

{ v

4 r

^,vv^,•r \ a^v r w}4. v 4k

M

^\ v

k wl.

? vCaution: If there is an amount on either fine 43 or line 44, you must file Form 4720.J tin„^:h tih^\'4r+^}+:'•v+ v\ 4 ., x^\v î,+^.'

Lobbying Expenditures During 4-Year Averaging PeriodN/A

Calendar year (or (a) (b ) ( c) (d) (e)fiscal year beginning In) ► 2003 2002 2001 2000 Total

45 Lobbying nontaxable

amount ........................ 0.46 Lobbying ceiling amount ^vv vv v M1v

k^ h vv Y. a{;+ }r^ki•k ^^ mby \vi

} ^

8 }v } 4_\'•U4 •r'K• Y

}z^ _r \ hLUt

} \ 4k

k {v (\4,C\"y;. ,v

L ^v ti: ^^ >ti^ }•\v "

{Oi +h 'O Li k `4

v

4v+ .{

a 4\

' \f i\:•ry Irv •r

r\^,irfy;

r}\'.k

v 'uWSC•%}

h{vrk•-

r +•

v4.'C'# ii:r\ 4 ,v}Z+ ^ kr;vr 4Q^k 4\44nviX v v {

-\\{{\ {v v SpA 4`

kJQF.x.+i+v^4v %\

\., v

i-

rpvINerr,EM-

0( 150% o l ne 45(e)) ......... LV.a 4hk: r r kh} } \ w.•r n :... v v

A . } l, \ c k\s k :{ r 4-: , k : ^., .,,,++ ^, k, •

47 Total lobbying

expenditures .................. 0.48 Grassroots nontaxable

amount ........................ 0.ts ceiling amount49 Grassroo

h

9\:pSr\k}+h±4`MV\\.+l^v,!,:i-

{.

+r(\y+^nxi y f{(({\ \}v}k xvh\^\v;jp+4^{}J{vY }

+

\ -

Mf li 480%

^r.$.

o k 0ne15 o a f : s ^ •

50 Grassroots lobbying

e enditures .................. 0.: art 9-MI lnhhvinn Antivitv by Nnnalar-tinn Puhlin Charities

(For reporting only by organizations that did not complete Part VI-A) (See page 12 of the

During the year, did the organization attempt to Influence national , state or local legislation , including any attempt toYes No Amount

Influence public opinion on a legislative matter or referendum , through the use of:

a Volunteers ............................................................................................................................................... X irk ',%lc+b Paid staff or management ( Include compensation in expenses reported on lines c through h.).....• ........................•...•• X m Q. ,+:

c Media advertisements ................................................................................................................................. Xd Mailings to members , legislators, or the public ............................................................................................... X

e Publications , or published or broadcast statements .......................................................................................... X

f Grants to other organizations for lobbying purposes ......................................................................................... X 55 i 190.

g Direct contact with legislators , their staffs, government officials , or a legislative body ................................... ••,••_••.••.. X 119 016.

It Rallies, demonstrations , seminars, conventions , speeches , lectures, or any other means .......................................... X

I Total lobbying expenditures (Add lines c through h .) .................................................... c: <% k 174 , 206.......................................If 'Yes* to any of the above , also attach a statement giving a detailed description of the lobbying activities . SEE STATEMENT 21

12-0 Schedule A (Form 990 or 990-EZ) 2003

4-Year Averaging Period Under Section 501(h)

(Some organizations that made a section 501(h) election do not have to complete all of the five columnsbelow. See the instructions for fines 45 through 50 on page 11 of the instructions.)

Schedule A (Form 990 or 990-EZ) 2003 OH IC ALTH CORPORATION 31-4394942 Page 6

wE^l; Information Regarding Transfers To and Transactions and Relationships With NoncharitableExempt Organizations (See page 12 of the instructions.)

51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section

501(c) of the Code ( other than section 501(c)(3) organizations) or in section 527, relating to political organizations?

a Transfers from the reporting organization to a noncharitable exempt organization of: Yes No

(1) Cash ........................................................................................................................................................................... 51a(I) X

(11) Other assets .................................................................................................................................................................. a(il) X

b Other transactions:

(I) Sales or exchanges of assets with a noncharitable exempt organization .................................................................................... :b(1) X

(11) Purchases of assets from a noncharitable exempt organization ... ....... ......... ..................... ......... ......... .................. -b(il) X

{III) Rental of facilities , equipment , or other assets ...................... ......... ......... ......... ......... ......... ......... .................. b(ill) X

N Reimbursement arranements ................................... b(Iv) X

(v) Loans or loan guarantees ............................ .................................................................................................................... b(v) X

(vi) Performance of services or membership or fundraising solicitations .......................................................................................... b(vi)

c Sharing of facilities , equipment , mailing lists , other assets, or paid employees ................................................................................. C X

d If the answer to any of the above is 'Yes ' complete the following schedule . Column (b) should always show the fair market value of the

goods, other assets, or services given by the reporting organization . If the organization received less than fair market value In anytransaction or sharing arrangement , show In column (d) the value of the goods, other assets , or services received:

(a) (b) (c) (d)Line no . Amount Involved Name of noncharitable exempt organization Description of transfers , transactions, and sharing arrangements

51 564,532. HOSPITAL PROPERTIES INC. OCCUPANCY EXPENSES

r

r

52 a Is the organization directly or Indirectly affiliated with, or related to , one or more tax-exempt organizations described In section 501 (c) of the

Code ( other than section 501(c)(3)) or In section 527? ..................................................................................................... © Yes No

b if Yes, complete the following schedule:

(a)Name of organization

(b)Type of organization

(c)Description of relationship

SOMC TITLE HOLDING CO. 5 01 ( C )( 2 ) AFFILIATE

HOSPITAL PROPERTIES INC. 5 01 ( C )( 2 ) SUBSIDIARY

32315112.055-ca Schedule A (Form 990 or 990-EZ) 2003

l

l

09/3012004 - 01:14:55 PM

INTEL HEALTH SERVICES INSURANCE CO., LTD.2003 FORM 5471 - 3 RATE, IND, MULTI

Year. 2003

STATEMENT 1- FORM 5471, PAGE 2, SCHEDULE CINCOME STATEMENT - U.S. DOLLARS

8 OTHERINCOMEPREMIUMS WRITTENPREMIUMS CEDEDMOVEMENT IN UNEARNED PREMIUMSMOVEMENT PREPAID PREMIUMS CEDED

4,431,000

(4.362.x)(732,714)716,673

TOTAL

16 OTHER DEDUCTIONSMISC OFFICE EXPENSES

52,959

46,404

Page 10

STATEMENT I

09/30/2004 - 01:14:56 PM

NTEL HEALTH SERVICES INSURANCE CO., LTD.2003 FORM 5471 - 3 RATE, IND, MULTI

Year. 2003

STATEMENT 2 - FORM 6471 , PAGE 2, SCHEDULE CINCOME STATEMENT - FUNCTIONAL CURRENCY

8 OTHER INCOMEPREMIUMS WRITTENPREMIUMS CEDEDMOVEMENT IN UNEARNED PREMIUMSMOVEMENT PREPAID PREMIUMS CEDED

TOTAL

16 OTHER DEDUCTIONSMISC OFFICE EXPENSES

4,431,000(4.362,000)(732,714)716,673

52,959

46,404

Page 11

STATEMENT 2

09/30/2004 - 01:14:56 PM

r INTEL HEALTH SERVICES INSURANCE CO., LTD.2003 FORM 5471 - 3 RATE. 1ND, MULTI

Year 2003

STATEMENT 3 - FORM 5471 , PAGE 3, SCHEDULE FBALANCE SHEET

BEGINNING ASSETS:

.4 OTHER CURRENT ASSETSPREPAID REINSURANCE PREMIUMS.LOSSES AND LOSS EXP RECOVERABLE

TOTAL

12 OTHER ASSETS• MISCELLANEOUS

BEGINNING LIABILITIES:

15 OTHER CURRENT LIABIU11ES• OTHER ACCRUALSUNEARNEDPREMIUM RESERVERESERVES FOR LOSS ADJ EXP

TOTAL

20 RETAINED EARNINGSRETAINED EARNINGS-APPROPRIATEDNET INCOME PER BOOKS

TOTAL

2,191,32712,300,000

14,491,327

4,706

14,8212,221.28612,300,000

14,536,107

94,3421,443

95,785

Page 12

STATEMENT3

09/30/2004 - 01:1456 PMC 2003 FORM 5471- 3 RATE, IND, MULTI,NTEL HEALTH SERVICES INSURANCE CO., LTD.Year. 2W3

STATEMENT 4 - FORM 5471, PAGE 3, SCHEDULE FBALANCE SHEET

c

ENDING ASSETS:

4 OTHER CURRENT ASSETSOTHER PREPAID EXPENSESPREPAID REINSURANCE PREMIUMSLOSSES AND LOSS EXP RECOVERABLE

TOTAL

ENDING 'UABILITIES:

15 OTHER CURRENT LIABILITIESUNEARNED PREMIUM RESERVERESERVES - FOR LOSS ADJ EXPIBNR LOSS RESERVES

TOTAL

20 RETAINED EARNINGSRETAINED EARNINGS-APPROPRIATEDNET INCOME PER BOOKS

TOTAL

4,6712,908.0008,900,000

11,812,671

2.954.0003,300,0005,600,000

11,854,000

95,7857,993

103,778

Page 13

STATEMENT 4

OHIOHEALTH CORPORATION 31-4394942

FORM 99b RENTAL INCOME STATEMENT 1

ACTIVITY GROSS

KIND AND LOCATION OF PROPERTY NUMBER RENTAL INCOME

RENTAL INCOME-SEVERAL LOCATIONS 1 1,331,312.

TOTAL TO FORM 990, PART I, LINE 6A 1,331,312.

STATEMENT(S) 1


FORM 990 RENTAL EXPENSES STATEMENT 2

ACTIVITYDESCRIPTION NUMBER AMOUNT TOTAL

RENTAL EXPENSES 2,969,565.- SUBTOTAL - 1 2,969,565.

TOTAL TO FORM 990, PART I, LINE 6B 2,969,565.

C

STATEMENT(S) 2


FORM 990 GAIN (LOSS) FROM PUBLICLY TRADED SECURITIES STATEMENT 3

C GROSS COST OR EXPENSE NET GAIN

DESCRIPTION SALES PRICE OTHER BASIS OF SALE OR {LOSS)

CORPORATE SECURTIES

AND INVESTMENTS 17,129,917. 0. 0. 17,129,917.

TO FORM 990, PART I, LINE 8 17,129,917. 0. 0. 17,129,917.

STATEMENT(S) 3


FORM 990 GAIN (LOSS) FROM SALE OF OTHER ASSETS STATEMENT 4

r- DATE DATE METHODDESCRIPTION ACQUIRED SOLD ACQUIRED

VARIOUS ASSETS VARIOUS VARIOUS PURCHASED

GROSS COST OR EXPENSE NET GAINNAME OF BUYER SALES PRICE OTHER BASIS OF SALE DEPREC OR (LOSS)

961,625. 253,981. 0. 0. 707,644.

TO FM 990, PART I, LN 8 961,625. 253,981. 0. 0. 707,644.

I

STATEMENT(S) 4


FORM 99'0 INCOME AND COST OF GOODS SOLD STATEMENT 5r INCLUDED ON PART I, LINE 10

INCOME

1. GROSS RECEIPTS . . . . . . . . . . . . . . .

2. RETURNS AND ALLOWANCES . . . . . . . . . . .

3. LINE 1 LESS LINE 2 . . . . . . . . . . . . .

7,793,422

7,793,422

4. COST OF GOODS SOLD (LINE 13) . . . . . . . .

5. GROSS PROFIT (LINE 3 LESS LINE 4) . . .

COST OF GOODS SOLD

6. INVENTORY AT BEGINNING OF YEAR . . . . . . .

7. MERCHANDISE PURCHASED . . . . . . . . . . .

8. COST OF LABOR . . . . . . . . . . . . . . .

9. MATERIALS AND SUPPLIES . . . . . . . . . . .

10. OTHER COSTS . . . . . . . . . . . . . . . .

11. ADD LINES 6 THROUGH 10 . . . . . . . . . . .

12. INVENTORY AT END OF YEAR . . . . . . . . . .

13. COST OF GOODS SOLD (LINE 11 LESS LINE 12). .

4,137,524

4,137,524

3,655,898

4,137,524

4,137,524

STATEMENT(S) 5


FORM 99'0 OTHER CHANGES IN NET ASSETS OR FUND BALANCES STATEMENT 6

L_..CRIPTION

CHANGE IN NET UNREALIZED GAINS ON INVESTMENTS

TRANSFER TO RELATED ORGANIZATION

CHANGE RELATED TO MINIMUM PENSION LIABILITY

CHANGE IN FAIR VALUE OF INTEREST RATE SWAP

RESTRICTED CONTRIBUTIONS RECEIVED

AMOUNT

21,735,549.<704,811.>148,820.

11,084,427.2,065,962.

TOTAL TO FORM 990, PART I, LINE 20 34,329,947.

STATEMENT(S) 6


FORM 990 OTHER EXPENSES STATEMENT 7

(A) (B) (C) (D)

DESCRIPTION

BANK CHARGESINSURANCEMISCELLANEOUSBAD DEBTPURCHASED SERVICESDUES , LICENSES, ANDREGULATORY FEESIT AND DATAPROCESSINGBILLING/MANAGEMENTFEESMARKETING AND PRTELEPHONE, WASTEDISPOSAL, CABLE ANDUTILITIESPURCHASED PHYSICIANSERVICES

TOTAL TO FM 990, LN 43

TOTAL

2,987,346.15,984,694.49,143,308.67,232,900.35, 388, 311.

852,491.

24,193,691.

43,009,691.11,557,569.

10,275,922.

18,112,550.

278,738,673.

PROGRAMSERVICES

2,425,970.12,981,043.39,908,389.54,598,619.28,738,206.

MANAGEMENTAND GENERAL FUNDRAISING

561,376.3,003,851.9,234,919.12,634,281.6,650,105.

692,292. 160,199.

19,647,258. 4,546,433.

34,927,390. 8,082,301.9,385,692. 2,171,877.

8,344,890. 1,931,032.

14,708,873. 3,403,677.

226,358,622. 52,380,051.

STATEMENT(S) 7

OHIOHEALTH CORPORATION

FORM 990

31-4394942

STATEMENT OF ORGANIZATION'S PRIMARY EXEMPT PURPOSE STATEMENT 8PART III

EXPLANATION

'OHIOHEALTH CORPORATION OPERATES IN A MANNER CONSISTENT WITH THEREQUIREMENTS OF REV. RUL. 69-545 THROUGH ITS PROVISION OF HEALTH CARESERVICES TO THE COMMUNITY, REGARDLESS OF ABILITY TO PAY. SEE ATTACHEDCOMMUNITY BENEFIT REPORT FOR ADDITIONAL INFORMATION.

C

STATEMENT(S) 8

r

r

STAT-A-^N 8 2/-

-po

L L

r

I

SipiE n&vr ? 5/7

r

r

r

I-N 100)

y

y

°Q

'1^1


FORM 990 NON-GOVERNMENT SECURITIES STATEMENT 9

r

SECURITY DESCRIPTION

CORPORATE STOCKSCORPORATE BONDSOTHER

TO 990, LN 54 COL B

r

l

CORPORATE CORPORATESTOCKS BONDS

206,342,000.59,221,000.

206,342,000. 59,221,000.

OTHERPUBLICLY TOTALTRADED OTHER NON-GOV'T

SECURITIES SECURITIES SECURITIES

206,342,000.59,221,000.

84947,839. 89,947,839.

89,947,839. 355,510,839 .

STATEMENT(S) 9


FORM 99.0 GOVERNMENT SECURITIES STATEMENT 10

DESCRIPTION

U.S. GOVERNMENT OBLIGATIONS

TOTAL TO FORM 990, LINE 54, COL B

r

I

U.S.GOVERNMENT

146,195,000.

STATE AND TOTAL GOV'TLOCAL GOV T SECURITIES

146,195,000.

146,195,000.

146,195,000.

STATEMENT(S) 10


FORM 990 OTHER INVESTMENTS STATEMENT 11

C VALUATIONDESCRIPTION METHOD AMOUNT

CASH AND CASH EQUIVALENTS MARKET VALUE 10,678,000.

TOTAL TO FORM 990, PART IV, LINE 56, COLUMN B 10,678,000.

STATEMENT(S) 11


FORM 990 OTHER ASSETS STATEMENT 12

'CRIPTION AMOUNT

DUE FROM AFFILIATES - LOANS AND NOTES 35,009,853.GOODWILL ( UNAMORTIZED ) 315,433.UNAMORTIZED BOND ISSUE COSTS 6,585,068.OTHER 5,463,229.INVESTMENT IN SUBSIDIARIES AND JOINT VENTURES 34,509,308.

TOTAL TO FORM 990, PART IV, LINE 58, COLUMN B 81,882,891.

r

STATEMENT(S) 12


FORM 990 OTHER LIABILITIES STATEMENT 13

,CRIPTION AMOUNT

OTHER LIABILITIES 61,613,793.

DUE TO AFFILIATES - LOANS AND NOTES 7,441,907.

TOTAL TO FORM 990, PART IV , LINE 65 , COLUMN B 69,055,700.

r

r

STATEMENT(S) 13

C

C

ObioHealth CorporationEIN: 31-4394942

Form 990

Long-Term Obligations

Long-term debt of OhioHealth Corporation and the OhioHealth Corporation Group consists of the following:

June 30, 2004

Principal Maturities Interest June 30, 2004

Series Description Ranges Rate Outstanding Principal

(In Thousands)

2003A Variable Auction Rate Hospital From $8,075,000 on November

Facilities Revenue Bonds 15, 2031 to $22,300,000 on

November 15, 2033 1.27% $52,050

2003B-1 Variable Auction Rate Hospital From $1,550,000 on November

Facilities Refunding 15, 2021 to $10,000,000 on

Revenue Bonds November 15, 2030 1.33% $67,250

2003B-2 Variable Auction Rate Hospital From $1,600,000 on November

Facilities Refunding 15, 2021 to $9,975,000 on

Revenue Bonds November 15, 2030 1.30% $67,400

2003C-1 Fixed Rate Hospital Facilities From $960,000 on May 15,

Refunding Revenue Bonds 2010 to $4,740,000 on May

15, 2018 - 4.88% $89,475

2003C-2 Fixed Rate Hospital Facilities From $4,965,000 on May 15,

Refunding Revenue Bonds 2019 to $10,335,000 on May

15, 2030 5.05% $33,145

2003D Variable Rate Hospital From $240,000 on July 1, 2004

Facilities Refunding to $845,000 on January 1,

Revenue Bonds 2030 1.08% $27,515

1999 Hospital Revenue Facilities $2,391,000 due on December

Bonds 1, 2004 5.25% $2,391

1998A Hospital Facilities Revenue From $220,000 on December

Bonds 1, 2009 to $2,775,000 on

December 1, 2011 5.40% $5,759

1998B Variable Rate Demand Hospital From $935,000 on December

Facilities Revenue Bonds 1, 2004 to $2,765,000 on

December 1, 2028 1.08% $42,616

STATEMENT 14 PAGE 1 OF 2

Long-Term Obligations (continued)

June 30, 2004

Principal Maturities Interest June 30, 2004

Series Description Ranges Rate Outstanding Principal

(In Thousands)

1996A Variable Rate Hospital From $1 ,645,000 on December

Revenue Refunding and 1, 2004 to $3,355,000 on

Improvement Bonds December 1, 2021 1.07% $84,764

1996B Variable Rate Hospital From $600,000 on December 1,

Revenue Refunding and 2004 to $ 1,220,000 on

Improvement Bonds December 1, 2020 1 .07% $29,155

1996C Variable Rate Hospital From $970,000 on December 1,

Revenue Refunding and 2004 to $ 1,280,000 on

Improvement Bonds December 1, 2011 1.07% $ 16,915

1993A Hospital Revenue Refmding, From $2,855,000 on May 15,

Serial Bonds 2005 to $5 ,830,000 on May

15, 2007 5.56% $14,205

Other, including obligations,

collateralized by property,

equipment, and capital leases Various installments various $6,810

C Total obligations $539,450

Unamortized

premium (discount) $813

$540,263

Less current portion of debt $14,759

Long term portion of debt $525,504

NOTE: This schedule represents the long-term debt, on a combined basis, for OhioHealth Corporation and all its

subsidiaries, including those in the OhioHealth Corporation Group Return.

STATEMENT 14 PAGE 2 OF 2

OhloHeal,r/ ration f1 vBoard LISA m 990 Compensation DisclosureFor the Year ended June 30, 2004

Column D - -Contributions to Column E -

Qualified and Expense Account

Column C - Column C - At. Nonqualifled Defended and other

Name Address Title Hours/Week Compensation Risk Bonus Compensation Plans allowances

1 Anderson, Ken11 B. 1087 Dennlaon Avenue. 3rd Floor, Board Member 4 - 6 Hrs/Mor

Columbus, OH 43201

2 Banks, Lisa 1087 Dennison Avenue, 3rd Floor, Board Member 4 - 6 Hrs/Moi

Columbus, OH 43201

3 Blom. David P. 1087 Dennison Avenue, 3rd Floor, President and CEO - OhioHealth 40 HraIWdek

Columbus. OH 43201

4 Chester, John J., Esq. 1087 Dennison Avenue, 3rd Floor, Chairman of the Board - OhloHealth 12 HnslMonlt

Columbus, OH 43201

5 Clark, Thomas H., III 1087 Dennison Avenue, 3rd Floor. Chairman of the Board - Marlon General 12 HrslMontl

Columbus, OH 43201 Hospital

6 Dever, Robert E , Esq. 1087 Dennison Avenue, 3rd Floor, Chairman of the Board - Southern Ohio Medical 8 - 8 HrsIMoi

Columbus, OH 43201 Center

7 Dewlre, Rev. Dr. Norman 1087 Dennison Avenue, 3rd Floor, Board Member 4.8 Hm/Moi

Columbus, OH 43201

8 Frasier, Ralph, Esq. 1087 Dennison Avenue, 3rd Floor. Treasurer 8 - 8 HralMoi

Columbus, OH 43201

9 Gem. Rev. Cyndy 1087 Dennison Avenue, 3rd Floor, Board Member 4 - 8 Hre/Moi

Columbus, OH 4320110 Glaser. Gary A. 1087 Dennison Avenue, 3rd Floor, Board Member 4 - 8 Hrs/Moi

Columbus, OH 43201

11 Hoaglin, Thomas E. 1087 Dennison Avenue, 3rd Floor, Vice Chairman of the Board - OhloHeanh 8 - 8 Hrs/MoiColumbus, OH 43201

12 Hodges. Ralph E. 1087 Dennison Avenue, 3rd Floor. Chairman of the Board - Grady Memorial 4 - 8 Hrs/Moi

Columbus, OH 43201 Hospital

13 Humphrey, Benjamin C. M.D. 1087 Dennison Avenue, 3rd Floor. Board Member 4 - 6 Hrs/Moi

Columbus, OH 43201

14 Johnston, Peter, D.O. 1087 Dennison Avenue, 3rd Floor, Board Member 4 - 8 Hrs!Moi

Columbus, OH 43201

15 Minister, Michael E., Esq. 1087 Dennison Avenue, 3rd Floor, Board Member 4 - 8 HrslMoi

Columbus, OH 43201

16 O'BrIen, Dan 1087 Dennison Avenue, 3rd Floor, Board Member 4 - e HrslMoiColumbus, OH 43201

17 Osbom, Ron, D.D.S. 1087 Dennison Avenue, 3rd Floor, Chairman of the Board - Hardin Hospital 4 - 6 Hrs/Moi

Columbus, OH 4320118 Ough, Bishop Bruce R. 1087 Dennison Avenue, 3rd Floor, Board Member 4 - 6 Hrs/Moi

Columbus, OH 4320119 Poll, Wayne, M.D. 1087 Dennlson Avenue, 3rd Floor, Medical Staff President - Riverside Hospital 4 - 6 Hrs/Moi

Columbus, OH 43201

20 Skulty, Robert, M 0. 1087 Dennison Avenue, 3rd Floor, Medical Staff President - Grant Hospital 4 - 6 Hrs/MoiColumbus, OH 43201

21 Smlalek, Richard, D.O. 1087 Dennison Avenue, 3rd Floor, Medical Staff President - Doctors Hospital 4 - 6 Hra/MoiColumbus, OH 43201

22 Thompson, Robert L., M.D. 1087 Dennison Avenue. 3rd Floor. Board Member 4 - 6 Hrs/MoiColumbus, OH 43201

23 Zelger, John W., Esq. 1087 Dennison Avenue, 3rd Floor, Secretary 6 - 8 HrslMoiColumbus, OH 43201

Total - Board Member Compensation

Ll

Page 1 of 2

fV

NONE NONE NONE NONE

NONE NONE NONE NONE

NONE NONE NONE NONE

NONE NONE NONE NONE

NONE NONE NONE NONE

NONE NONE NONE NONE

NONE NONE NONE NONE

NONE NONE NONE NONE

NONE NONE NONE NONE

NONE NONE NONE NONE

NONE NONE NONE NONE

NONE NONE NONE NONE

NONE NONE NONE NONE

NONE NONE NONE NONE

NONE NONE NONE NONE

NONE NONE NONE NONE

NONE NONE NONE NONE

NONE NONE NONE NONE

$75,000 NONE NONE NONE

$181,507 $7,450 $16,000 NONE

NONE NONE NONE NONE

NONE NONE NONE NONE

NONE NONE NONE NONE

236,507 $7,450 $ 16,000 $0

OhioHealth Corporation

Board List and Form 990 Compensation Disclosure

For the Year Ended June 30 2004

Column C

Column C - AI-Risk

Name Address Title Hours/Week Compensat ion B onus'

Kev Employees

24 Arnetl Randal M 1087 Dennison Avenue 3rd Floor, President - SOMC 40 Hrs/Week $251,161 $123,253 $0 $138,806 $0

Columbus OH 43201

25 Bachman, Ronald J 1087 Dennison Avenue 3rd Floor. President Marron - General Hospital 40 HrsN tteek $191,369 $65,209 $0 $75 844 so

Columbus OH 43201

26 Blom David P 1087 Dennison Avenue 3rd Floor, PrestdentJCEO - OhloHealth 40 Hrs/Week $593,004 $275,520 $252,486 $487,400 $0

Columbus OH 43201

27 Evans Joan 1087 Dennison Avenue 3rd Floor. Sr VP - System Advancement 40 Hrs/Week $228,659 $80,000 $0 $12,000 $0

Columbus OH 43201

28 Falcone M D Robert E 1087 Dennison Avenue 3rd Floor, President - Grant Medical Center 40 Hrs/Week $286,654 $103,480 $0 $74,385 "' $0

Columbus OH 43201

29 Garlock, Steven J 1087 Dennison Avenue, 3rd Floor, Sr VP - System Development and Regional 40 HrsliNeek $201,517 $90,562 $0 $64 308 "' $0

Columbus, OH 43201 Operations

30 Gruber, Kreg 1087 Dennison Avenue 3rd Floor, President - Doctors OhioHeatth Corporation 40 Hrs/Week $160,077 $63,001 $0 $47 049 $0

Columbus OH 43201

31 Hagen Bruce 1087 Dennison Avenue 3rd Floor President - Riverside Methodist Hospital 40 Hrs/Week $264 736 $74,990 $0 $96 663 $0

Columbus OH 43201

32 Kaiser Joel 1087 Dennison Avenue 3rd Floor. COO - Doctors Nelsonville 40 HrsiWeek $96,630 $24,710 $o $8 419 $0

Columbus OH 43201

33 Louge Michael W 1087 Dennison Avenue 3rd Floor, CFO - OhioHealth 40 Hrs/Week $311 333 $142,473 $0 $188,656 $0

Columbus OH 43201

34 Millen Robert 1087 Dennison Avenue 3rd Floor, COO - OhroHealth 40 Hrs/Week $0 $0 $0 $0 $0

Columbus OH 43201

35 Morehead M D Charles David 1087 Dennison Avenue 3rd Floor, Sr VP & Chief Medical Officer 40 Hrs/Week $290,349 $110,291 $0 $30,000 $o

Columbus OH 43201

36 Pandora II Frank T 1087 Dennison Avenue 3rd Floor. Sr VP and General Counsel - OhloHeallh 40 Hrs/Week $279 741 $121,060 $98,866 $154,066 $0

Columbus OH 43201

37 Plousha-Moore Debra 1087 Dennison Avenue 3rd Floor Sr VP - Human Resources 40 Hrs/Week $208 828 $93,786 $0 $118,655 $0

Columbus OH 43201

38 Seckinger Mark R 1087 Dennison Avenue 3rd Floor, PresldenlfCEO - Hardin Memonal 40 Hrs/Week $139 376 $37,826 $0 $29 030 $0

Columbus OH 43201

39 Shuter Mark H (Term 8/31103) 1087 Dennison Avenue 3rd Floor, President - Grant/Riverside/Doctors Hospitals 40 Hrs/Week $373,013 $212,006 $0 $26 000 $0

Columbus OH 43201

Total - Key Employee Compensation $3 876 447 S1 , 618 , 167 $351 352 $1 , 551 , 281 $0

Grand Total $4 112,954 $1 , 625,617 $351,352 $1 , 567,281 $0

General CommentsPursuant to Reg 1 6033-2(a)(2)(h), compensation is based on 2003 calendar year W-2's

Any persons employed by OhioHealth Corporation or the rolaled entities noted above are eligible to receive any standard employee benefits

in addition to compensation and retirement plan contributions noted Since contributions to the employee welfare benefit plans are made in aggregate

based upon group actuarial factors and historical claims experience apportioning specific amounts to individuals is not readily possible

These include, but are not limited to the following non-taxable employee welfare benefits which were made available to this employed, compensated officer

1) Health insurance benefits

2) Group life insurance (portions of which are taxed)

3) Unemployment benefits

4) Disability benefits

Compensation and benefits for executives are reviewed annually by independent consultants to ensure total compensation packages are at fair-market rates

Board member compensation is for other medical and administrative services, not for board duties

' The al-risk bonus is perfornlanced based and payments are made only if certain threshold requirements in the areas of chanty care, accreditation

and financial performance are met The threshold requirements were met and bonuses were paid and calculated and based on objective criteria that include

clinical quality, patient, physician and employee satisfaction and financial items

Additional taxable compensation in column C is related to taxes due on benefits accrued under the supplemental executive retirement plan These arrangements

are an industry standard

-Certain officers have arrangements which provide for supplemental retirement benefits These arrangements are an industry standard and are unfunded and non-vested

Due to the substantial nSk of forfeiture provision there is no guarantee that these officers will ever receive these benefits

^' The above individual was paid by OHPMS EIN 31-1351965

Column C -Tax Payments

on

Supplemental

Executive

Retirement

Plan

Column D -

Contributions to

Ouallfed and

Nonqualifled

Deferred

Compensation Plans

Column E -

Expense Account

and other

allowan ces

hw 5Page 2 of 2

OhioHealth Corporation

E.I.N. 31-4394942

For the twelve months ended June 30, 2004

PART VI. LINE 80b - RELATED ORGANIZATIONS

EXEMPT AFFILIATESDoctors Health Corporation of NelsonvilleDoctors OhioHealth CorporationDoctors Private Duty Nursing CorporationFriends of Southern Ohio Medical Center, Inc.OhioHealth Practice Management ServicesOhioHealth FoundationHardin Health Foundation

Hardin Home HealthHardin Memorial Hospital

Hardin Physician FoundationHempstead ManorHomeReachHomeReach HomeCare, Inc.Hospital Properties, Inc.

Marion General Hospital, Inc.OhioHealth Systems Service Company

RMH Medical Research FoundationSouthern Ohio Medical Center

SOMC FoundationSOMC Medical Care Foundation, Inc.

SOMC Title Holding Company

NON-EXEMPT AFFILIATESDoctors Health Corporation ofTrimble TownshipHardinCare, Inc.OhioHealth Star Properties, Inc.Medic Transport, Inc.Medstart, Inc.OhioHealth Star CorporationPrime Construction Services, Inc.Prime Medical Group, Inc.Doctors Office Corporation - Refugee RoadPrimary Care of Galloway

Primary Care of Hillard

STATEMENT 16


FORM 990 PART VIII - RELATIONSHIP OF ACTIVITIES TO STATEMENT 17C ACCOMPLISHMENT OF EXEMPT PURPOSES

LINE EXPLANATION OF RELATIONSHIP OF ACTIVITIES

93& THE VARIOUS HEALTH SERVICES PROVIDED ARE THE VEHICLES BY WHICH THE103 HOSPITALS CARRY OUT THEIR EXEMPT CHARITABLE PURPOSES OF PROVIDING

HEALTH CARE TO THE COMMUNITY. SEE PART III - PROGRAM SERVICEACCOMPLISHMENTS FOR A MORE DETAILED DESCRIPTION OF ACTIVITIES WHICHCONTRIBUTE IMPORTANTLY TO THE HOSPITAL'S EXEMPT PURPOSE.

STATEMENT(S) 17

OHIOHEALTH CORPORATIONEIN: 31-4394942

FORM 990, PART IX - INFORMATION REGARDING TAXABLE SUBSIDIARIESJUNE 30, 2004 Y.E.

NAME, ADDRESS & ID NUMBER OF PERCENT END-OF-YEARCORPORATION OR PARTNERSHIP OWNERSHIP NATURE OF BUSINESS TOTAL INCOME ASSETS

OHIOHEALTH AMBULATORY CARE LTD1875 TAMARACK CIRCLE NORTHCOLUMBUS, OH 43229EIN: 31-1582622 50% HEALTH SERVICES $ 7,140,000 $ 2,118,000

OHIOHEALTH GROUP, LTD.445 HUTCHINSON AVE.COLUMBUS, OH 43223EIN: 31-1446804 50% ADMINISTRATIVE SERVICES $ 6,564,000 $ 4,191,000

OHIOHEALTH STAR CORPORATION &SUBSIDIARIES3333 CHIPPEWA STREETCOLUMBUS, OH 43204EIN: 31-1119936 100% ADMINISTRATIVE SERVICES $ 3.029,421 $ 6,604.911

CENTRAL OHIO MEDICAL TEXTILES575 HARMON AVENUECOLUMBUS, OH 43223EIN: 38-3643188 50% LAUNDRY SERVICES $ 3,592.348 $ 15,228.906

OHIO MEDICAL TRANSPORTATION, INC.(D.BA MEDFLIGHT)2827 WEST DUBLIN-GRANVILLE ROADCOLUMBUS, OH 43235

C EIN: 31 -1428613 50% CRITICAL CARE TRANSPORT $ 33,824,000 $ 14,064,000

NOTE: Total Income represents total revenues.

STATEMENT 18

OhloHeal(' orationForm 990', jute A Five Highest Paid EmployeesFor the Year znded June 30, 2004

Name Address Title

Too Five Hlahest Paid Employees1 Hindman, Michael C. 1087 Dennison Avenue, 3rd Floor,

Columbus, OH 432012 Dono, Frank V. 1087 Dennison Avenue, 3rd Floor,

Columbus, OH 432013 Gilbert, Robert J. 1087 Dennison Avenue, 3rd Floor,

Columbus, OH 432014 Schuda, Marian K 1087 Dennison Avenue, 3rd Floor,

Columbus, OH 43201

5 Montoney. Mark R. 1087 Dennison Avenue, 3rd Floor,Columbus, OH 43201

Totals

System VP - ReglClinlcal Une

VP Medical Affairs1CMO Doctors Hospital

System VP - Ambulatory Services

VP Medical Affairs Riverside Methodist Hospital

VP CtlnlcaUQuality Services

General CommentsPursuant to Reg.1.8033-2(a)(2)(h), compensation is based on 2003 calendar year W-2's.

Cotcimn D -Contributions to Column E -

Column C - At. Qualified and xpense Account

Column C - Risk Nonquallfled Deferred and other

Hours/Week Compensation Bonus • Compensation Plans allowances

40 Hr3/Week $290,313 $107,511 $30,000 $0

40 Hrs/Week $260,020 $71,000 $14,000 $0

40 Hrs/Week $210,642 $80,641 $77,901 •• $0

40 HrsMWeek $213,261 $73,592 $26,000 $0

40 HrslWeek $224,802 $58,858' $26,000 $0

$1,199,038 $391,602 $173,901 so

Any persons employed by OhioHealth Corporation or the related entities noted above are eligible to receive any standard employee benefitsIn addition to compensation and retirement plan contributions noted. Since contributions to the employee welfare benefit plans are made in aggregatebased upon group actuarial factors and historical claims experience, apportioning specific amounts to individuals Is not readily possible.These Include, but are not limited to, the following non-taxable employee welfare benefits which were made available to this employed, compensated officer.

1) Health Insurance benefits2) Group life Insurance (portions of which are taxed)3) Unemployment benefits4) Disability benefits

Compensation and benefits for executives are reviewed annually by Independent consultants to ensure total compensation packages are at fair-market rates:

The at-risk bonus Is performanced based and payments are made only If certain threshold requirements In the areas of charity care, accreditationand financial performance are met The threshold requirements were met and bonuses were paid and calculated and based on objective criteria that Includeclinical quality, patient, physician and employee satisfaction and financial Items.

Certain officers have arrangements which provide for supplemental retirement benefits. These arrangements are an Industry standard and are unfunded and non-vested.Due to the substantial risk of forfeiture provision, there Is no guarantee that these officers will ever receive these benefits.

Page 1 of 1

( OhioHealth Corporationl EIN: 31-4394942

Statement for 990, Schedule A

All transactions identified herein are subject to OhioHealth's conflict of interest policy,

including disclosure and appropriate review. Directors, officers, key employees or

related persons do not participate in decisions regarding such transactions and are absent

from the room when decisions are made. Directors, officers, key employee or related

persons may have availed themselves of health or medical services from OhioHealth or

one of its related entities during this reporting period. All services are provided to

OhioHealth at market rates.

Robert Dever, Esq., Director of OhioHealth Corporation and of Southern Ohio Medical

Center, performs legal services for Southern Ohio Medical Center.

Ralph K. Frasier, Esq., Director of OhioHealth Corporation and Chair of the Finance and

Audit Committee, is Of Counsel to a law firm that provides legal services to OhioHealth.

Mr. Frasier does not personally provide services to OhioHealth.

Thomas E. Hoaglin, Director of OhioHealth Corporation, is Chief Executive Officer and

shareholder of Huntington Bancshares, Inc. OhioHealth has banking relationship with

the Huntington. Mr. Hoaglin does not personally provide services to OhioHealth.

Michael E. Minister, Esq., Director of OhioHealth Corporation, is a partner in a law firm

which provides legal services upon request for OhioHealth and certain subsidiaries. Mr.Minister does not personally provide services to OhioHealth.

Dan O'Brien, Director of OhioHealth Corporation and member of the Finance and AuditCommittee of OhioHealth, has an ownership interest in the Heritage Golf Club of

Hilliard, Ohio. Several OhioHealth-related persons have a group membership atHeritage. Additionally, Mr. O'Brien's brother owns KPRS O'Brien Construction, aconstruction company which occasionally does business from OhioHealth.

John Zeiger, Esq., Director and Secretary of the Board of OhioHealth Corporation,performed legal services for OhioHealth.

STATEMENT 20


SCHEDULE A STATEMENT OF LOBBYING ACTIVITIES - PART VI-B STATEMENT 21

C 'fIOHEALTH CORPORATION PAYS DUES TO OHIO HOSPITAL ASSOCIATION AND AMERICAN

HOSPITAL ASSOCIATION. FOR 2003, THE PERCENTAGES OF DUES RELATED TO LOBBYING

ACTIVITIES WERE 146% FOR OHIO HOSPITAL ASSOCIATION AND 24.19% FOR AMERICAN

HOSPITAL ASSOCIATIONOHIOHEALTH CORPORATION PAID CAPITOL ADVOCATES, A REGISTERED

LOBBYING FIRM, FOR SERVICES RELATED TO LOBBYING ACTIVITIES RELEVANT TO

HEALTH CARE ORGANIZATIONS.

STATEMENT(S) 21

Form 8868 App?' Mon for Extension of Time I File anX2000) Exempt Organization Return OMB No. 1545-1709D tn,a of ubtn utyu, snvice ► File a separate application for each return.

• If you are fang for an Automatic 3-Month Extension, complete only Part I and check this box ........................................................

• If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part II (on page 2 of this form).Note: Do not complete Part 11 unless you have already been granted an automatic 3-month extension on a previously filed Form 8868.

Automatic 3-Month Extension of Time - Only submit original (no copies needed)

Note: Form 9904 corporations requesting an automatic 6-month extension - check this box and conV*te Part I only ........................... q

All other corporations (inciuding Form 990-C filers) must use Form 7004 to request an extension of time to hie hcome taxreturns. Partnerships, REMICs and trusts must use Form 8736 to request an extension of time to file Form 1065,1066, or 1041.

Type or Name of Exempt Organization Employer Identification number

print

OHIOHEALTH CORPORATION 31-43949420,, db, 1, Number, street , and room or suite no. If a P.O. box, see instructions.fro 1087 DENNISON AVENUE 3RD FL00Rnum see

W*wdsxm City, town or post office, state, and ZIP code. For a foreign address, see instructions.COLUMBUS OH 43201

Check type of return to be filed (fie a separate application for each retuno:

Form 990 q Form 990-T (corporation) q Form 4720

q Form 990-BL q Form 990-T (sec. 401 (a) or 408(e) trust) q Form 5227

q Form 990-EZ q Form 990-T (trust other than above) q Form 6069

q Form 9WF q Form 1041 ,A q Form 6870

• If the organization does not have an office or place of business in the United States, check this box ..................................................Y q

• K this is fora Group Return, enter the organization's four digit Group Exemption Number (Ga4 . If this is for the whole group, check this

box ► q . It It Is for part of the group, check this box ► [] and attach a list with the names and EINs of at members the extension will cover.

I I request an automatic 3 mcnth P-month, foc 990-T corporation ) extension of time unto FEBRUARY 15, 2 0 0 5 .

to file the exempt organization return for the organization named above. The extension Is for the organization's return for.► q calendar year or

►® tax year beginning JUL 1, 2003 , and ending JUN 3 0 , 2 0 0 4

2 If this tax year Is for less than 12 months, check reason: q Initial return 0 irnal return q Change In accounting period

3a If this application b for Form 990-BI, 990-PF. 990-T, 4720, or 6069 , enter the tentative tax, less anynonrefundable credits. See instructions ...............................................................................................................

b if this application Is for Form 990-PF or 990•T, enter any refundable credits and estimated

tax payments made. Include any Pry Year overpayment allowed as a credit ...................

c Balance Due. Subtract line 3b from line 3a. Include your payment with this form, or, If required, deposit with FTDcoupon or, if required, by using EFTPS (Bectronie Federal Tax Payment System). See instructions ........................ . N/A

Signature and Verification

Under penal ies of pe4u I declare that I have examined this form, including accompanying schedules and statements , and to the best of my knowledge and belief,it Is true , coned, and k in 1ete,.aAthat 1 am aythortzed to prel4re this form.

Signature - ( '1-A A/y[î"u4*Y1'1VV Title 1

WA For Paperwork Reduction Act Notice, see Instruction

cPA-

Up

2W EW PM ShmCindnnatl , Ohio 45202.5190

IillForm 8868 (12-2000)

1os-0,-

Form 8868 ( 12-2000) Page 2

• it you are tdtiSg for an Additional (not automatic) 3-Month Extension, complete only Part 11 and check this box .............................1~

Note: Only complete Part 11 if you have already been granted on automatic 3-month extension on a previously filed Form 8868-0 If you are fang for an Automatic 3-Month Extension , complete only Part t (on page 1 ) .

€ Additional (not automatic 3-Month Extension of Time - Must file Original and One COPY,r .v

Type orName of Exempt Organ

iEmployer identification number

print OHEALTH CORPORATION 31-4394942

Number, street , and room or suite no . It a P.O. box. see Instructions . For IRS use only1087 DENNISON AVENUE 3RD FLOORrayab

see City, town or post office, state , and ZIP code. For a foreign address, see instructions.OLUMBUS , OH 43201 .

Check We of return to be filed ( 11e a separate application for each return):

[X] Forrn 990 D Form 990fZ O Fonn 990-T (sec. 401(ai) or 408(a) trust) O Form 1041-1 D Form 5227 O Form 8870

[3 Form 99GBL 0 Form 990 PF [] Form 990-T (mst other than above) C] Form 4720 C] Form 6069

STOP: Do not complete Part 11 if you were not already granted an automatic 3-month extension on a previously filed Form 8868.

• It the organization does not have an office or place of business In the United States, check this box ........................ _... ..T 0..................• It this Is for a Group Return, enter the organization's four digit Group Exemption Number{GQ'q .If this is for the whole group. check t is

box r 0. If It is for part of the group, ehectc this box►0 and attach a ist wtth Me names and E1Ns of all members the extension is for.

4 1 request an additional 3-month extension of time until MAY 116-t 2005

6 For calendar year . or other tax year beginning JUL 1 , 2003 and ending JUN 30, 2004'.6 If this tax year Is for less than 12 months, check reason: Initial return Rnal return U crange in accounting Paw7 State in detall why you need the extension

THE INFORMATION NECESSARY TO FILE A COMPLETE AND ACCURATE RETURN IS NOTYET AVAILABLE.

&a . It this application is for Form 990-BL. 99"F, 990-T, 4720, or 6069, enter the tentative tax, less any';bnrefundable credits. See hstructions ................................... •_ ............... _....... _............... ......................... .....

b It this application is for Form 990-PF, 990-T, 4720, or 6069, enter any refundable credits and estrnatedtax payments made. Include any prior year overpayment allowed as a credd and any amount paidpreviously with Form 8868 .................... _........................................................... .............................................. $

C Balance Due. Subtract line 8b from line 8a. Include your payment with this form, or, K required, deposit with ADcoupon or, if required, by using EFTPS (Electronic Federal Tax Payment System). See Instructions ............ _.......... $ N/A

Signature and VerificationUnder pedallies of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my bowiedge and belief,ii is tnie, correct, a e, and th I am authorized to prepare this form.

S natureTide - CPA- Date ` 2-/'V05-

Notice to Applicant - To *Be Completed by the IRS

12/we have approved this application . Please attach this form to the organization 's return.

OWe have not approved this application . However, we have granted a 10-day grace period from the later of the date shdwn below or the due

date of the organization's return (including any prior extensions). This grace period Is considered to be a valid extension of time for elections

otherwise required to be made on a timely return . Please attach this form to the organization 's return. .

ED We have not approved this application . After considering the reasons stated in Item 7, we cannot grant your request for an extension of tine to

file. We are not granting the 10day grace period.

OWe cannot consider this application because It was filed after the due date of the return for which an extension was ^tION APPROVEDDo

FEB 2 8 2005BY.-

Director WAWEISKOPF r:rFi n nM=p,

Alternate Mailing Address - Enter the address If you want the copy of this application for an additional 3-month extensi^ 8 MOGDENdifferent than the one entered above.

NameTE TAX LLP A'

Type Number and street (include suite, room , or apt . no.) Or a P .O. box numberorprint 250 EAST FIFTH STREET,. SUITE 1900

City or town, province or state , and country (including postal or ZIP code)CINCINNATI, OH 45 202

Form 8868 (12-2000)

Documents

Return ofOrganization ExemptFromIncomeTax 0MBNo.IUS-00990s.foundationcenter.org/990_pdf_archive/314/314394942/314394… · Return ofOrganization ExemptFromIncomeTax 0MBNo.IUS-00 form