Bellville Medical Center: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- Bellville Medical Center (EIN 27-4005511)
- Tax period
- 2020-07-01 to 2021-06-30
- Filed
- 2022-05-16
- IRS object ID
- 202241369349317214
- Schema version
- 2020v4.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-05-16T19:30:10-05:00 | ReturnTs |
| Tax Period End | 2021-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14241 DALLAS PARKWAY SUITE 1100 | AddressLine1Txt |
| City | DALLAS | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 75254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 274005511 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Bellville Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % CRAIG MORLEY | InCareOfNm |
| Business Name Control | BELL | BusinessNameControlTxt |
| Phone | 9794137400 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 44 North Cummings | AddressLine1Txt |
| City | Bellville | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 77418 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Craig Morley | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 9797763777 | PhoneNum |
| Signature | 2022-05-16 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Craig | PersonFirstNm |
| Person Last | Morley | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Jeanette Verrelli | PreparerPersonNm |
| PTIN | P00742631 | PTIN |
| Phone | 9727028262 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Daniel Bonk | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 44 North Cummings | AddressLine1Txt |
| City | Bellville | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 77418 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $16,407,520 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.bellvillemc.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2010 | FormationYr |
| Legal Domicile State | TX | LegalDomicileStateCd |
| Activity Or Mission | BELLVILLE MEDICAL CENTER'S ("BMC") PRIMARY PURPOSE IS TO SUPPORT THE RESIDENTS OF AUSTIN COUNTY, TEXAS WITH QUALITY HEALTHCARE. BMC IS THE ONLY HOSPITAL IN THE COUNTY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 149 | TotalEmployeeCnt |
| Total Volunteers | 4 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,622,043 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,344,874 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $10,471,094 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $13,881,039 | CYProgramServiceRevenueAmt |
| PY Investment Income | $13,554 | PYInvestmentIncomeAmt |
| CY Investment Income | $5,502 | CYInvestmentIncomeAmt |
| PY Other Revenue | $200 | PYOtherRevenueAmt |
| CY Other Revenue | $176,105 | CYOtherRevenueAmt |
| PY Total Revenue | $12,106,891 | PYTotalRevenueAmt |
| CY Total Revenue | $16,407,520 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $5,403,973 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,505,935 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,297,235 | PYOtherExpensesAmt |
| CY Other Expenses | $10,696,125 | CYOtherExpensesAmt |
| PY Total Expenses | $12,701,208 | PYTotalExpensesAmt |
| CY Total Expenses | $19,202,060 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$594,317 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,794,540 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $6,716,694 | TotalAssetsBOYAmt |
| Total Assets EOY | $4,955,264 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,372,665 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,775,964 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $344,029 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$1,820,700 | NetAssetsOrFundBalancesEOYAmt |
| Mission | BMC'S MISSION IS TO PROVIDE QUALITY HEALTHCARE TO THE RESIDENTS OF AUSTIN COUNTY, TEXAS AND THE SURROUNDING COMMUNITIES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $15,991,250 | ExpenseAmt |
| Revenue | $14,038,195 | RevenueAmt |
| Desc | BMC OFFERS CONVENIENT, CLOSE-TO-HOME IN-PATIENT CARE AND OUT-PATIENT SERVICES, OUTPATIENT SURGICAL SERVICES AND COMPLETE IMAGING AND LABORATORY SERVICES. THE HOSPITAL ALSO OFFERS SKILLED NURSING CARE, OBSERVATION BEDS, SWING BEDS, AND PHYSICAL THERAPY, OCCUPATIONAL AND SPEECH THERAPY. THE PHYSICIAN-STAFFED EMERGENCY DEPARTMENT IS A LEVEL IV TRAUMA CENTER AND A LEVEL II STROKE CENTER. | Desc |
| Total Program Service Expenses | $15,991,250 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 57 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 149 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CRAIG MORLEY | PersonNm |
| Phone | 9794137400 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 44 NORTH CUMMINGS | AddressLine1Txt |
| City | BELLVILLE | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 77418 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Key EmployeeKeyEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|---|
| DON BOSSE MD | |||||||||
| PHYSICIAN | 40.0 | 0.0 | Yes (X) | $276,371 | $0 | $14,070 | |||
| SHAWN JOHNSON MD | |||||||||
| PHYSICIAN | 40.0 | 0.0 | $109,039 | $0 | $7,967 | Yes (X) | |||
| CRAIG MORLEY | |||||||||
| CFO | 24.0 | 0.0 | $82,225 | $0 | $13,052 | Yes (X) | |||
| NANCY DORNON | |||||||||
| VICE-CHAIR | 20.0 | 0.0 | $25,367 | $0 | $9,498 | Yes (X) | Yes (X) | ||
| TONY CAUSEY | |||||||||
| CHAIR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| MIKE KOEHN | |||||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |||
| BRYAN MAEDGEN | |||||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |||
| JILL BRANDT | |||||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |||
| GLENN LANGE | |||||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |||
| CINDY BRYANT | |||||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |||
| MERLENE BYLER | |||||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |||
| PAUL JONES | |||||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |||
| TAUNIA ELICK | |||||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |||
| ROY SMITH | |||||||||
| SECRETARY/TREASURER | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| DANIEL BONK | |||||||||
| CEO | 40.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $493,002 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $44,587 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CONCORD MEDICAL GROUP OF TEXAS PLLC | |||||
| 2800 CORPORATE DR 103 | FLOWER MOUND | TX | 75028 | emergency services | $1,034,570 |
| ERH SHARED SERVICES LLC | |||||
| 185 SOUTH STATE STREET SUITE 1300 | SALT LAKE CITY | UT | 84111 | MGMT SERVICES | $503,589 |
| CLINICAL PATHOLOGY LABORATORIES | |||||
| 9200 WALL STREET | AUSTIN | TX | 78754 | LAB SERVICES | $170,188 |
| HUNTER PHARMACY | |||||
| 3420 EXECUTIVE CENTER DRIVE SUITE | AUSTIN | TX | 78731 | PHARMACY SERVICES | $145,206 |
| Roshal Imaging Services inc | |||||
| 440 Cobia Dr Ste 1302 | KATY | TX | 77494 | imaging svcs | $208,160 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $1,200,000 | RelatedOrganizationsAmt |
| Government Grants | $1,141,500 | GovernmentGrantsAmt |
| All Other Contributions | $3,374 | AllOtherContributionsAmt |
| Total Contributions | $2,344,874 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 622110 | $13,724,606 | $13,724,606 |
| MEDICAL OFFICE RENT REVENUE | 531190 | $135,342 | $135,342 |
| OTHER OPERATING REVENUE | 622110 | $21,091 | $21,091 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $13,881,039 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,502 | TotalRevenueColumnAmt |
| Exclusion | $5,502 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| CAFETERIA REVENUE | 722514 | $18,949 | $18,949 | |
| MEDICAL RECORDS REVENUE | 561000 | $10,931 | $10,931 | |
| MISCELLANEOUS INCOME | 900099 | $146,225 | $146,225 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $176,105 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $16,407,520 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,038,195 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $24,451 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $420,583 | TotalAmt |
| Program Services | $332,176 | ProgramServicesAmt |
| Management And General | $88,407 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,729,798 | TotalAmt |
| Program Services | $5,315,050 | ProgramServicesAmt |
| Management And General | $1,414,748 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35 | TotalAmt |
| Program Services | $28 | ProgramServicesAmt |
| Management And General | $7 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $807,338 | TotalAmt |
| Program Services | $637,619 | ProgramServicesAmt |
| Management And General | $169,719 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $548,181 | TotalAmt |
| Program Services | $432,942 | ProgramServicesAmt |
| Management And General | $115,239 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $605,555 | TotalAmt |
| Program Services | $478,255 | ProgramServicesAmt |
| Management And General | $127,300 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,040 | TotalAmt |
| Management And General | $7,040 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $77,861 | TotalAmt |
| Management And General | $77,861 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,239,377 | TotalAmt |
| Program Services | $2,619,888 | ProgramServicesAmt |
| Management And General | $619,489 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,335 | TotalAmt |
| Program Services | $36,970 | ProgramServicesAmt |
| Management And General | $365 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $102,002 | TotalAmt |
| Program Services | $80,559 | ProgramServicesAmt |
| Management And General | $21,443 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,471,674 | TotalAmt |
| Program Services | $1,162,298 | ProgramServicesAmt |
| Management And General | $309,376 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,688 | TotalAmt |
| Program Services | $9,231 | ProgramServicesAmt |
| Management And General | $2,457 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,238 | TotalAmt |
| Program Services | $978 | ProgramServicesAmt |
| Management And General | $260 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,646 | TotalAmt |
| Program Services | $1,300 | ProgramServicesAmt |
| Management And General | $346 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $259,792 | TotalAmt |
| Program Services | $205,178 | ProgramServicesAmt |
| Management And General | $54,614 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $157,893 | TotalAmt |
| Program Services | $124,701 | ProgramServicesAmt |
| Management And General | $33,192 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT EXPENSE | $2,262,794 | $2,262,794 | |
| MEDICAL SUPPLIES | $1,656,563 | $1,656,563 | |
| EQUIP REPAIRS & MAINTENANCE | $596,968 | $471,473 | $125,495 |
| DUES & SUBSCRIPTIONS | $39,524 | $31,215 | $8,309 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $167,175 | TotalAmt |
| Program Services | $132,032 | ProgramServicesAmt |
| Management And General | $35,143 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,202,060 | TotalAmt |
| Program Services | $15,991,250 | ProgramServicesAmt |
| Management And General | $3,210,810 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,016,035 | BOYAmt |
| EOY | $40,343 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $400,350 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $962,749 | BOYAmt |
| EOY | $2,224,402 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $249,045 | BOYAmt |
| EOY | $158,242 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,782 | BOYAmt |
| EOY | $169,444 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $2,826,746 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $978,230 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,371,691 | BOYAmt |
| EOY | $1,848,516 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $69,392 | BOYAmt |
| EOY | $113,967 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,716,694 | BOYAmt |
| EOY | $4,955,264 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $868,869 | BOYAmt |
| EOY | $1,571,751 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $3,521,267 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,503,796 | BOYAmt |
| EOY | $1,682,946 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,372,665 | BOYAmt |
| EOY | $6,775,964 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $344,029 | BOYAmt |
| EOY | -$1,820,700 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $344,029 | BOYAmt |
| EOY | -$1,820,700 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,716,694 | BOYAmt |
| EOY | $4,955,264 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$2,794,540 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | $629,811 | PriorPeriodAdjustmentsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | false | FSAuditedInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $2,995 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $2,995 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1I | FormAndLineReferenceDesc |
| Explanation | OTHER ACTIVITIES: BELLVILLE MEDICAL CENTER PAYS DUES TO TORCH. 10% OF THESE DUES ARE RELATED TO LOBBYING EXPENSES. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp | |
| Land | LandGrp | |
| Buildings | BuildingsGrp |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,000 | OtherCostOrOtherBasisAmt |
| Depreciation | $256 | DepreciationAmt |
| Book Value | $9,744 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,738,565 | OtherCostOrOtherBasisAmt |
| Depreciation | $977,974 | DepreciationAmt |
| Book Value | $1,760,591 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $78,181 | OtherCostOrOtherBasisAmt |
| Book Value | $78,181 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,848,516 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| CAPITAL LEASE OBLIGATION | $72,461 |
| ESTIMATED AMOUNTS DUE TO 3RD-PARTY | $1,610,485 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,682,946 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PART X, LINE 2 | FormAndLineReferenceDesc |
| Explanation | ASC 740 FOOTNOTE: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 300. | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 500. | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,079,720 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,079,720 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06370 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,191,899 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $871,073 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $320,826 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01890 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,893 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,898 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $9,995 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,290,512 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $879,971 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,410,541 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08320 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $31,041 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $31,041 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $31,041 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $31,041 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,321,553 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $879,971 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,441,582 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08500 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,262,794 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $923,220 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $2,696,310 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,049,305 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$352,995 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | false | WrittenDebtCollectionPolicyInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELLVILLE MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 44 NORTH CUMMINGS | AddressLine1Txt |
| City | BELLVILLE | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 77418 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.BELLVILLEMC.ORG | WebsiteAddressTxt |
| State License | 100120 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELLVILLE MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | SEE PART V, SECTION C | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION C | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 300. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 500. | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | See Part V, Section C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | See Part V, Section C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART V, SECTION B, LINE 5 | PERSONS FROM THE COMMUNITY: THE CHNA REPORT INCORPORATES DATA FROM THREE SOURCES: -EXISTING DATA FROM PUBLIC SOURCES -QUALITATIVE DATA FROM COMMUNITY DISCUSSION GROUPS IN THE BRAZOS VALLEY REGION -RANDOMLY SAMPLE HOUSEHOLD AND PURPOSIVE SAMPLED CLINIC BASED SURVEYS. THE EXISTING DATA COMPRISED OF DATA FROM LOCAL STATE AND FEDERAL SOURCES, INCLUDING THE TEXAS DEPARTMENT OF STATE HEALTH SERVICES, THE US CENSUS BUREAU, THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM SURVEY FROM THE CENTER FOR DISEASE CONTROL AND PREVENTION, THE TEXAS WORKFORCE COMMISSION, THE KAISER FAMILY FOUNDATION, THE TEXAS DEPARTMENT OF PUBLIC SAFETY, THE EPISCOPAL HEALTH FOUNDATION, AND THE COUNTY HEALTH RANKINS PROJECT AT THE UNIVERSITY OF WISCONSIN. COMMUNITY DISCUSSION GROUPS WERE ORGANIZED WITH ASSISTANCE FROM LOCAL COMMUNITY CONTACTS. INCLUDED IN THE GROUPS WERE CLINICAL AND OTHER MEDICAL/HEALTH/HUMAN SERVICE PROVIDERS, COMMUNITY LEADERS, AND GENERAL CONSUMERS OF HEALTH AND HEALTH-RELATED CARE. A MAJORITY OF THE HOUSEHOLD SURVEYS WERE CONDUCTED THROUGH A RANDOM SAMPLE OF ADULT RESIDENTS WITH MOBILE OR LANDLINE TELEPHONES BILLED TO A RESIDENCE IN THE GREATER BRAZOS VALLEY REGION. THE IDENTIFIED RESIDENTS WERE MAILED A SURVEY AND WERE INVITED TO ANONYMOUSLY RESPOND ONLINE OR VIA A TOLL-FREE CALL. THOSE THAT DID NOT RESPOND WERE CALLED TO SEE IF THEY WOULD LIKE TO PARTICIPATE IN THE SURVEY. ADDITIONAL RESIDENTS IN THE BRAZOS VALLEY REGION WERE INCLUDED BY SURVEYING PATIENTS IN WAITING ROOMS OF LOCAL HEALTH-RELATED ORGANIZATIONS THAT SERVE A LOW SOCIOECONOMIC STATUS AND/OR MINORITY POPULATION. |
| SCHEDULE H, PART V, SECTION B, LINE 6A & 6B | OTHER HOSPITAL FACILITIES & OTHER ORGANIZATIONS: BMC WAS AFFILIATED WITH ST JOSEPH REGIONAL HEALTH SYSTEM ("SJRHS") PART OF CATHOLIC HEALTH INITIATIVES ("CHI") FROM 07/01/18 TO 05/06/19 IN THE TAX YEAR ENDING 06/30/19. THE BRAZOS VALLEY REGION HEALTH ASSESSMENT (CHNA REPORT) DOES NOT SPECIFICALLY NAME THE HOSPITALS OR OTHER HEALTHCARE FACILITIES. HOWEVER, THE CHNA REPORT DOES SPECIFY THE COUNTIES INCLUDED IN THE CHNA REPORT - AUSTIN, BRAZOS, BURLESON, GRIMES, LEON, MADISON, ROBERTSON, AND WASHINGTON COUNTIES OF THE STATE OF TEXAS. BELLVILLE IS IN AUSTIN COUNTY. AUSTIN COUNTY IS SPECIFICALLY INCLUDED AS PART OF THE SERVICE DELIVERY AREA OF ORGANIZATIONS REPRESENTED BY THE BRAZOS VALLEY HEALTH COALITION, WHICH INCLUDES SJRHS. SJRHS INCLUDES HOSPITALS IN THE OTHER COUNTIES OF THE BRAZOS VALLEY. SJRHS INCLUDES NON-HOSPITAL HEALTHCARE FACILITIES IN THE BRAZOS VALLEY. THE CHNA REPORT INCLUDES THESE FACILITIES. |
| SCHEDULE H, PART V, SECTION B, LINE 7B & 10A | COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN: https://www.bellvillemc.org/wp-content/uploads/2022/02/Bellville-Medical-C enter-CHNA-2021.docx.pdf HTTPS://STJOSEPH.STLUKESHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFIT |
| SCHEDULE H, PART V, SECTION B, LINE 11 | NEEDS ADDRESSED AND NOT ADDRESSED: SJRHS TRANSFERRED ITS INTEREST IN BMC TO BELLVILLE HOSPITAL DISTRICT "BHD" ON MAY 7, 2019. BMC WAS INCLUDED IN THE BRAZOS VALLEY CHNA REPORT CONDUCTED IN THE 2018 TAX YEAR. THE TOP ISSUES IDENTIFIED BY AUSTIN COUNTY RESIDENTS (THE AREA BMC SERVES) INCLUDED BEING A mEDICALLY UNDERSERVED AREA, LACK OF TRANSPORTATION, LIMITED MENTAL HEALTH SERVICES, AND LACK OF RESOURCES FOR YOUTH AND SENIORS. THROUGH THE BHD, BMC HAS EXPANDED ITS SERVICES TO ITS COMMUNITY TO INCLUDE A CERTIFIED LEVEL IV TRAUMA AND CERTIFIED LEVEL II STROKE ER AND AVAILABLE AIR AMBULANCE. BMC HAS EXPANDED ON THE NUMBER OF SPECIALISTS, INCLUDING GENERAL SURGERY, ONCOLOGY, CARDIOLOGY, PODIATRY, OPTHALMOLOGY, OB/GYN, UROLOGY, ENT, AND PAIN MANAGEMENT. PRIMARY CARE PROVIDERS INCLUDE INTERNAL AND FAMILY MEDICINE AND PEDIATRICS. ITS THERAPY DEPARTMENT PROVIDES INPATIENT AND OUTPATIENT CARE. BMC CONTINUES TO ASSESS ITS COMMUNITY NEEDS AND TAKE STEPS TO MEET THOSE NEEDS. |
| SCHEDULE H, PART V, SECTION B, LINE 16A & 16B | Availability of Financial assistance documents: The FAP and Application can be found at the following address: https://www.bellvillemc.org/about/hospital-information/ |
| SCHEDULE H, PART V, SECTION B | 501R COMPLIANCE: WHEN THE HOSPITAL WAS AFFILIATED WITH ST JOSEPH REGIONAL HEALTH SYSTEM, IT FOLLOWED THE FINANCIAL ASSISTANCE POLICY OF THE CATHOLIC HEALTH INITIATIVES. UPON SEPARATING FROM THE AFFILIATED SYSTEM MAY 2019, THE HOSPITAL NEEDED TO CREATE ITS OWN FINANCIAL ASSISTANCE POLICY. As of the 2021 fiscal year, THE HOSPITAL is still improving A FEW AREAS WITHIN THE FINANCIAL ASSISTANCE DOCUMENTS WHERE IT IS NOT YET FULLY COMPLIANT WITH FINAL 501R REGULATIONS. THE POLICY NEEDS TO HAVE BILLING AND COLLECTIONS LANGUAGE ADDED, AS WELL AS EXTRAORDINARY COLLECTION ACTIONS POLICIES. THE POLICY ALSO NEEDS LANGUAGE DESCRIBING THE TIME PERIOD TO APPLY AND THE PROVIDERS COVERED UNDER THE POLICY. WHEN THE POLICY HAS BEEN UPDATED, IT ALONG WITH THE PLAIN LANGUAGE SUMMARY AND APPLICATION WILL BE LOADED ONTO THE HOSPITAL'S WEBSITE. MANAGEMENT IS WORKING DILIGENTLY TO MAINTAIN COMPLIANCE AND WILL CORRECT ANY ADDITIONAL FAILURES TO COMPLY AS THEY ARE IDENTIFIED. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TRI-COUNTY ER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1036 NORTH CIRCLE DRIVE STE 102 | AddressLine1Txt |
| City | SEALY | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 77474 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | ER CLINIC | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 7, COLUMN F | PERCENT OF TOTAL EXPENSE: BAD DEBT EXPENSE OF $2,262,794 WAS INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT WAS SUBTRACTED FROM TOTAL EXPENSE FOR THE CALCULATION OF PERCENT OF TOTAL EXPENSE IN THIS COLUMN. |
| SCHEDULE H, PART I, LINE 7 | COSTING METHODOLOGY FOR COMMUNITY BENEFIT COSTS: THE AMOUNTS REPORTED ON THE TABLE ON PART I, LINE 7 WERE CALCULATED USING THE COST-TO-CHARGE RATIO DERIVED FROM COMPLETING WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES FROM THE IRS INSTRUCTIONS. |
| SCHEDULE H, PART I, LINE 3C | FACTORS OTHER THAN FPG DETERMINING FREE OR DISCOUNTED CARE: HOSPITAL USES THE FOLLOWING CRITERIA TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE: -ASSET LEVEL -MEDICAL INDIGENCY -INSURANCE STATUS -UNDERINSURANCE STATUS |
| SCHEDULE H, PART III, SECTION A, LINE 3 | BAD DEBT EXPENSE: THE AMOUNT REPORTED IS BASED ON THE BAD DEBT PER THE ORGANIZATION'S INCOME STATEMENT |
| SCHEDULE H, PART III, SECTION A, LINE 3 | BAD DEBT ATTRIBUTABLE TO PATIENTS UNDER FINANCIAL ASSISTANCE POLICY: THE ORGANIZATION HAS ESTIMATED THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE CHARITY CARE POLICY USING THE COST TO CHARGE RATIO METHODOLOGY. BAD DEBT EXPENSE SHOULD BE CONSIDERED COMMUNITY BENEFIT BECAUSE THIS IS UNCOMPENSATED HEALTHCARE PROVIDED TO RESIDENTS OF THE COMMUNITY. |
| SCHEDULE H, PART III, SECTION A, LINE 4 | BAD DEBT FOOTNOTE: THE DISTRICT REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS, AND OTHERS. THE DISTRICT PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. |
| SCHEDULE H, PART III, SECTION B, LINE 8 | COSTING METHODOLOGY: THE ORGANIZATION HAD A MEDICARE SHORTFALL IN THE AMOUNT OF $352,995. THE STATE OF TEXAS TREATS MEDICARE SHORTFALL AS COMMUNITY BENEFIT FOR MEETING STATUTORY REQUIREMENTS FOR CHARITY CARE AND COMMUNITY BENEFIT. THE MEDICAL CENTER USES COST REPORT METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS BASED ON MEDICAID OR MEDICARE DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. |
| SCHEDULE H, PART VI, LINE 2 | NEEDS ASSESSMENT: THE COMMUNITY'S NEEDS INFORMATION IS GARNERED FROM PATIENT SATISFACTION SURVEYS, EMPLOYEES, AND PHYSICIANS IN ADDITION TO THE CHNA CONDUCTED EVERY THREE YEARS. |
| SCHEDULE H, PART VI, LINE 3 | PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: CURRENT PRACTICE AT BMC IS THAT IF A PATIENT ASKS ABOUT FAP, WE SHARE ALL OF OUR INFORMATION. WE DO NOT PRESENTLY PROACTIVELY INFORM A PATIENT ABOUT OUR FAP. IF A PATIENT INQUIRES, WE GLADLY SHARE THE INFORMATION WITH THE PATIENT. AS THE HOSPITAL UPDATES THE FINANCIAL ASSISTANCE POLICY, PROCEDURES WILL BE PUT IN PLACE TO EDUCATE ALL PATIENTS OF FINANCIAL ASSISTANCE OPPORTUNITIES. |
| SCHEDULE H, PART VI, LINE 4 | COMMUNITY INFORMATION: BELLVILLE IS A CITY IN THE U.S. STATE OF TEXAS AND THE SEAT OF AUSTIN COUNTY. THE CITY'S POPULATION WAS 4,097 AT THE 2010 CENSUS. IT SITS IN A RURAL SETTING ABOUT HALF-WAY BETWEEN HOUSTON AND AUSTIN TEXAS, IN BETWEEN STATE HIGHWAY 290 AND INTERSTATE 90. AUSTIN COUNTY HAS A POPULATION OF APPROX. 30,000. THE RACIAL MAKEUP OF THE COUNTY IS 80.22% WHITE, 10.64% AFRICAN AMERICAN, 0.28% NATIVE AMERICAN, 0.29% ASIAN, 6.99% FROM OTHER RACES, AND 1.58% FROM TWO OR MORE RACES. ABOUT 16.13% OF THE POPULATION WAS HISPANIC OR LATINO OF ANY RACE. THE MEDIAN INCOME FOR A HOUSEHOLD IN THE COUNTY WAS $38,615, AND FOR A FAMILY WAS $46,342. THE NEAREST HOSPITALS ARE IN BRENHAM (18 MILES NORTHWEST) AND KATY (33 MILES SOUTHEAST). OVER 50% OF PATIENTS SERVED ARE COVERED BY MEDICARE, WITH 25% WITH COMMERCIAL, 12% SELF-PAY AND 13% MEDICAID. THE COUNTY HAS 4 ACTIVE PRIMARY CARE PHYSICIANS WITH APPROX. 5 MIDLEVEL PROVIDERS. THE HOSPITAL IS SUPPORTED BY A LOCAL TAX DISTRICT. MOST SPECIALTY BASED MEDICAL PROVIDERS ARE BASED OUTSIDE OF THE COUNTY AND ASSOCIATED WITH OTHER HOSPITALS. A FEW SPECIALISTS ROTATE THROUGH ON A WEEKLY BASIS AT THE HOSPITAL. POPULATION HAS BEEN RELATIVELY STABLE UNTIL RECENTLY THERE HAVE BEEN A NUMBER OF NEW HOUSING STARTS (SEALY - 1000 AND BELLVILLE - 400). SOME NEW INDUSTRY AND ECONOMIC GROWTH HAS ALSO RECENTLY BEEN ADDED IN SEALY. |
| SCHEDULE H, PART VI, LINE 5 | PROMOTION OF COMMUNITY HEALTH: THE ORGANIZATION'S HOSPITAL FACILITIES PROMOTE HEALTH FOR THE BENEFIT OF THE COMMUNITY. MEDICAL STAFF PRIVILEGES IN THE HOSPITAL ARE AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA, CONSISTENT WITH THE SIZE AND NATURE OF ITS FACILITIES. THE ORGANIZATION'S HOSPITAL FACILITIES HAVE AN OPEN MEDICAL STAFF. ITS BOARD IS COMPOSED OF PROMINENT CITIZENS IN THE COMMUNITY. EXCESS FUNDS ARE GENERALLY APPLIED TO EXPANSION AND REPLACEMENT OF EXISTING FACILITIES AND EQUIPMENT, AMORTIZATION OF INDEBTEDNESS, IMPROVEMENT IN PATIENT CARE, AND MEDICAL TRAINING, EDUCATION, AND RESEARCH. THE FACILITIES TREAT PERSONS PAYING THEIR BILLS WITH THE AID OF PUBLIC PROGRAMS LIKE MEDICARE AND MEDICAID. ALL PATIENTS PRESENTING AT THE HOSPITAL FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE ARE TREATED REGARDLESS OF THEIR ABILITY TO PAY FOR SUCH TREATMENT. |
| SCHEDULE H, PART VI, LINE 6 | AFFILIATED HEALTH CARE SYSTEM: NOT APPLICABLE |
| SCHEDULE H, PART VI, LINE 7 | STATE FILING OF COMMUNITY BENEFIT REPORT: TEXAS |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DON BOSSE MD | PersonNm |
| Title | PHYSICIAN | TitleTxt |
| Base Compensation Filing Org | $245,174 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $31,197 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $14,070 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $290,441 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (17 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1A | DELEGATION OF AUTHORITY: WHEN THE BOARD IS NOT IN SESSION THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE ALL OF THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE HOSPITAL, UNLESS SUCH AUTHORITY IS LIMITED BY THE BOARD OR BYLAWS. |
| FORM 990, PART VI, SECTION A, LINE 3 | DELEGATION OF MANAGEMENT: THE DISTRICT ENTERED INTO A MANAGEMENT AGREEMENT WITH ERH LLC TO MANAGE THE HOSPITAL. SERVICES INCLUDED PROVIDING EXECUTIVE ASSISTANCE AND THE OVERSIGHT OF DAY-TO-DAY OPERATIONS. PER IRS GUIDANCE, NO COMPENSATION IS SHOWN ON FORM 990, PART VII FOR THE CALENDAR YEAR FOR THIS INDIVIDUAL: JUANITA ROMANS (PARTIAL YEAR) $128,000 DANIEL BONK $70,289 CRAIG MORLEY (PARTIAL YEAR) $NONE |
| FORM 990, PART VI, SECTION A, LINE 6 | MEMBERS AND SHAREHOLDERS: THE SOLE MEMBER OF THE HOSPITAL IS BELLVILLE HOSPITAL DISTRICT. |
| FORM 990 PART VI, SECTION A, LINE 7A | MEMBERS WITH POWER TO ELECT GOVERNING BODY: THE DISTRICT HAS THE POWER TO APPOINT AND REMOVE ALL BOARD MEMBERS FOR THE HOSPITAL. |
| FORM 990, PART VI, SECTION B, LINE 11B | REVIEW OF FORM 990: MANAGEMENT REVIEWS THE RETURN AND PROVIDES IT TO THE BOARD OF DIRECTORS AFTER FILING THE RETURN WITH THE IRS. |
| FORM 990, PART VI, SECTION C, LINE 19 | AVAILABILITY OF DOCUMENTS: EXCEPT AS PROVIDED IN BMC'S FORM 1023 AND FORM 990'S, BMC DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. |
| FORM 990, PART VI, SECTION B, LINE 12C | PROCESS TO MONITOR AND ENFORCE COMPLIANCE WITH CONFLICT OF INTEREST POLICY: THE OFFICERS AND DIRECTORS ANNUALLY DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST. THE STATEMENTS ARE READ DURING THE BOARD MEETING, AND IF A CONFLICT IS FOUND TO EXIST, THE CONFLICT MEMBER RECUSES THEMSELVES FROM VOTING AND DISCUSSIONS. |
| FORM 990, PART VI, SECTION B, LINE 15A & 15B | COMPENSATION REVIEW: FOR BOTH THE CEO AND CFO POSITIONS, COMPENSATION FOR THESE POSITIONS WERE REVIEWED AGAINST EXTERNAL COMPARATIVE DATA AND APPROVED BY THE BOARD AND THE MANAGEMENT COMPANY (ERH). |
| FORM 990, PART IV, LINE 12 & PART XII, LINE 2 | AUDITED FINANCIAL STATEMENTS: THE ORGANIZATION HAS ANSWERED "NO" TO THE QUESTIONS REGARDING AN AUDIT IN PART IV, LINE 12B AND PART XII. THE ORGANIZATION IS IN THE PROCESS OF AN AUDIT OF THE FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2021. HOWEVER, AT THE TIME OF FILING THIS RETURN, THE AUDIT IS NOT YET COMPLETE. THE ORGANIZATION HAS ATTACHED A COPY OF ITS MOST RECENT AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2020 TO THE 990 AND ANSWERED YES TO PART IV, LINE 20B. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PHYSICIAN FEES TOTAL FEES:1813469 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CHI ASSESSMENT FEES TOTAL FEES:1376 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:VENDOR ADMIN FEE TOTAL FEES:140304 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONTRACT LABOR TOTAL FEES:47788 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PURCHASED SERVICES TOTAL FEES:363337 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:COLLECTION SERVICES TOTAL FEES:21703 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONSULTING FEES TOTAL FEES:91860 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER PROFESSIONAL FEES TOTAL FEES:759540 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELLVILLE HOSPITAL DISTRICT | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 44 NORTH CUMMINGS | AddressLine1Txt |
| City | BELLVILLE | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 77418 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 760636528 | EIN |
| Primary Activities | HOSPITAL | PrimaryActivitiesTxt |
| Legal Domicile State | TX | LegalDomicileStateCd |
| Exempt Code Section | GOVT | ExemptCodeSectionTxt |
| Public Charity Status | N/A | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
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