ADAMS COUNTY REGIONAL MEDICAL CENTER: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- ADAMS COUNTY REGIONAL MEDICAL CENTER (EIN 81-2817266)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-10-28
- IRS object ID
- 202103019349301975
- 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 D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-10-28T13:52:35-05:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 550486667 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Arnett Carbis Toothman LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O Box 2629 | AddressLine1Txt |
| City | Charleston | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25329 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 812817266 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Adams County Regional Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ADAM | BusinessNameControlTxt |
| Phone | 8778295500 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 230 Medical Center Dr | AddressLine1Txt |
| City | Seaman | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45679 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Pete R Dagenbach | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 9373863001 | PhoneNum |
| Signature | 2021-10-28 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Pete | PersonFirstNm |
| Person Last | Dagenbach | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Dolores Rose | PreparerPersonNm |
| PTIN | P01286262 | PTIN |
| Phone | 3043460441 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| 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 | Pete R Dagenbach | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 230 Medical Center Dr | AddressLine1Txt |
| City | Seaman | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45679 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $38,670,161 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | acrmc.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2016 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | To provide quality health care close to home and to meet community's needs, excel at customer service and be the first choice for healthcare needs. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 269 | TotalEmployeeCnt |
| Total Volunteers | 25 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $12,973 | PYContributionsGrantsAmt |
| CY Contributions Grants | $136,181 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $7,961,651 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $33,255,389 | CYProgramServiceRevenueAmt |
| PY Investment Income | $8,720 | PYInvestmentIncomeAmt |
| CY Investment Income | $19,757 | CYInvestmentIncomeAmt |
| PY Other Revenue | $546,307 | PYOtherRevenueAmt |
| CY Other Revenue | $5,258,834 | CYOtherRevenueAmt |
| PY Total Revenue | $8,529,651 | PYTotalRevenueAmt |
| CY Total Revenue | $38,670,161 | 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 | $3,185,422 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,174,222 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,891,556 | PYOtherExpensesAmt |
| CY Other Expenses | $25,339,134 | CYOtherExpensesAmt |
| PY Total Expenses | $8,076,978 | PYTotalExpensesAmt |
| CY Total Expenses | $37,513,356 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $452,673 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,156,805 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $36,797,475 | TotalAssetsBOYAmt |
| Total Assets EOY | $44,624,639 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $28,780,820 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $35,399,708 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $8,016,655 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,224,931 | NetAssetsOrFundBalancesEOYAmt |
| Mission | To provide quality health care close to home. To meet the community's needs, to excel at customer service and to be your first choice for healthcare needs. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $23,853,653 | ExpenseAmt |
| Revenue | $38,514,223 | RevenueAmt |
| Desc | ACRMC has five locations and provides a wide range of services to meet the healthcare needs of Adams County and its surrounding communities. Health care services provided include, but are not limited to: surgical, orthopedic, women's health, rehabilitation, senior life solutions, sleep lab, advanced imaging and cardio/pulmonary. It is a critical access hospital with 25 beds and 24/7/365 emergency department and online care. ACRMC has provided 3,416 adult and pediatric beds, 1,450 swing-beds, 1,370 observation bed days. Charity care was provided in the amount of $87,381. An annual health fair provides affordable heatlh screenings and an opportunity for community members to share feedback on their thoughts and desires regarding the health and well-being of their communities, through a survey. | Desc |
| Total Program Service Expenses | $23,853,653 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | Yes (1) | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 20 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 269 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pete Dagenbach CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9373863007 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 230 Medical Center Dr | AddressLine1Txt |
| City | Seaman | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45679 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| Jack McCoy | |||||||
| Chairman | 1.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Sherri Spenser | |||||||
| Vice-Chair | 1.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Chad Wilson | |||||||
| Treasurer | 1.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Dane Clark | |||||||
| Member | 1.50 | Yes (X) | $0 | $0 | $0 | ||
| Spud Gustin | |||||||
| Member | 1.50 | Yes (X) | $0 | $0 | $0 | ||
| Matt Armstrong | |||||||
| Member | 1.50 | Yes (X) | $0 | $0 | $0 | ||
| Peggy Chalker | |||||||
| Member | 1.50 | Yes (X) | $0 | $0 | $0 | ||
| Alan Bird | |||||||
| CEO | 40.00 | Yes (X) | $0 | $0 | $0 | ||
| Pete Dagenbach | |||||||
| CFO | 40.00 | Yes (X) | $143,973 | $0 | $26,279 | ||
| Sarah Gerlach | |||||||
| DO | 40.00 | $248,379 | $0 | $4,863 | Yes (X) | ||
| Rachel D Cummings | |||||||
| CNO | 40.00 | $146,267 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $538,619 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $31,142 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 3 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Emergency Professional Services Inc | |||||
| PO Box 634850 | Cincinnati | OH | 452634850 | Staffing ER Physicians | $731,362 |
| Rural Hospital Group | |||||
| 4770 N Bellview Ave Suite 205 | Gladstone | MO | 64116 | Hospital Management Group | $580,285 |
| RDI | |||||
| 4350 Glandale-Milford Rd Suite 250 | Cincinnati | OH | 45242 | IT Support and Staffing | $496,560 |
| Psychiatric Medical Care Inc | |||||
| PO Box 734606 | Dallas | TX | 753734606 | Senior Life Solution Program | $423,902 |
| TKH Anesthesia LLC | |||||
| 3675 River Birch Ct | Bellbrook | OH | 45305 | Anesthesia Services | $345,640 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $35,192 | GovernmentGrantsAmt |
| All Other Contributions | $100,989 | AllOtherContributionsAmt |
| Total Contributions | $136,181 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Patient Services | Desc |
| Business | 622110 | BusinessCd |
| Total Revenue Column | $33,255,389 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $33,255,389 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $33,255,389 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,757 | TotalRevenueColumnAmt |
| Exclusion | $19,757 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Govt Stimulus Revenue | 900099 | $3,947,991 | $3,947,991 |
| Sales Tax Levy Income | 900099 | $605,113 | $605,113 |
| Cares Act | 900099 | $283,184 | $283,184 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $422,546 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $422,546 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $5,258,834 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $38,670,161 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $38,514,223 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $19,757 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $170,252 | TotalAmt |
| Program Services | $73,532 | ProgramServicesAmt |
| Management And General | $96,720 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,138,513 | TotalAmt |
| Program Services | $4,378,824 | ProgramServicesAmt |
| Management And General | $5,759,689 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $759,199 | TotalAmt |
| Program Services | $327,898 | ProgramServicesAmt |
| Management And General | $431,301 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,106,258 | TotalAmt |
| Program Services | $477,793 | ProgramServicesAmt |
| Management And General | $628,465 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $104,864 | TotalAmt |
| Management And General | $104,864 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,535,766 | TotalAmt |
| Program Services | $3,789,538 | ProgramServicesAmt |
| Management And General | $2,746,228 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,252 | TotalAmt |
| Management And General | $70,252 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,643,301 | TotalAmt |
| Program Services | $710,242 | ProgramServicesAmt |
| Management And General | $933,059 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $476,920 | TotalAmt |
| Program Services | $205,982 | ProgramServicesAmt |
| Management And General | $270,938 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,496 | TotalAmt |
| Program Services | $14,467 | ProgramServicesAmt |
| Management And General | $19,029 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,816,117 | TotalAmt |
| Program Services | $784,381 | ProgramServicesAmt |
| Management And General | $1,031,736 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,571,513 | TotalAmt |
| Program Services | $678,736 | ProgramServicesAmt |
| Management And General | $892,777 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $249,560 | TotalAmt |
| Program Services | $107,785 | ProgramServicesAmt |
| Management And General | $141,775 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Bad Debt | $8,900,725 | $8,900,725 | |
| Medical Supplies | $2,998,632 | $2,998,632 | |
| Medicaid Assistance | $514,410 | $222,174 | $292,236 |
| Dues and Subscriptions | $125,512 | $54,209 | $71,303 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $298,066 | TotalAmt |
| Program Services | $128,735 | ProgramServicesAmt |
| Management And General | $169,331 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,513,356 | TotalAmt |
| Program Services | $23,853,653 | ProgramServicesAmt |
| Management And General | $13,659,703 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,340,706 | BOYAmt |
| EOY | $10,695,009 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,888,850 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,970,556 | BOYAmt |
| EOY | $3,926,907 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $303,707 | BOYAmt |
| EOY | $325,141 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,542 | BOYAmt |
| EOY | $243,377 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $24,458,627 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,943,211 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,106,106 | BOYAmt |
| EOY | $22,515,416 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,405 | BOYAmt |
| EOY | $59,122 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,569,846 | BOYAmt |
| EOY | $2,518,139 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $89,570 | BOYAmt |
| EOY | $175,464 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $325,037 | BOYAmt |
| EOY | $2,277,214 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,797,475 | BOYAmt |
| EOY | $44,624,639 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,153,724 | BOYAmt |
| EOY | $4,629,962 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $3,878,754 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,003,981 | BOYAmt |
| EOY | $24,050,906 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,842 | BOYAmt |
| EOY | $64,588 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $572,273 | BOYAmt |
| EOY | $2,775,498 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,780,820 | BOYAmt |
| EOY | $35,399,708 | 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 | $7,939,852 | BOYAmt |
| EOY | $9,122,925 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $76,803 | BOYAmt |
| EOY | $102,006 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,016,655 | BOYAmt |
| EOY | $9,224,931 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,797,475 | BOYAmt |
| EOY | $44,624,639 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,156,805 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $2,471 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $49,000 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | 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 D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $19,353,100 | OtherCostOrOtherBasisAmt |
| Depreciation | $742,677 | DepreciationAmt |
| Book Value | $18,610,423 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,381,899 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,141,784 | DepreciationAmt |
| Book Value | $2,240,115 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,723,628 | OtherCostOrOtherBasisAmt |
| Depreciation | $58,750 | DepreciationAmt |
| Book Value | $1,664,878 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $22,515,416 | TotalBookValueLandBuildingsAmt |
Invst Program Related Org InvstProgramRelatedOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Bond Indenture | Desc |
| Book Value | $2,518,139 | BookValueAmt |
| Method Valuation | C | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Program Rltd | $2,518,139 | TotalBookValueProgramRltdAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Donor Restricted funds | $102,006 |
| WV Family Med Building Restricted | $2,103,955 |
| Estimate Third Party Settlements | $71,253 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,277,214 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Capital lease obligations | $336,464 |
| PPP Loan | $2,439,034 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,775,498 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $29,729,064 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $2,471 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $2,471 | RevenueNotReportedAmt |
| Revenue Subtotal | $29,726,593 | RevenueSubtotalAmt |
| Other Revenues Not Included | $8,943,568 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $8,943,568 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $38,670,161 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $28,594,991 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $28,594,991 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $8,918,365 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $8,918,365 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $37,513,356 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | The Hospital is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code (Code) and has been recognized as tax exempt under Section 501(a) of the Code. Accordingly, no provision for income taxes has been provided. The Center follows the guidance for accounting for uncertainty in income taxes recognized in a company's financial statements that prescribes a recognition threshold of more-likely-than-not to be sustained upon examination by the appropriate taxing authority. Measurement of the tax uncertainty occurs if the recognition threshold has been met. The Center's policy is to recognize interest related to unrecognized tax benefits in interest expense and penalties in operating expenses. There were no interest or penalties recognized on the statement of operations and changes in net assets in 2020. |
| Part XI, Line 2d - Other Adjustments: | Net asset increase for amount of consideration in excess of FV for purchase Transfer from County- donor restricted funds |
| Part XI, Line 4b - Other Adjustments: | Bad debt expense 8,900,725. Revenue netted with expense on fin. stmts. 17,640. Revenue reported on 990 not reported on fin. stmts. 25,203. |
| Part XII, Line 4b - Other Adjustments: | Bad debt expense 8,900,725. Revenue netted with expense on FS 17,640. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $677,845 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $516,160 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $161,685 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00430 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,379,044 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,260,499 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,118,545 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05650 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,056,889 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,776,659 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,280,230 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06080 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,056,889 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,776,659 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,280,230 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06080 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reimbursed By Medicare | $5,730,347 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,792,871 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$62,524 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| 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 | Adams County Regional Medical Center Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 230 Medical Center Drive | AddressLine1Txt |
| City | Seaman | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45679 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | https://acrmc.com/ | WebsiteAddressTxt |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Adams County Regional Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | Yes (1) | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | 0 | CHNAConductedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https://acrmc.com/financial-assistance/ | FAPAvailableOnWebsiteURLTxt |
| 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 (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| 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 (1) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Adams County Regional Medical Center | FormAndLineReferenceDesc |
| Explanation | Part V, Section B, Line 2: The Center's nonprofit entity was organized and registered in the State of Ohio in 2016 and received 501(c)3 nonprofit status from the IRS effective May 31, 2016. However, the nonprofit Center did not acquire the County owned hospital until October 1, 2019.On October 1, 2019, the Center acquired all of the assets, the operations, and assumed all of the liabilities, excluding the Pension and OPEB liabilities of the Adams County Regional Medical Center (County Owned). The Center transitioned to the 501(c)3 nonprofit hospital as of October 1, 2019. The Center is in the process of conducting a community health needs assessment as of the filing date of the 990 tax return. | ExplanationTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - Family Medicine - Georgetown | ||||
| 900 Mt Orab Pike | Georgetown | OH | 45131 | Clinic |
| 2 - Family Medicine - West Union | ||||
| 211 North Wilson Drive | West Union | OH | 45693 | Clinic |
| 3 - Family Medicine - Winchester | ||||
| 19262 State Route 136 | Winchester | OH | 45697 | Clinic |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part III, Line 8: | The Medicare cost report was used to calculate the Medicare allowable costs and reimbursements. |
| Part VI, Line 2: | The Center provides an annual health fair screening and asks the participants to complete a survey. |
| Part VI, Line 3: | All patients are informed of application process, prior to service. |
| Part VI, Line 4: | Adams County is a rural, medically underserved area, located approximately fifty miles east of Cincinnati along the Ohio River. Adams County has a population of approximately 28,550. In the County, the population is spread out, with 26.40% under the age of 18, 8.70% from 18 to 24, 28.20% from 25 to 44, 23.40% from 45 to 64, and 13.30% who were 65 years of age or older. The median age was 36 years. The median household income is $36,894. Approximately 20% of the population is in poverty. |
| Part VI, Line 5: | The community health fair and a rural health clinic with walk-in appointments. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Sarah Gerlach | ||||||||||||||
| DO | $248,379 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $4,863 | $0 | $253,242 | $0 | $0 | $0 |
| Pete Dagenbach | ||||||||||||||
| CFO | $143,973 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $26,279 | $0 | $170,252 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Form 990, Part VII, Section A, Line 5 | FormAndLineReferenceDesc |
| Explanation | Unrelated Organization Officer Compensation: The Center has a management services agreement with Rural Hospital Group. The Rural Hospital Group provides a full-time Chief Executive Officer (CEO) to the Hospital. As of the filing date of the 990, Alan Bird is the CEO. The CEO's compensation for the period of 1/1/20 to 12/31/20 was $193,750. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | County of Adams OH Series 2019 Bonds | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| CUSIP | 00610PAH9 | CUSIPNum |
| Bond Issued | 2019-09-27 | BondIssuedDt |
| Issue Price | $25,400,000 | IssuePriceAmt |
| Purpose | To finance acquisition of existing hospital facilities in Adams County, OH | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | $24,892,000 | TotalProceedsAmt |
| In Reserve Fund | $2,075,280 | InReserveFundAmt |
| Issuance Costs From Proceeds | $508,000 | IssuanceCostsFromProceedsAmt |
| Refunding Tax Exempt Bonds | Yes (1) | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | 0 | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | 0 | ProceduresCorrectiveActionInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section B, line 11b | The 990 will be distributed to all board members. It will be presented and discussed at a Board of Trustees meeting after the completion of Form 990. |
| Form 990, Part VI, Section B, line 12c | ACRMC Conflict of Interest Policy requires that all personnel shall upon hire and annually thereafter sign a statement which affirms the person's understanding and adherence to the policy. The compliance committee meets each quarter and the HIM Director performs HIPAA audits. |
| Form 990, Part VI, Section B, line 15 | Salary surveys and recommendations from the CEO are used to determine the organization's officers or key employees salaries. The salary recommendations are reviewed and approved by the CEO. |
| Form 990, Part VI, Section C, line 19 | The organization's governing documents, policies and financial statements are available upon request. |
| Form 990, Part IX, line 11g | Maintenance Contracts: Program service expenses 526,764. Management and general expenses 692,879. Fundraising expenses 0. Total expenses 1,219,643. Other Purchased Services: Program service expenses 1,561,065. Management and general expenses 2,053,349. Fundraising expenses 0. Total expenses 3,614,414. Contracted Medical Services: Program service expenses 1,701,709. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,701,709. |
| Form 990, Part XI, line 9: | Non-controlling interest of joint venture 49,000. |
Schedule R IRS990ScheduleR
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Adams County Regional Medical Pain Management LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 230 Medical Center Dr | AddressLine1Txt |
| City | Seaman | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45679 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 853030741 | EIN |
| Primary Activities | Healthcare | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Adams County Regional Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | Related | PredominantIncomeTypeTxt |
| Share Of Total Income | -$12,907 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $50,995 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | 0 | GeneralOrManagingPartnerInd |
| Ownership | 0.51000 | OwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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