COMMUNITY HOSPICE INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPICE INC (EIN 31-0970252)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-05-06
- IRS object ID
- 202011279349300811
- Schema version
- 2019v5.0
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-05-06T09:12:45-05:00 | ReturnTs |
| Tax Period End | 2019-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 611129886 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KELLEY GALLOWAY SMITH GOOLSBY PSC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 CORPORATE COURT PO BOX 990 | AddressLine1Txt |
| City | ASHLAND | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 411050990 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 310970252 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPICE INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 6063291890 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1480 CARTER AVENUE | AddressLine1Txt |
| City | ASHLAND | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 41101 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SUSAN HUNT | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 6063291890 | PhoneNum |
| Signature | 2020-04-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | PHILLIP M LAYNE CPA | PreparerPersonNm |
| PTIN | P00039427 | PTIN |
| Phone | 6063291811 | PhoneNum |
| Preparation | 2020-04-13 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 76.190.68.218 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-05-06 | IPDt |
| IP Tm | 09:12:45 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 4FF71876BB1DFA0BD65C4A45E5063C573D2D80D1 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | B333CAFA7A4EFEF33F86122F41ED96CB52456C1C | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2020-09-23 17:36:50Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SUSAN HUNT | PrincipalOfficerNm |
| Gross Receipts | $17,481,412 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CHOSPICE.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1979 | FormationYr |
| Legal Domicile State | KY | LegalDomicileStateCd |
| Activity Or Mission | PROVIDING MEDICAL CARE TO TERMINALLY ILL PATIENTS | ActivityOrMissionDesc |
| Voting Members Governing Body | 17 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 17 | VotingMembersIndependentCnt |
| Total Employee | 143 | TotalEmployeeCnt |
| Total Volunteers | 219 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $102,359 | PYContributionsGrantsAmt |
| CY Contributions Grants | $123,699 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $13,118,037 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $13,935,892 | CYProgramServiceRevenueAmt |
| PY Investment Income | $291,521 | PYInvestmentIncomeAmt |
| CY Investment Income | $652,462 | CYInvestmentIncomeAmt |
| PY Other Revenue | $44,955 | PYOtherRevenueAmt |
| CY Other Revenue | $32,659 | CYOtherRevenueAmt |
| PY Total Revenue | $13,556,872 | PYTotalRevenueAmt |
| CY Total Revenue | $14,744,712 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,737,587 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,006,348 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,634,880 | PYOtherExpensesAmt |
| CY Other Expenses | $6,359,141 | CYOtherExpensesAmt |
| PY Total Expenses | $12,372,467 | PYTotalExpensesAmt |
| CY Total Expenses | $13,365,489 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,184,405 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,379,223 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $29,402,225 | TotalAssetsBOYAmt |
| Total Assets EOY | $32,816,189 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,690,941 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,902,362 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $27,711,284 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $30,913,827 | NetAssetsOrFundBalancesEOYAmt |
| Mission | PROVIDING MEDICAL CARE TO TERMINALLY ILL PATIENTS | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $11,323,863 | ExpenseAmt |
| Revenue | $13,935,892 | RevenueAmt |
| Desc | PROVIDING MEDICAL CARE, SOCIAL SERVICES, AND SPIRITUAL SUPPORT TO TERMINALLY ILL PATIENTS AND THEIR FAMILIES. | Desc |
| Total Program Service Expenses | $11,323,863 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | 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 | Yes (true) | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | 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 | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| 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 | Yes (true) | 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 | false | 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 | 87 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | false | BackupWthldComplianceInd |
| Employee | 143 | 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 |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| Taxable Distributions | false | TaxableDistributionsInd |
| Distribution To Donor | false | DistributionToDonorInd |
| 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 | 17 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 17 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | 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 | Yes (true) | 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 | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | KY | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHARLOTTE HORN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6063291890 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1480 CARTER AVENUE | AddressLine1Txt |
| City | ASHLAND | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 41101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd |
|---|---|---|---|---|---|---|
| KRISTIE DICKESS | ||||||
| MEDICAL DIRE | Yes (X) | $200,719 | $0 | $21,935 | ||
| SUSAN HUNT | ||||||
| EXECUTIVE DI | Yes (X) | $177,068 | $0 | $14,753 | ||
| JULIE CARR | ||||||
| NURSE PRACTI | Yes (X) | $124,911 | $0 | $0 | ||
| SANDY ZERKLE | ||||||
| DIRECTOR OF | Yes (X) | $118,019 | $0 | $0 | ||
| CHARLOTTE HORN | ||||||
| DIRECTOR OF | Yes (X) | $101,372 | $0 | $0 | ||
| TOM BURNETTE | ||||||
| BOARD OF DIR | $0 | $0 | $0 | Yes (X) | ||
| DR STACY CAUDILL | ||||||
| BOARD OF DIR | $0 | $0 | $0 | Yes (X) | ||
| DR JOHN DARNELL | ||||||
| BOARD OF DIR | $0 | $0 | $0 | Yes (X) | ||
| KATHY ELAM | ||||||
| VOLUNTEER | $0 | $0 | $0 | Yes (X) | ||
| JANSEN FENNELL | ||||||
| PRESIDENT | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| SUSAN FRIED | ||||||
| BOARD OF DIR | $0 | $0 | $0 | Yes (X) | ||
| STEVE GILMORE | ||||||
| BOARD OF DIR | $0 | $0 | $0 | Yes (X) | ||
| THERESA HALL | ||||||
| BOARD OF DIR | $0 | $0 | $0 | Yes (X) | ||
| AUTUMN MCFANN | ||||||
| VICE PRESIDE | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| MARY KAY MCGINNIS-RUARK | ||||||
| SECRETARY | $0 | $0 | $0 | Yes (X) | ||
| NAN MCGUIRE | ||||||
| BOARD OF DIR | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| JENNIFER SPARKS | ||||||
| PAST PRESIDE | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| JASON SUMAN | ||||||
| TREASURER | $0 | $0 | $0 | Yes (X) | ||
| BRUCE VANHORN | ||||||
| BOARD OF DIR | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| LUKE VINCENT | ||||||
| ATTORNEY | $0 | $0 | $0 | Yes (X) | ||
| CHRISTA WILEY | ||||||
| BOARD OF DIR | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $722,089 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $36,688 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | 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 |
|---|---|---|---|---|---|
| ENCLARA PHARMACY | |||||
| PO BOX 95000-7255 | PHILADELPHIA | PA | 19195 | PHARMACY | $610,136 |
| WOODLAND OAKS OPERATIONS | |||||
| 300 PROVIDER COURT SUITE 100 | RICHMOND | KY | 40475 | NURSING HOME SE | $441,635 |
| AHF OHIO | |||||
| 5920 VENTURE DR SUITE 100 | DUBLIN | OH | 43017 | NURSING FACILIT | $333,200 |
| MEDLINE INDUSTRIES | |||||
| DEPT CH14400 | PALATINE | IL | 600554400 | MEDICAL SUPPLY | $251,062 |
| IRONTON OPCO | |||||
| 1050 CLINTON ST | IRONTON | OH | 45638 | NURSING HOME SE | $247,108 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 12 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $123,699 | AllOtherContributionsAmt |
| Total Contributions | $123,699 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT CARE - HOME CARE | Desc |
| Business | 621610 | BusinessCd |
| Total Revenue Column | $13,935,892 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $13,935,892 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $13,935,892 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $408,891 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $408,891 | RelatedOrExemptFuncIncomeAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,972,159 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,728,588 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $243,571 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $243,571 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $243,571 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $16,496 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $8,112 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,384 | TotalRevenueColumnAmt |
| Exclusion | $8,384 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $24,275 | TotalRevenueColumnAmt |
| Exclusion | $24,275 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $24,275 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,744,712 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,588,354 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $32,659 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,248,531 | TotalAmt |
| Program Services | $4,921,135 | ProgramServicesAmt |
| Management And General | $1,327,396 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $315,578 | TotalAmt |
| Program Services | $236,683 | ProgramServicesAmt |
| Management And General | $78,895 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $442,239 | TotalAmt |
| Program Services | $331,679 | ProgramServicesAmt |
| Management And General | $110,560 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,067 | TotalAmt |
| Program Services | $34,550 | ProgramServicesAmt |
| Management And General | $11,517 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,057 | TotalAmt |
| Program Services | $37,542 | ProgramServicesAmt |
| Management And General | $12,515 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,073 | TotalAmt |
| Program Services | $33,806 | ProgramServicesAmt |
| Management And General | $11,267 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,558 | TotalAmt |
| Program Services | $12,419 | ProgramServicesAmt |
| Management And General | $4,139 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,264 | TotalAmt |
| Program Services | $23,448 | ProgramServicesAmt |
| Management And General | $7,816 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $183,952 | TotalAmt |
| Program Services | $170,856 | ProgramServicesAmt |
| Management And General | $13,096 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,391 | TotalAmt |
| Program Services | $52,793 | ProgramServicesAmt |
| Management And General | $17,598 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $308,347 | TotalAmt |
| Program Services | $231,260 | ProgramServicesAmt |
| Management And General | $77,087 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $537,302 | TotalAmt |
| Program Services | $402,976 | ProgramServicesAmt |
| Management And General | $134,326 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| CONTRACTED PROFESSIONAL S | $2,799,888 | $2,781,462 | $18,426 |
| MEDICATION | $640,235 | $640,235 | |
| MAINTENANCE AND REPAIRS | $312,579 | $234,434 | $78,145 |
| MEDICAL EQUIPMENT RENTAL | $308,724 | $308,724 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,008,704 | TotalAmt |
| Program Services | $869,861 | ProgramServicesAmt |
| Management And General | $138,843 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,365,489 | TotalAmt |
| Program Services | $11,323,863 | ProgramServicesAmt |
| Management And General | $2,041,626 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,809,698 | BOYAmt |
| EOY | -$59,973 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,096,129 | BOYAmt |
| EOY | $7,211,247 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $875,266 | BOYAmt |
| EOY | $1,821,783 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,797 | BOYAmt |
| EOY | $23,054 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,643 | BOYAmt |
| EOY | $29,908 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $9,661,737 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,019,945 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,802,992 | BOYAmt |
| EOY | $5,641,792 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,743,698 | BOYAmt |
| EOY | $18,111,224 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,002 | BOYAmt |
| EOY | $37,154 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,402,225 | BOYAmt |
| EOY | $32,816,189 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,690,941 | BOYAmt |
| EOY | $1,902,362 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,690,941 | BOYAmt |
| EOY | $1,902,362 | 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 | $27,711,284 | BOYAmt |
| EOY | $30,913,827 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,711,284 | BOYAmt |
| EOY | $30,913,827 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,402,225 | BOYAmt |
| EOY | $32,816,189 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,379,223 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,823,320 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | 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 (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $139,036 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $137,403 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $102,844 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $102,359 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $123,699 | CurrentTaxYearAmt |
| Total | $605,341 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $139,036 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $137,403 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $102,844 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $102,359 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $123,699 | CurrentTaxYearAmt |
| Total | $605,341 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $605,341 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $173,626 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $180,679 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $223,355 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $322,555 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $482,815 | CurrentTaxYearAmt |
| Total | $1,383,030 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $56,368 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $51,513 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $42,245 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $54,961 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $40,771 | CurrentTaxYearAmt |
| Total | $245,858 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $2,234,229 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $40,223,125 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.27090 | PublicSupportCY170Pct |
| Public Support PY170 | 0.30080 | PublicSupportPY170Pct |
| Ten Pct Facts Crcmstncs Test CY | Yes (X) | TenPctFactsCrcmstncsTestCYInd |
| Facts And Circumstances Test | OVER 14 MILLION OF THE 16 MILLION IN REVENUES IS FROM PATIENT CARE SERVICES, THEREFORE, WE REQUEST THAT THIS FACT BE TAKEN INTO CONSIDERATION WHEN REVIEWING THE 33 1/3% TEST. | FactsAndCircumstancesTestTxt |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART II, LINE 10 | MISCELLANEOUS 245,858 |
| PART II, LINE 17A | OVER 14 MILLION OF THE 16 MILLION IN REVENUES IS FROM PATIENT CARE SERVICES, THEREFORE, WE REQUEST THAT THIS FACT BE TAKEN INTO CONSIDERATION WHEN REVIEWING THE 33 1/3% TEST. |
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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $917,458 | OtherCostOrOtherBasisAmt |
| Book Value | $917,458 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,524,204 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,241,436 | DepreciationAmt |
| Book Value | $4,282,768 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $72,053 | OtherCostOrOtherBasisAmt |
| Depreciation | $72,053 | DepreciationAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,552,668 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,365,602 | DepreciationAmt |
| Book Value | $187,066 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $595,354 | OtherCostOrOtherBasisAmt |
| Depreciation | $340,854 | DepreciationAmt |
| Book Value | $254,500 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,641,792 | TotalBookValueLandBuildingsAmt |
Invst Program Related Org InvstProgramRelatedOrgGrp (7 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| PUBLICLY TRADED SECURITIES | $10,013,182 | F |
| CORPORATE BONDS | $3,738,224 | F |
| CDS & MONEY MARTKET ACCOUNTS | $1,604,164 | F |
| MUTUAL FUNDS | $1,506,467 | F |
| MUNICIPAL BONDS | $569,771 | F |
| US GOVERNMENT AGENCIES | $446,194 | F |
| FIXED ACCOUNTS | $233,222 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Program Rltd | $18,111,224 | TotalBookValueProgramRltdAmt |
| Total Rev Etc Audited Fincl Stmt | $16,568,032 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $1,823,320 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $1,823,320 | RevenueNotReportedAmt |
| Revenue Subtotal | $14,744,712 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $14,744,712 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $13,365,489 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $13,365,489 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $13,365,489 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 4, PART XI, LINE 2D | NET LOSS ON SALE OF ASSETS 0 |
| SCHEDULE D, PAGE 4, PART XI, LINE 4B | FUNDRASING EXPENSES 0 NET LOSS ON SALE OF ASSETS 0 |
| SCHEDULE D, PAGE 4, PART XII, LINE 2D | NET LOSS ON SALE OF ASSETS 0 FUNDRAISING EXPENSES 0 |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | STYLE SHOW | Event1Nm |
| Gross Receipts Event1 | $9,379 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $9,379 | GrossRevenueEvent1Amt |
| Food And Beverage Event1 | $4,156 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $853 | OtherDirectExpensesEvent1Amt |
| Event2 | MEMORIAL BRICKS | Event2Nm |
| Gross Receipts Event2 | $5,900 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $5,900 | GrossRevenueEvent2Amt |
| Other Direct Expenses Event2 | $963 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $15,279 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $15,279 | GrossRevenueTotalEventsAmt |
| Food And Beverage Total Events | $4,156 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $1,816 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $5,972 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $9,307 | NetIncomeSummaryAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| 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 (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|---|
| KRISTIE DICKESS | |||||
| MEDICAL DIRECTOR | $191,722 | $8,997 | $10,035 | $11,900 | $222,654 |
| SUSAN HUNT | |||||
| EXECUTIVE DIRECTOR | $165,017 | $12,051 | $8,853 | $5,900 | $191,821 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (4 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| KINGS DAUGHTERS MEDICAL CENTER | |||
| DIRECTOR IS EMP | $130,281 | MEDICAL SERVICES PRO | false |
| OUR LADY OF BELLEFONTE HOSPITAL | |||
| DIRECTOR IS EMP | $45,873 | MEDICAL SERVICES PRO | false |
| (no name) | |||
| false | |||
| CITY NATIONAL BANK | |||
| DIRECTOR IS EMP | $817,782 | BANK CD | false |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART V | FormAndLineReferenceDesc |
| Explanation | KINGS DAUGHTERS MEDICAL CENTER: DIRECTOR IS THE PATIENT SERVICES DIRECTOR. OUR LADY OF BELLEFONTE HOSPITAL: DIRECTOR IS THE DIRECTOR OF MISSIONS. CITY NATIONAL BANK: DIRECTOR IS AN EMPLOYEE. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 11B | THE 990 IS REVIEWED BY THE EXECUTIVE DIRECTOR, THE DIRECTOR OF FINANCE, AND THE FINANCE COMMITTEE. THE GOVERNING BOARD IS THEN NOTIFIED THAT THE RETURN IS COMPLETED AND THEY ARE NOTIFIED OF THE DUE DATE AND THAT THE RETURN IS AVAILABLE TO THEM FOR REVIEW IF THEY DEEM NECESSARY IN THE BUSINESS OFFICE. |
| FORM 990, PAGE 6, PART VI, LINE 12C | CONFLICT OF INTEREST FORMS ARE COMPLETED WHEN FIRST JOINING THE BOARD. |
| FORM 990, PAGE 6, PART VI, LINE 19 | COPIES ARE PROVIDED AT OUR ADMINISTRATIVE OFFICES UPON REQUEST. |
| FORM 990, PART XI, LINE 9 | NET LOSS ON SALE OF ASSETS 0 FUNDRASING EXPENSES 0 NET LOSS ON SALE OF ASSETS 0 NET LOSS ON SALE OF ASSETS 0 FUNDRAISING EXPENSES 0 |
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