SELBY GENERAL HOSPITAL: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- SELBY GENERAL HOSPITAL (EIN 31-4413259)
- Tax period
- 2016-10-01 to 2017-09-30
- Filed
- 2018-08-13
- IRS object ID
- 201812259349301786
- Schema version
- 2016v3.0
- 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
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-08-13T15:38:12-05:00 | ReturnTs |
| Tax Period End | 2017-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 271235638 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCM CPAS & ADVISORS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 462 S FOURTH ST SUITE 2600 | AddressLine1Txt |
| City | LOUISVILLE | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 402023445 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 314413259 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SELBY GENERAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SELB | BusinessNameControlTxt |
| Phone | 7405682071 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1106 COLGATE DRIVE | AddressLine1Txt |
| City | MARIETTA | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45750 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ERIC YOUNG | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 7405682071 | PhoneNum |
| Signature | 2018-08-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | BOB MORELAND CPA | PreparerPersonNm |
| PTIN | P00418596 | PTIN |
| Phone | 5027491900 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ERIC YOUNG | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 MATTHEW ST | AddressLine1Txt |
| City | MARIETTA | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45750 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $47,560,738 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MHSYSTEM.ORG/SGH | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1939 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | SELBY GENERAL HOSPITAL IS A NOT-FOR-PROFIT CRITICAL ACCESS HOSPITAL WHERE SERVICE EXCELLENCE AND CLINICAL QUALITY CREATE THE REGION'S BEST EXPERIENCE FOR PATIENTS AND THEIR FAMILIES, PHYSICIANS, THE COMMUNITY AND OUR EMPLOYEES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 17 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 14 | VotingMembersIndependentCnt |
| Total Employee | 222 | TotalEmployeeCnt |
| Total Volunteers | 20 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $50,627,388 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $47,547,412 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$4 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $218,704 | PYOtherRevenueAmt |
| CY Other Revenue | $13,326 | CYOtherRevenueAmt |
| PY Total Revenue | $50,846,088 | PYTotalRevenueAmt |
| CY Total Revenue | $47,560,738 | 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 | $15,783,566 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $15,362,399 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $29,297,228 | PYOtherExpensesAmt |
| CY Other Expenses | $30,441,657 | CYOtherExpensesAmt |
| PY Total Expenses | $45,080,794 | PYTotalExpensesAmt |
| CY Total Expenses | $45,804,056 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,765,294 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,756,682 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $47,630,870 | TotalAssetsBOYAmt |
| Total Assets EOY | $48,416,848 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $45,706,380 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $44,735,676 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,924,490 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,681,172 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | SELBY GENERAL HOSPITAL IS A NOT-FOR-PROFIT CRITICAL ACCESS HOSPITAL WHERE SERVICE EXCELLENCE AND CLINICAL QUALITY CREATE THE REGION'S BEST EXPERIENCE FOR PATIENTS AND THEIR FAMILIES, PHYSICIANS, THE COMMUNITY AND OUR EMPLOYEES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $29,113,814 | ExpenseAmt |
| Revenue | $47,547,412 | RevenueAmt |
| Desc | DURING THE TWELVE MONTHS ENDING SEPTEMBER 30, 2017 THE HOSPITAL PROVIDED 6,478 INPATIENT CARE DAYS, 7,744 HOURS OF OBSERVATION CARE, 2,218 SURGICAL CASES, 23,369 PHYSICAL THERAPY PROCEDURES, 7,574 EMERGENCY VISITS AND 12,210 IMAGING PROCEDURES.SELBY BELIEVES IN MORE THAN PROVIDING THE BEST LOCAL HEALTHCARE. WE BELIEVE IN INVESTING IN OUR COMMUNITY, SUPPORTING OUR NEIGHBORS, OUR FAMILIES AND FRIENDS. OUR COMMITMENT IS TRULY TO OUR COMMUNITY - AS AN EMPLOYER, AS A CORPORATE CITIZEN AND AS A COMMUNITY RESOURCE AND AS A HEALTHCARE PROVIDER. TO THAT END, THE HOSPITAL, ITS PHYSICIANS, STAFF AND VOLUNTEERS EXTEND THEMSELVES WELL BEYOND PATIENT CARE. WE PROVIDE COMMUNITY CLINICAL SUPPORT SERVICES, WELLNESS EDUCATION, PROGRAMS, SUPPORT GROUPS, FINANCIAL SUPPORT TO LOCAL ORGANIZATIONS, AND OUR OWN PERSONAL TIME TO ENSURE THE HIGHEST QUALITY OF LIFE FOR EVERYONE WITHIN OUR COMMUNITY. WE CALL IT GIVING BACK. PART OF OUR MISSION EXTENDS TO WELLNESS EDUCATION AND HEALTH PREVENTION. WE SPEAK OUT IN OUR COMMUNITY, WE SPONSOR SUPPORT GROUPS, WE PROVIDE DOZENS OF WELLNESS PROGRAMS AND WE PROVIDE MONTHLY OPPORTUNITIES FOR FREE AND/OR LOW COST HEALTH SCREENINGS. THE HOSPITAL SUPPORTS PARTNERSHIPS, COMMUNITY HEALTH COALITIONS, AREA CHAMBERS OF COMMERCE, LOCAL NOT-FOR-PROFIT ORGANIZATIONS, LOCAL SCHOOLS AND GOVERNMENTS. ADDITIONALLY, MANY OF OUR STAFF MEMBERS, PHYSICIANS AND VOLUNTEERS DONATE THEIR TIME TO SERVE ON LOCAL BOARDS, COMMITTEES, AND ASSOCIATIONS. WE PROVIDE OPPORTUNITIES FOR LOCAL STUDENTS TO TRAIN WITHIN OUR HOSPITAL UNDER VARIOUS EDUCATIONAL PROGRAMS AND AGREEMENTS WITH AREA SCHOOL SYSTEMS. THIS SERVES BOTH THE STUDENTS AND THE COMMUNITY AS IT OFTEN INCREASES OUR SUPPLY OF LOCAL HEALTH CARE WORKERS. | Desc |
| Total Program Service Expenses | $29,113,814 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | 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 | 0 | TaxExemptBondsInd |
| 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 | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| 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 | 279 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 222 | 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 17 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 14 | 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 | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | 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 | ERIC YOUNG | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7405682071 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1106 COLEGATE DRIVE | AddressLine1Txt |
| City | MARIETTA | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45750 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| THOMAS TUCKER | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MICHAEL IADEROSA | ||||||||
| CHAIRMAN | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| COLLEEN COOK | ||||||||
| VICE-CHAIRMAN | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| MICHAEL ARCHER | ||||||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| MARK BRADLEY | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DENNIE BURCHETT | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JOSEPH COOPER MD | ||||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $387,355 | $37,763 | Yes (X) | 40.00 | |
| THOMAS DANFORD DDS | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| CHARLOTTE HATFIELD PHD | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| LARRY HAWN | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JOHN MATTHEWS | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JAY STOWE | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JAMES BARENGO | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JOHN LEE MD | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $583,877 | $37,420 | |||
| LARRY UNROE | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| SHERYL HOLDREN | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DAN BREECE DO | ||||||||
| MEDICAL STAFF PRESIDENT | 1.00 | Yes (X) | $0 | $775,804 | $38,380 | 40.00 | ||
| ERIC YOUNG | ||||||||
| CFO | 1.00 | $0 | $493,005 | $55,818 | Yes (X) | 40.00 | ||
| STEPHEN SMITH | ||||||||
| CEO | 40.00 | $281,374 | $0 | $36,381 | Yes (X) | |||
| KEVIN GANNON | ||||||||
| PHYSICIAN | 40.00 | $123,287 | $0 | $36,029 | Yes (X) | |||
| KRIS LINDSEY | ||||||||
| PHYSICAL THERAPIST | 40.00 | $114,996 | $0 | $27,151 | Yes (X) | |||
| VINCE STOLLAR | ||||||||
| DIRECTOR OF PHARMACY | 40.00 | $137,234 | $0 | $36,260 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $656,891 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,240,041 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $305,202 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CARETECH SOLUTIONS INC | |||||
| PO BOX 674271 | DETROIT | MI | 48267 | INFORMATION TECH. | $534,694 |
| JACKSON NURSE PROF | |||||
| PO BOX 404118 | ATLANTA | GA | 30384 | RN STAFFING | $258,847 |
| PHARMACY SYSTEM INC | |||||
| PO BOX 71-0716 | COLUMBUS | OH | 43271 | PHARMACY STAFF | $161,823 |
| SHEARWATER HEALTH INC | |||||
| 20 BURTON HILLS BLVD SUITE 400 | NASHVILLE | TN | 37215 | NURSING STAFF | $110,651 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE | Desc |
| Business | 623000 | BusinessCd |
| Total Revenue Column | $47,547,412 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $47,547,412 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $47,547,412 | TotalProgramServiceRevenueAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $13,326 | TotalRevenueColumnAmt |
| Exclusion | $13,326 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $13,326 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $47,560,738 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $47,547,412 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $13,326 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $281,374 | TotalAmt |
| Management And General | $281,374 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,883,629 | TotalAmt |
| Program Services | $9,107,801 | ProgramServicesAmt |
| Management And General | $2,775,828 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $253,506 | TotalAmt |
| Program Services | $163,645 | ProgramServicesAmt |
| Management And General | $89,861 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,066,424 | TotalAmt |
| Program Services | $1,427,439 | ProgramServicesAmt |
| Management And General | $638,985 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $877,466 | TotalAmt |
| Program Services | $659,231 | ProgramServicesAmt |
| Management And General | $218,235 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,532 | TotalAmt |
| Management And General | $4,532 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,373 | TotalAmt |
| Management And General | $39,373 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,724 | TotalAmt |
| Management And General | $11,724 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,047 | TotalAmt |
| Program Services | $4,936 | ProgramServicesAmt |
| Management And General | $31,111 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $70,772 | TotalAmt |
| Program Services | $30,613 | ProgramServicesAmt |
| Management And General | $40,159 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $934,455 | TotalAmt |
| Management And General | $934,455 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,128,570 | TotalAmt |
| Management And General | $2,128,570 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES MEDICAL AND DR | $12,391,798 | $12,181,655 | $210,143 |
| PURCHASED SERVICES | $10,609,294 | $2,433,995 | $8,175,299 |
| BAD DEBT EXPENSE | $1,935,588 | $1,935,588 | |
| RENTAL OF EQUIPMENT | $706,592 | $519,239 | $187,353 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,572,912 | TotalAmt |
| Program Services | $649,672 | ProgramServicesAmt |
| Management And General | $923,240 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,804,056 | TotalAmt |
| Program Services | $29,113,814 | ProgramServicesAmt |
| Management And General | $16,690,242 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $550 | BOYAmt |
| EOY | $550 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,932,648 | BOYAmt |
| EOY | $5,863,226 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $638,306 | BOYAmt |
| EOY | $729,398 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $64,645,085 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $26,927,189 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,928,217 | BOYAmt |
| EOY | $37,717,896 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,131,149 | BOYAmt |
| EOY | $4,105,778 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,630,870 | BOYAmt |
| EOY | $48,416,848 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,999,373 | BOYAmt |
| EOY | $1,339,700 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,707,007 | BOYAmt |
| EOY | $43,395,976 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,706,380 | BOYAmt |
| EOY | $44,735,676 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,924,490 | BOYAmt |
| EOY | $3,681,172 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,924,490 | BOYAmt |
| EOY | $3,681,172 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,630,870 | BOYAmt |
| EOY | $48,416,848 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,756,682 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $5,292 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $5,292 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL PAYS DUES TO THE OHIO HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. THE AMOUNT REPORTED REPRESENTS THE PORTION OF THOSE DUES USED BY THE NAMED ORGANIZATIONS FOR LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $85,190 | OtherCostOrOtherBasisAmt |
| Book Value | $85,190 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $44,270,894 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,831,302 | DepreciationAmt |
| Book Value | $30,439,592 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $20,289,001 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,095,887 | DepreciationAmt |
| Book Value | $7,193,114 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $37,717,896 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ESTIMATED THIRD PARTY SETTLEMENTS | Desc |
| Book Value | $4,105,778 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $4,105,778 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO MARIETTA MEMORIAL HOSPITAL | $21,168,900 |
| DUE TO MMH - BONDS | $22,227,076 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $43,395,976 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE SYSTEM, EXCLUDING MSC, MOHP AND THE INNOVATION CENTER, IS ORGANIZED AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE UNITED STATES INTERNAL REVENUE CODE. MSC, MOHP AND THE INNOVATION CENTER ARE ORGANIZED AS LIMITED LIABILITY COMPANIES, WHEREBY, NET TAXABLE INCOME IS TAXED DIRECTLY TO THE MEMBERS AND NOT MSC, MOHP OR THE INNOVATION CENTER. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE SYSTEM AND RECOGNIZE A TAX LIABILITY IF THE SYSTEM HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE SYSTEM, AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2017 AND 2016, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. AS SUCH, THE SYSTEM IS GENERALLY EXEMPT FROM INCOME TAXES. HOWEVER, THE SYSTEM, EXCLUDING MSC, MOHP AND THE INNOVATION CENTER, IS REQUIRED TO FILE FEDERAL FORM 990 RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX WHICH IS AN INFORMATIONAL RETURN ONLY. THE SYSTEM, MSC, AND MOHP HAVE FILED THEIR TAX RETURNS FOR PERIODS THROUGH 2016. THE RETURNS FOR MSC AND MOHP ARE GENERALLY OPEN TO EXAMINATION BY THE RELEVANT TAXING AUTHORITIES FOR A PERIOD OF THREE YEARS FROM THE LATER OF THE DATE THE RETURN WAS FILED OR ITS DUE DATE (INCLUDING APPROVED EXTENSIONS). THE SYSTEM, MSC AND MOHP ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS. HOWEVER, AS OF THE DATE THE CONSOLIDATED FINANCIAL STATEMENTS WERE ISSUED, THERE WERE NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. | ExplanationTxt |
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 |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 668 | PersonsServedCnt |
| Total Community Benefit Expns | $727,028 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $727,028 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01660 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 6082 | PersonsServedCnt |
| Total Community Benefit Expns | $5,877,379 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,641,573 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,235,806 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13020 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 6750 | PersonsServedCnt |
| Total Community Benefit Expns | $6,604,407 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,641,573 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,962,834 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.14680 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $80,778 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $80,778 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $80,778 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $80,778 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 6750 | PersonsServedCnt |
| Total Community Benefit Expns | $6,685,185 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,641,573 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,043,612 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.14860 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,935,588 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $2,894,858 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,388,393 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$493,535 | 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 | SELBY GENERAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1106 COLEGATE DRIVE | AddressLine1Txt |
| City | MARIETTA | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45750 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.MHSYSTEM.ORG/SGH | WebsiteAddressTxt |
| 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 | SELBY GENERAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | 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 | 14 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.MHSYSTEM.ORG/COMMUNITYBENEFITS | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 14 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.MHSYSTEM.ORG/COMMUNITYBENEFITS | StrategyWebsiteURLTxt |
| 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 | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 100.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| 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 | WWW.MHSYSTEM.ORG/INDEXC55D.HTML?ID=136&SID=1 | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.MHSYSTEM.ORG/INDEXC55D.HTML?ID=136&SID=1 | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.MHSYSTEM.ORG/INDEXC55D.HTML?ID=136&SID=1 | FAPSummaryOnWebsiteURLTxt |
| 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 |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| None Made | Yes (X) | NoneMadeInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SELBY GENERAL HOSPITAL | PART V, SECTION B, LINE 5: KEY INFORMANT INTERVIEWS WERE CONDUCTED AT TWO WASHCO WELLNESS PARTNERS MEETINGS, AND A SURVEY WAS COMPLETED BY COMMUNITY RESIDENTS. THE TWO WASHCO WELLNESS PARTNERS MEETINGS WERE HELD ON MAY 24 AND JUNE 2, 2016, AT THE WASHINGTON COUNTY EMERGENCY OPERATIONS CENTER. THESE WERE TWO IDENTICAL MEETINGS, ONE CONDUCTED IN THE MORNING AND ONE IN THE EVENING TO ALLOW FOR GREATER ATTENDANCE BY COMMUNITY PARTNERS. TWO PUBLIC HEALTH ACCREDITATION TECHNICIANS FROM THE WASHINGTON COUNTY HEALTH DEPARTMENT FACILITATED THE MEETINGS. THE SECOND OUTREACH ACTIVITY TOOK PLACE AT THE WASHINGTON COUNTY FAIR, WHICH WAS HELD IN MARIETTA, OHIO, FROM SEPTEMBER 2 THROUGH 6, 2016. PUBLIC HEALTH OFFICIALS FROM THE WASHINGTON COUNTY HEALTH DEPARTMENT ENGAGED FAIR ATTENDEES WITH THE PAPER SURVEY AT AN APPOINTED BOOTH, RESULTING IN 89 COMPLETED SURVEYS. SURVEYS WERE COLLECTED ON SEPTEMBER 3 FROM 9 A.M. TO 6 P.M., SEPTEMBER 4 FROM 11 A.M. TO 5 P.M., AND SEPTEMBER 5 FROM 10 A.M. TO 5 P.M. ADDITIONALLY, THIS SURVEY WAS ADVERTISED ON THE WASHINGTON COUNTY WEBSITE, THE WASHINGTON COUNTY HEALTH DEPARTMENT'S FACEBOOK PAGE, AND THE WASHCO WELLNESS PARTNERS' FACEBOOK PAGE, AND IT WAS SENT TO ALL WASHINGTON COUNTY EMPLOYEES. THE SURVEY CLOSED ON SEPTEMBER 7, AND ITS TOTAL ACCUMULATION (BOTH PAPER AND ONLINE) WAS 244.AMERICAN RED CROSS: CHRIS MARRERO BEHAVIORAL HEALTH BOARD-THE RIGHT PATH: CATHY HARPER BUCKEYE BILLS-AREA AGENCY ON AGING: MINDY CAYTON CITY OF MARIETTA: CATHY HARPER FAMILY AND CHILDREN FIRST: CINDY DAVIS MARIETTA CITY HEALTH DEPARTMENT: VICKIE KELLY KELLY MILLER JONNI TUCKER MARIETTA COLLEGE (PHYSICIAN ASSISTANT PROGRAM): MIRANDA COLLINS MARIETTA CONVENTION AND VISITORS BUREAU: JERI KNOWLTO MEMORIAL HEALTH SYSTEM: SHAWN BAIL O'NEILL CENTER: CONNIE HUNTSMANPROACTIVE HEALTH SOLUTIONS: DARREN SWARTZ RETIRED AND SENIOR VOLUNTEER PROGRAM (RSVP): LISA VALENTINE WASHINGTON COUNTY HEALTH DEPARTMENT: JODY ALDEN JAYNE CALL ANGELA LOWRY COURT WITSCHEY RICHARD WITTBERG WASHINGTON STATE COMMUNITY COLLEGE : HEATHER KINCAID YMCA : SUZY ZUMWALDE |
| SELBY GENERAL HOSPITAL | PART V, SECTION B, LINE 6A: MARIETTA MEMORIAL HOSPITAL |
| SELBY GENERAL HOSPITAL | PART V, SECTION B, LINE 11: 2014 -2017 ACTION PLANDETAILS ABOUT CURRENT FINDINGS AND THE PLANS FOR FUTURE IMPROVEMENTS. THE FOLLOWING ACTIONS WILL BE CONTINUED BY THE MEMORIAL HEALTH SYSTEM (MARIETTA MEMORIAL HOSPITAL AND SELBY GENERAL HOSPITAL) IN RESPONSE TO THE 2014 COMMUNITY HEALTH ASSESSMENT AND COMMUNITY HEALTH COUNCIL STAKEHOLDER REPORT.1. CREATE CONSISTENT DATA SETS TO UNDERSTAND THE TRENDS IN OUR COMMUNITY HEALTH NEEDS AND THE IMPACT OF OUR ACTIONS OVER TIME. RESULT: COLLABORATIVE WORK WITH MOV AND WASHINGTON COUNTY HEALTH DEPARTMENTS, NEW MORE INTEGRATIVE APPROACH TO CHNA. RESULT: CONTINUED USE OF SURVEY WITH COMMUNITY AGENCIES AND HEALTH ENTITIES. 2. SUPPORT THE COMMUNITY HEALTH COUNCIL.RESULT: CONTINUED PROVISION OF SPACE, CLERICAL SUPPORT AND ADMINISTRATIVE PARTICIPATION.3. PROMOTE DISEASE DETECTION AND PREVENTION IN THE COMMUNITY.A. OFFER MORE PREVENTION AND WELLNESS OUTREACH SERVICES TO LOCAL EMPLOYERS (E.G. HEALTH SCREENINGS, HEALTH EDUCATION, EXERCISE AND NUTRITIONAL SERVICES). RESULT: DEVELOPMENT OF LIVE MEMORIAL WELL, A SUB-BRAND OF THE MEMORIAL HEALTH SYSTEM DEDICATED TO WELLNESS AND PREVENTION THROUGH COMPLIMENTARY OR LIFESTYLE MEDICINE. FOCUSING ON MOVEMENT/EXERCISE, HEALTHY EATING, LEARNING OPPORTUNITIES AND BUILDING RELATIONSHIPS AND SHARING WITHIN THE COMMUNITY.RESULT: CONTINUED OUTREACH CLINICS AND SCREENINGS OFFERED IN THE COMMUNITY. IN FY 2016 OVER 3,200 COMMUNITY MEMBERS ATTENDED SCREENINGS HELD AT LOCAL BUSINESSES, COMMUNITY EVENTS AND THE HOSPITAL. SCREENINGS FOCUSED ON BLOOD PRESSURE, WEIGHT, BLOOD SUGAR, CHOLESTEROL, A1C, PSA AND MULTIPHASIC. 4. PARTNER WITH MARIETTA COLLEGE AND PEOPLE'S BANK TO SUSTAIN THE HUNGER SOLUTIONS TASKFORCE WORK TO REDUCE HUNGER IN THE COMMUNITY.RESULT: HELD FIRST ANNUAL BOUNTY BY THE RIVER FUND-RAISING EVENT RESULTING IN $22,000 RAISED. CONTINUED LOCAL ORGANIZATIONAL FUND-RAISING BY FOUNDING PARTNER ORGANIZATIONS WITH PEOPLES BANK RAISING $54,936 AND MHS RAISING $21,775. RESULT: PROVIDED $21,748.27 IN SUPPORT OF LIVE HEALTHY KIDS PROGRAM AND $155,936.93 IN DIRECT FOOD ASSISTANCE THROUGH SEO FOOD BANK AND LOCAL PARTICIPATING FOOD PAN TRIES IN 2015 AND 2016. 5. SUPPORT MENTAL HEALTH NEEDS IN THE COMMUNITY.RESULT: DEVELOPING A STRATEGIC PARTNERSHIP WITH THE WASHINGTON COUNTY BEHAVIORAL HEALTH BOARD TO POSITION MEMORIAL HEALTH SYSTEM AS A RELIABLE RESOURCE FOR BEHAVIORAL HEALTH INFORMATION, EDUCATION, TRAINING AND TREATMENT FOR GERIATRIC BEHAVIORAL HEALTH SERVICES. BECOME THE STRATEGIC PARTNER FOR THE MENTAL HEALTH FIRST AIDE TRAINING OFFERED TO PROFESSIONALS AND THE COMMUNITY.> MENTAL HEALTH FIRST AID IS A GROUNDBREAKING PUBLIC EDUCATION PROGRAM THAT HELPS THE CONSUMERS AND PROFESSIONALS IDENTIFY, UNDERSTAND, AND RESPOND TO SIGNS OF MENTAL ILLNESS AND SUBSTANCE ABUSE DISORDERS.RESULT: ESTABLISH MHS AS THE CENTER FOR BEHAVIORAL HEALTH EDUCATION FOR PROFESSIONALS AND CONSUMERS. OFFER QUARTERLY TRAINING FOR PROVIDERS ON MENTAL HEALTH TOPICS INCLUDING SUICIDE PREVENTION, DEPRESSION IN THE ELDERLY, TRAUMA INFORMED CARE IN OUTPATIENT SETTINGS, MANAGING DIFFICULT BEHAVIORS. PROVIDE QUARTERLY LUNCH AND LEARN EDUCATION SERIES. ESTABLISH A MONTHLY COMMUNITY LECTURE SERIES "CHANGING PERCEPTIONS ABOUT MENTAL ILLNESS". IDENTIFY SUPPORT GROUPS NEEDED IN THE COMMUNITY SUCH AS ALZHEIMER SUPPORT GROUP, INTENSIVE OUTPATIENT GRADUATE SUPPORT GROUP, BARIATRIC SUPPORT GROUP, PSYCHOSOCIAL EDUCATION GROUP.6. CONTINUE TO PROVIDE SMOKING CESSATION PROGRAM TO THE COMMUNITY.7. CONTINUED DEVELOPMENT OF THE CONTACT CENTER A. ADD NURSE TRIAGERESULT: NURSE TRIAGE LINE. THE NURSE TRIAGE LINE IS STAFFED 24 HOURS AND OPEN TO THE PUBLIC. THE NURSE TRIAGE LINE ALSO SERVES AS AN AFTER-HOURS NURSE LINE FOR 50 PCPS AND SPECIALISTS. IT AVERAGES 3038 INCOMING CALLS AND 125 TRIAGES PER MONTH AND HAS PARTICIPATED IN THE PREVENTION OF 258 UNNECESSARY ED VISITS LAST YEAR.RESULT: SCHEDULING POST DISCHARGE APPOINTMENTS THE CONTACT CENTER STARTED A PILOT IN JANUARY, 2017 TO SCHEDULE PATIENT'S FOLLOW-UP APPOINTMENTS PRIOR TO DISCHARGE. CURRENTLY, THE CONTACT CENTER IS SCHEDULING FOR 11 CLINICS AND OVER 20 PROVIDERS. THE PILOT REMAINS SUCCESSFUL WITH EXPANSION TO MORE CLINICS REGULARLY.RESULT: DISCHARGE CALLS. THE CONTACT CENTER CONDUCTS 100% OF DISCHARGE CALLS INCLUDING THOSE FOR IN PATIENT STAYS AND OUTPATIENT PROCEDURES WITH AN AVERAGE OF 80% CONTACTED. THE CONTACT CENTER INCREASED THE PERCENTAGE OF POST ED VISIT CALLS ATTEMPTED FROM 6% TO 97% OVER THE LAST 12 MONTHS. THE CONTACT CENTER CONDUCTED OVER 71,000 FOLLOW UP CALLS OVER THE LAST 12 MONTHS WITH AN AVERAGE OF 6,000 CALLS MONTHLY.INFORMATION RECEIVED FROM FOLLOW-UP CALLS IS USED TO TREND PATIENT UNDERSTANDING OF DISCHARGE INSTRUCTIONS AND OTHER DATA POINTS. RESULTS ARE SHARED WITH DEPARTMENTS MONTHLY. 8. DEVELOP A REGIONAL NETWORK TO MANAGE POPULATION HEALTHA. ASSIST COMMUNITY AND POST-ACUTE CARE SETTINGS IN TRANSITION TO ACORESULT: MMH LEADING A PAC COALITION THAT MEETS MONTHLY TO WORK ON PATIENT CARE COORDINATION AND TRANSITION OPPORTUNITIES ALONG WITH QUALITY INCENTIVES WHICH INCLUDE METRICS FOR ACOS AND THE FIVE STAR QUALITY REPORT BASED ON CMS REQUIREMENTS. THIS GROUP ALSO WORKS ON OTHER PATIENT CARE NEEDS OR OPPORTUNITIES BASED ON CASE REVIEW AND REPORTED CONCERNS. RESULT: MMH CONTINUES TO SUPPORT THE COMMUNITY BASED CARE TRANSITION PROGRAM WITH OUR LOCAL AREA ON AGING AGENCY-BUCKEYE HILLS. THIS INCLUDES EXTENDING THIS COMMUNITY SERVICE AFTER THE CMS GRANT HAS CONCLUDED. OUR PROGRAM WAS RANK 2ND IN NATION BASED ON METRICS AND RESULTS SHARED BY ALL 175 PROGRAMS NATIONWIDE. WE ARE CONTINUING TO WORK ON MAINTAINING THIS PROGRAM ONCE THE CMS PROJECT CONCLUDES. RESULT: CLINISYNC IS HELPING MHS AND OUR COMMUNITY PAC ENSURE ELECTRONIC ACCESS AND SHARING OF THE EHR. B. REDUCE HOSPITAL READMISSIONSRESULT: READMISSION TEAM. MEMORIAL HEALTH SYSTEM IS FOCUSED TO REDUCE READMISSIONS THAT ARE PREVENTABLE. THE READMISSION SUBCOMMITTEE WAS FORMED AND CHARTERED IN JUNE 2016. THIS IS A MULTIDISCIPLINARY SUBCOMMITTEE/TEAM WHICH INCLUDES REPRESENTATIVES FROM MED ICAL STAFF; CARE MANAGEMENT; CLINIC OPERATIONS; QUALITY; NURSING; HOME HEALTH IS REVIEWING DATA AND DEVELOPING A MULTI-PRONGED APPROACH TO REDUCE READMIS SIONS. KEY AREAS OF FOCUS ARE AS FOLLOWS:> PATIENT/FAMILY: PROVIDING EDUCATION AND TOOLS ON KEY AREAS OF HEALTH CONCERNS SUCH AS DISEASE MANAGEMENT, MEDICATIONS, ETC.;> CLINICS/PHYSICIAN OFFICES: FOLLOWING CHRONIC PATIENTS AND THOSE RECENTLY DISCHARGED CLOSELY, EDUCATION, ETC.;> MEDICAL STAFF/NURSING: ONGOING EDUCATION, WORKING WITH IT ON DEVELOPING APPROPRIATE NOTIFICATION OF RECENT DISCHARGE, CASE REVIEWS, ETC.;> CARE MANAGEMENT: UTILIZATION OF APPROPRIATE LEVEL OF CARE AND RESOURCES ARE PROVIDED FOR PATIENTS GOING HOME SUCH AS COMMUNITY RESOURCES, HOME HEALTH, ETC.;> NUMEROUS OTHERS ARE INVOLVED WITH THIS HIGH PRIORITY SUCH AS EDUCATIONAL SERVICES, QUALITY, IT, CONTACT CENTER, MARKETING, ETC.RESULT: CREATION OF CARE COORDINATOR POSITION IN OUTPATIENT CLINICS. CONTACT ADMITTED PATIENT AFTER DISCHARGE FOLLOWING TCM GUIDELINES (48 BUSINESS HOURS) TO CHECK PATIENT STATUS, ANSWER QUESTIONS, AND ADDRESS ANY BARRIERS. REINFORCING THE ZONES FOR READMISSION INITIATED ON THE INPATIENT SIDE, WHEN APPROPRIATE. TRACKING PATIENTS WITH FREQUENT AND INAPPROPRIATE ED UTILIZATION AND INITIATING CONVERSATIONS ABOUT PROPER UTILIZATION OF HEALTH SYSTEM RESOURCES.C. CHRONIC DISEASE MANAGEMENT RESULT: CONDUCTING PILOT PROGRAM IN 2017 WITH MHS DIABETIC EMPLOYEES TO DEVELOP PROTOCOLS AND PROGRAM THAT CAN BE REPLICATED FOR OTHER DISEASES AND OTHER SEGMENTS OF THE COMMUNITY. RESULT: CREATION OF CARE COORDINATOR POSITION IN OUTPATIENT CLINICS. INITIAL FOCUS OF THE CARE COORDINATOR POSITION IS ASSISTING WITH IMPROVING THE MANAGEMENT OF OUR DIABETIC POPULATION. INCLUDES:> IDENTIFYING POORLY MANAGED PATIENTS.> IDENTIFYING ADDITIONAL DIABETIC RESOURCES THAT MAY BE BENEFICIAL FOR THE PATIENT (EX. DIABETIC EDUCATION CENTER, EVIDENCE AND COMMUNITY BASED DIABETIC EDUCATION CLASSES).> ONE ON ONE EDUCATION IN THE OFFICE.> ASSISTING THE PROVIDER AND STAFF TO ADDRESS ALL ITEMS IN THE DIA BETIC BUNDLE AND PROPERLY DOCUMENT. A HYPERTENSION BUNDLE IS BEING DEVELOPED IN 2017, THE CARE COORDINATORS WILL ASSIST WITH IMPROVING THE MANAGEMENT OF THIS CHRONIC DISEASE POPULATION9. PROVIDE INSURANCE ALTERNATIVE DESIGNED TO REDUCE HEALTHCARE SPENDING OF LOCAL BUSINESSES THROUGH SHARED RISK MODELRESULT: WE HAVE NOT BEEN ABLE TO EXECUTE ON THIS ACTION ITEM DUE TO RESOURCES CONCEN TRATING ON OUR ACO DEVELOPMENT AND WORK. 10. ASSIST COMMUNITY MEMBERS IN SIGNING UP FOR INSURANCE THROUGH THE AFFORDABLE CARE ACT11. DEVELOP PHYSICIAN SUCCESSION PLANS TO ENSURE CONTINUED ACCESS TO CARE IN LIGHT OF BABY BOOMER RETIREMENTS12. EXPAND BREAST CANCER TREATMENT13. EXPAND CARDIOVASCULAR SERVICES. |
| SELBY GENERAL HOSPITAL | PART V, SECTION B, LINE 16J: APPLICATION IS ON THE BACK OF THE ACCOUNT STATEMENT MAILER. |
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART III, LINE 2: | ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON THE SYSTEM'S EVALUATION OF ITS MAJOR PAYOR SOURCES OF REVENUE, THE AGING OF THE ACCOUNTS, HISTORICAL LOSSES, CURRENT ECONOMIC CONDITIONS, AND OTHER FACTORS UNIQUE TO THEIR SERVICE AREA AND THE HEALTHCARE INDUSTRY. |
| PART III, LINE 3: | THE HOSPITAL HAS A DETAILED FINANCIAL ASSISTANCE POLICY WHICH STATES THAT TO PARTICIPATE IN CHARITY CARE CANDIDATES MUST COOPERATE FULLY. IN ADDITION THE HOSPITAL EDUCATES PATIENTS WILL LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THIS REASON THE ORGANIZATION BELIEVES THAT IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE. |
| PART III, LINE 4: | ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON THE SYSTEM'S EVALUATION OF ITS MAJOR PAYOR SOURCES OF REVENUE, THE AGING OF THE ACCOUNTS, HISTORICAL LOSSES, CURRENT ECONOMIC CONDITIONS, AND OTHER FACTORS UNIQUE TO THEIR SERVICE AREA AND THE HEALTHCARE INDUSTRY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PAYMENTS, WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL, THE SYSTEM RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.THE SEPTEMBER 30, 2017 AND 2016 ALLOWANCE FOR DOUBTFUL ACCOUNTS OF $51,022,179 AND $44,088,234, RESPECTIVELY, RELATES TO RESERVES FOR SELF-PAY BALANCES.THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS BASED ON A PERCENTAGE OF SELF-PAY ACCOUNTS RECEIVABLE AT SEPTEMBER 30, 2017 AND 2016. THE SYSTEM'S SELF-PAY WRITE-OFFS DECREASED $831,879 FROM $26,662,981 FOR 2016 TO $25,831,102 FOR 2017. THE SYSTEM DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR DOUBTFUL ACCOUNTS FROM THIRD-PARTY PAYORS, NOR DID IT HAVE SIGNIFICANT WRITE-OFFS FROM THIRD-PARTY PAYORS. |
| PART III, LINE 8: | THE SHORTFALL IS THE RESULT OF THE HOSPITAL SUBSIDIZING AN INPATIENT PHYSICAL REHABILITATION UNIT (10 BEDS) FOR WHICH MEDICARE DOES NOT PAY FULL COST.THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED 9/30/17 REPORT: HOSPITAL STATEMENT OF REIMBURSABLE COST. |
| PART III, LINE 9B: | PATIENTS ARE ENCOURAGED BY THE FINANCIAL ADVOCATES TO COMPLETE A CHARITY APPLICATION AND THUS AVOID THE COLLECTION PROCEDURE. THIS IS WRITTEN ON THE PATIENT BILLING STATEMENT. |
| PART VI, LINE 3: | WWW.MHSYSTEM.ORG/INDEXC55D.HTML?ID=136&SID=1 |
| PART VI, LINE 4: | WASHINGTON COUNY HAS A SIGNIFICANT SENIOR POPULATION. THE PER CAPITA INCOME IN WASHINGTON COUNTY IS LOWER THAN THE STATE MEDIAN, AND 15% OF THE OVERALL COUNTY POPULATION IS BELOW THE POVERTY LINE. OF THE CHILDREN IN WASHINGTON COUNTY, 21% LIVE IN POVERTY. IN THE COUNTY, 10.8% OF THE RESIDENTS LACK HEALTH INSURANCE. OF THE CHILDREN IN WASHINGTON COUNTY, 25.5% RESIDE IN SINGLE-PARENT HOUSEHOLDS. THERE IS A HIGHER THAN AVERAGE NUMBER OF ADULTS RESIDING IN WASHINGTON COUNTY WHO DO NOT HAVE ADEQUATE SOCIAL OR EMOTIONAL SUPPORT. THERE IS A HIGHER THAN AVERAGE NUMBER OF GRANDPARENTS WHO SERVE AS PRIMARY CAREGIVERS TO CHILDREN IN WASHINGTON COUNTY. THERE IS A HIGHER PERCENTAGE OF SMOKERS IN WASHINGTON COUNTY THAN IN THE STATE OR NATION. WASHINGTON COUNTY HAS A HIGHER RATE OF OBESITY THAN THE STATE OR NATION. WASHINGTON COUNTY HAS A LOWER RATE OF INDIVIDUALS WHO WALK OR RIDE A BICYCLE TO WORK AND LESS OVERALL PHYSICAL ACTIVITY THAN THE STATE OR NATION. THE COUNTY HAS A HIGHER PERCENTAGE OF THE POPULATION THAT SELF-REPORTS A POOR OR FAIR HEALTH STATUS COMPARED TO INDIVIDUALS ACROSS THE STATE OR NATION. THE MORTALITY RATES FOR UNINTENTIONAL INJURY, LUNG DISEASE, AND STROKE ARE HIGHER IN WASHINGTON COUNTY THAN THE STATE OR NATIONAL AVERAGE. |
| PART VI, LINE 5: | WE ENHANCE THE QUALITY OF LIFE IN THE MID-OHIO VALLEY. WE NURTURE AND CARE FOR OUR COMMUNITY BY CARING FOR YOU, YOUR FRIENDS, NEIGHBOR AND RELATIVES 24 HOURS A DAY, SEVEN DAYS A WEEK, 365 DAYS A YEAR. WE ARE QUALITY - WITH ACCREDITATIONS, CERTIFICATIONS AND DESIGNATIONS TO EXPRESS, UTILIZE AND DEMONSTRATE OUR EXPERTISE. WE ARE PART OF A SYSTEM THAT EXTENDS ACCESS TO SPECIALISTS AND NATIONALLY RECOGNIZED CARE. WE ARE A PILLAR IN THIS COMMUNITY WITH ROOTS FIRMLY PLANTED IN THE REGIONS WE SERVE. WE ARE AT YOUR DOORSTEP, WITH PROGRAMS AND EDUCATIONAL INFORMATION THAT PROMOTE GOOD HEALTH AND DISEASE PREVENTION. WE ARE VOLUNTEERS AT LOCAL COMMUNITY EVENTS. WE ARE ADVOCATES FOR SUPERIOR HEALTH CARE SYSTEMS. WE ARE TEACHERS, TRAINING FUTURE HEALTH CARE PROFESSIONALS. WE ARE COMPASSIONATE, CARING AND DEDICATED TO CREATING A HEALTH CARE SETTING IN WHICH QUALITY OF LIFE AND SERVICE EXCELLENCE ARE EXPERIENCED BY OUR PATIENTS THEIR FAMILIES, THE MEDICAL STAFF AND THE COMMUNITY. WE ARE SELBY GENERAL HOSPITAL. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | OH |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JOSEPH COOPER MD | ||||||||||||||
| SECRETARY | $0 | $381,033 | $0 | $6,322 | $0 | $0 | $0 | $1,060 | $0 | $36,703 | $0 | $425,118 | $0 | $0 |
| JOHN LEE MD | ||||||||||||||
| BOARD MEMBER | $0 | $583,877 | $0 | $0 | $0 | $0 | $0 | $1,060 | $0 | $36,360 | $0 | $621,297 | $0 | $0 |
| DAN BREECE DO | ||||||||||||||
| MEDICAL STAFF PRESIDENT | $0 | $744,304 | $0 | $31,500 | $0 | $0 | $0 | $1,060 | $0 | $37,320 | $0 | $814,184 | $0 | $0 |
| ERIC YOUNG | ||||||||||||||
| CFO | $0 | $405,505 | $0 | $87,500 | $0 | $0 | $0 | $19,060 | $0 | $36,758 | $0 | $548,823 | $0 | $0 |
| STEPHEN SMITH | ||||||||||||||
| CEO | $232,857 | $0 | $48,517 | $0 | $0 | $0 | $790 | $0 | $35,591 | $0 | $317,755 | $0 | $0 | $0 |
| KEVIN GANNON | ||||||||||||||
| PHYSICIAN | $117,027 | $0 | $6,260 | $0 | $0 | $0 | $407 | $0 | $35,622 | $0 | $159,316 | $0 | $0 | $0 |
| VINCE STOLLAR | ||||||||||||||
| DIRECTOR OF PHARMACY | $136,934 | $0 | $300 | $0 | $0 | $0 | $537 | $0 | $35,723 | $0 | $173,494 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4B | FormAndLineReferenceDesc |
| Explanation | THE FOLLOWING CONTRIBUTIONS WERE MADE TO THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN FOR THE FISCAL YEAR ENDED 9/30/2017: JOSEPH COOPER, MD - $1,060 JOHN LEE, MD - $1,060 DAN BREECE, DO - $1,060 ERIC YOUNG - $1,060 | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MIKE ARCHER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | BOARD MEMBER | RelationshipDescriptionTxt |
| Transaction | $1,057,721 | TransactionAmt |
| Transaction | BUILDING RENT | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE SHALL HAVE ALL THE POWERS AND DUTIES OF THE BOARD OF DIRECTORS IN THE INTERIM BETWEEN MEETINGS OF THE LATTER, EXCEPT AS LIMITED BY THIS CODE OF REGULATIONS OR BY SPECIFIC INSTRUCTION OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE SHALL NOT HAVE POWER TO ELECT DIRECTORS. A SUMMARY OF THE PROCEEDINGS OF THE EXECUTIVE COMMITTEE SHALL BE REPORTED TO THE BOARD AT ITS NEXT MEETING. THE EXECUTIVE COMMITTEE SHALL MAINTAIN THE COMPENSATION COMMITTEE AND NOMINATING COMMITTEE. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE PROCESS OF REVIEWING THE FORM 990 ENTAILS A DETAILED REVIEW BY THE ORGANIZATION'S ACCOUNTING DEPARTMENT. THE GOVERNING BODY RECEIVES AN ELECTRONIC COPY OF THE FORM 990 INCLUDING REQUIRED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, FOR REVIEW AFTER THE RETURN HAS BEEN FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE WRITTEN CONFLICT OF INTEREST POLICY IS REGULARLY AND CONSISTENTLY MONITORED AND COMPLIANCE ENFORCED BY THE CORPORATE INTEGRITY COMMITTEE. THE SCOPE OF THIS POLICY INCLUDES THE DIRECTORS,OFFICERS AND SENIOR EXECUTIVES. THE PURPOSE OF THE POLICY IS TO PROTECT THE HOSPITAL'S INTEREST WHEN IT IS CONNTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF AN INTERESTED OFFICER, DIRECTOR OR PERSON. ANY CONFLICT RESULTING IN INELIGIBILITY FOR OR REMOVAL FROM THE BOARD OR SPECIFIC COMMITTEES INCLUDE THE FOLLOWING: A. REPEATED, INTENTIONAL FAILURE TO DISCLOSE A CONFLICT OF INTEREST. B.HAVING A FAMILIY MEMBER WHO IS A SENIOR EXECUTIVE FOR THE HOSPITAL. C. A MATERIAL INVESTMENT OR EMPLOYMENT RELATIONSHIP INVOLVING AN INTERESTED PERSON IN AN ASC, A PROPRIETARY HOSPITAL, OR NURSING FACILTIY WHTIN THE HSOPITAL'S SERVICE AREA THAT IS NOT OWNED BY THE HOSPITAL. ANNUAL DISCLOSURES ARE REQUIRED SETTING FORTH ALL BUSINESS AND OTHER AFFILIATIONS, WHICH RELATE IN ANY WAY TO THE HOSPITAL.. THE COMMITTEE RECOMMENDS THE DISQUALIFICATION OR REMOVAL OF INTERESTED PERSONS WHEN NECESSARY AND REPORTS TO THE BOARD THOSE DIRECTORS WHICH THE COMMITTEE HAS DETERMINED MEET THE DEFINITION OF INDEPENDENT DIRECTOR. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION COMMITTEE REVIEWS FAIR MARKET WAGE DATA. SPECIFIC APPROVAL OF BOARD MUST BE SOUGHT IF PHYSICIAN COMPENSATION IS 75% OR GREATER OF MEDIAN IN THE ANNUAL MGMA STUDY. EXECUTIVE AND ALL OTHER HOSPITAL STAFF COMPENSATION IS SET AT MEDIAN. AN EXECUTIVE COMPENSATION FIRM IS UTILIZED (YAFFE & COMPANY). A SEPARATE INDEPENDENT CONSULTANT (VMG) IS RETAINED FOR PHYSICIAN COMPENSATION STUDIES AS NEEDED. |
| FORM 990, PART VI, SECTION C, LINE 19 | YES. THE DOCUMENTS CAN BE VIEWED IN THE ADMINISTRATION OFFICE. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|
| MARIETTA AREA HEALTHCARE INC | |||||||||
| 401 MATTHEW STREET | MARIETTA | OH | 45750 | 311126451 | MANAGEMENT | OH | 501(C)(3) | 0 | |
| MARIETTA HEALTHCARE PHYSICIANS INC | |||||||||
| 401 MATTHEW STREET | MARIETTA | OH | 45750 | 311375125 | PHYSICIAN GROUP | OH | 501(C)(3) | 0 | MARIETTA AREA HEALTHCARE INC |
| MEMORIAL HEALTH FOUNDATION | |||||||||
| 401 MATTHEW STREET | MARIETTA | OH | 45750 | 311011321 | SUPPORTING ORG | OH | 501(C)(3) | 0 | MARIETTA AREA HEALTHCARE INC |
| MARIETTA MEMORIAL HOSPITAL | |||||||||
| 401 MATTHEW STREET | MARIETTA | OH | 45750 | 314379509 | HOSPITAL | OH | 501(C)(3) | 0 | MARIETTA AREA HEALTHCARE INC |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|
| MARIETTA OCUPATIONAL HEALTH PARTNERS LLC | ||||||||
| 401 MATTHEW ST | MARIETTA | OH | 45750 | 043587132 | OCCUPATIONAL HEALTH | OH | 0 | 0 |
| MARIETTA SURGERY CENTER LLC | ||||||||
| 611 2ND ST | MARIETTA | OH | 45750 | 311684367 | SURGERY | OH | 0 | 0 |
| 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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