GIBSON GENERAL HOSPITAL INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- GIBSON GENERAL HOSPITAL INC (EIN 35-0877575)
- Tax period
- 2016-10-01 to 2017-09-30
- Filed
- 2018-04-02
- IRS object ID
- 201830929349300983
- 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 B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-04-02T18:55:18-05:00 | ReturnTs |
| Tax Period End | 2017-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 351178661 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Blue & Co LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 N Meridian St Suite 200 | AddressLine1Txt |
| City | Indianapolis | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46204 | 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 | 350877575 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Gibson General Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GIBS | BusinessNameControlTxt |
| Phone | 8123853401 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1808 Sherman Drive | AddressLine1Txt |
| City | Princeton | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47670 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | emmett c schuster | PersonNm |
| Person Title | ceo | PersonTitleTxt |
| Phone | 8123853401 | PhoneNum |
| Signature | 2018-04-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Amber Kocher CPA | PreparerPersonNm |
| PTIN | P01286298 | PTIN |
| Phone | 3176334705 | PhoneNum |
| Preparation | 2018-04-02 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 184.0.71.246 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-04-02 | IPDt |
| IP Tm | 18:55:15 | IPTm |
| IP Timezone | ED | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DB79E0D6220D8C9E881682F2265FA72E8C0F7A33 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 48BB13F909289851469C7DA648BAC11FC748AA42 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | emmett c schuster | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1808 Sherman Drive | AddressLine1Txt |
| City | Princeton | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47670 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $30,119,690 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.gibsongeneral.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1941 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | to provide high quality, patient-centered, cost-effective care for people in the community. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 15 | VotingMembersIndependentCnt |
| Total Employee | 408 | TotalEmployeeCnt |
| Total Volunteers | 40 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $111,233 | PYContributionsGrantsAmt |
| CY Contributions Grants | $227,932 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $33,111,853 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $29,409,953 | CYProgramServiceRevenueAmt |
| PY Investment Income | $351,120 | PYInvestmentIncomeAmt |
| CY Investment Income | $14,946 | CYInvestmentIncomeAmt |
| PY Other Revenue | $342,938 | PYOtherRevenueAmt |
| CY Other Revenue | $466,859 | CYOtherRevenueAmt |
| PY Total Revenue | $33,917,144 | PYTotalRevenueAmt |
| CY Total Revenue | $30,119,690 | 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 | $18,255,806 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $16,167,844 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $15,836,238 | PYOtherExpensesAmt |
| CY Other Expenses | $12,190,528 | CYOtherExpensesAmt |
| PY Total Expenses | $34,092,044 | PYTotalExpensesAmt |
| CY Total Expenses | $28,358,372 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$174,900 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,761,318 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $20,555,925 | TotalAssetsBOYAmt |
| Total Assets EOY | $22,282,548 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $10,599,013 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $10,940,910 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $9,956,912 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $11,341,638 | NetAssetsOrFundBalancesEOYAmt |
| Mission | the mission of gibson general hospital and the skilled nursing facility is to provide high quality, patient-centered, cost-effective care for people in our community. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $22,554,419 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $29,620,218 | RevenueAmt |
| Desc | the hospital's mission is to provide high quality and cost-effective healthcare, which includes patient, outpatient, and emergency care services to the residents of the surrounding tri-state area. all expenses relate to costs associated with providing these services, and mainly include salaries and wages to staff and supplies cost. there were 323 admissions and 30,276 visits during the year. | Desc |
| Total Program Service Expenses | $22,554,419 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| 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 | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | 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 | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 72 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 408 | 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 | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 15 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 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 | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | IN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | James Childers | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8123853401 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1808 Sherman drive | AddressLine1Txt |
| City | princeton | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47670 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (28 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| robert gibson jr | |||||||||
| board chairman | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| marion jochim | |||||||||
| board vice-chair | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| j robert kinkle | |||||||||
| second vice-chair | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| mike wood | |||||||||
| secretary | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| susan straub | |||||||||
| treasurer | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Krishna Murthy MD | |||||||||
| chief of staff | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| george a ballard | |||||||||
| board member | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| alan Douglas | |||||||||
| board member 1/1-9/30/17 | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Jared Florence | |||||||||
| board member 1/1-9/30/17 | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Dr michael green | |||||||||
| board member | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| MS Krishna MD | |||||||||
| board member | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| stephen lankford | |||||||||
| board member | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Shawn McCoy | |||||||||
| board member 1/1-9/30/17 | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Derek McGraw | |||||||||
| board member 11/1/16-9/30/17 | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Henry brewster MD | |||||||||
| board member 10/1-11/1/16 | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Allen White MD | |||||||||
| board member 1/1-9/30/17 | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| larry johnson | |||||||||
| board member 10/1-12/31/16 | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| donald j hauke | |||||||||
| board member 10/1-12/31/16 | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| sherri smith | |||||||||
| board member 10/1-12/31/16 | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| george ankenbrand | |||||||||
| board member 10/1-12/31/16 | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| emmett schuster | |||||||||
| chief executive officer | 50.00 | 0.00 | Yes (X) | $201,713 | $0 | $17,855 | |||
| James Childers | |||||||||
| chief financial officer | 50.00 | 0.00 | Yes (X) | $82,564 | $0 | $1,423 | |||
| lori phillips | |||||||||
| chief nursing officer | 50.00 | 0.00 | $152,359 | $0 | $159 | Yes (X) | |||
| Phillip Rosett | |||||||||
| Physician | 40.00 | 0.00 | $359,905 | $0 | $19,374 | Yes (X) | |||
| corey a potts | |||||||||
| crna | 40.00 | 0.00 | $252,362 | $0 | $18,120 | Yes (X) | |||
| stephen r shoemaker | |||||||||
| physician | 40.00 | 0.00 | $242,253 | $0 | $19,298 | Yes (X) | |||
| richard m clark | |||||||||
| physician | 40.00 | 0.00 | $241,872 | $0 | $26,239 | Yes (X) | |||
| Kwabena Owusu-Dekyi | |||||||||
| Physician | 40.00 | 0.00 | $182,418 | $0 | $19,348 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,715,446 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $121,816 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 12 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Thomas Joseph MD | |||||
| 1808 Sherman drive | princeton | IN | 47670 | Medical pro fees | $585,640 |
| blake titzer | |||||
| po box 130 | inglefield | IN | 47618 | medical pro fees | $374,542 |
| philomina thuruthumaly md | |||||
| 1707 brentwood drive | princeton | IN | 47670 | medical pro fees | $243,750 |
| Alliant Management Services | |||||
| 1280 B Meridian St Suite 400 | Carmel | IN | 46032 | Management Services | $144,661 |
| Medical Staffing Solutions LLC | |||||
| 9700 HWY 57 North Suite A | evansville | IN | 47725 | Recruitment | $142,358 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $10,432 | RelatedOrganizationsAmt |
| All Other Contributions | $217,500 | AllOtherContributionsAmt |
| Total Contributions | $227,932 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Service Revenue | 624100 | $26,803,240 | $26,803,240 |
| Long Term Care Revenue | 623000 | $2,606,713 | $2,606,713 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $29,409,953 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,946 | TotalRevenueColumnAmt |
| Exclusion | $14,946 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $59,192 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $59,192 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $59,192 | TotalRevenueColumnAmt |
| Exclusion | $59,192 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Cafeteria Revenue | Desc |
| Business | 722210 | BusinessCd |
| Total Revenue Column | $137,150 | TotalRevenueColumnAmt |
| Exclusion | $137,150 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $270,517 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $210,265 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $60,252 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $407,667 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $30,119,690 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $29,620,218 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $271,540 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $436,636 | TotalAmt |
| Management And General | $436,636 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,711,518 | TotalAmt |
| Program Services | $11,373,177 | ProgramServicesAmt |
| Management And General | $1,338,341 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $177,482 | TotalAmt |
| Program Services | $143,267 | ProgramServicesAmt |
| Management And General | $34,215 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,915,896 | TotalAmt |
| Program Services | $1,530,410 | ProgramServicesAmt |
| Management And General | $385,486 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $926,312 | TotalAmt |
| Program Services | $783,563 | ProgramServicesAmt |
| Management And General | $142,749 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $801,552 | TotalAmt |
| Management And General | $801,552 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $157,894 | TotalAmt |
| Management And General | $157,894 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,292,628 | TotalAmt |
| Program Services | $2,499,677 | ProgramServicesAmt |
| Management And General | $792,951 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $156,691 | TotalAmt |
| Program Services | $156,691 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $650,679 | TotalAmt |
| Program Services | $511,440 | ProgramServicesAmt |
| Management And General | $139,239 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,860,650 | TotalAmt |
| Program Services | $942,580 | ProgramServicesAmt |
| Management And General | $918,070 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,056 | TotalAmt |
| Program Services | $78,103 | ProgramServicesAmt |
| Management And General | $7,953 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $295,898 | TotalAmt |
| Program Services | $295,898 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,269,751 | TotalAmt |
| Program Services | $1,210,143 | ProgramServicesAmt |
| Management And General | $59,608 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $400,544 | TotalAmt |
| Program Services | $42,548 | ProgramServicesAmt |
| Management And General | $357,996 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical & Drug Supplies | $2,214,265 | $2,209,999 | $4,266 |
| HAF Expense | $625,118 | $625,118 | |
| Dues & Sub. | $332,653 | $105,656 | $226,997 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,149 | TotalAmt |
| Program Services | $46,149 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,358,372 | TotalAmt |
| Program Services | $22,554,419 | ProgramServicesAmt |
| Management And General | $5,803,953 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,112,783 | BOYAmt |
| EOY | $2,793,850 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,147,978 | BOYAmt |
| EOY | $4,146,257 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,399,288 | BOYAmt |
| EOY | $3,285,892 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $756,580 | BOYAmt |
| EOY | $783,371 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $273,611 | BOYAmt |
| EOY | $248,364 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $35,066,130 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $24,777,482 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,365,493 | BOYAmt |
| EOY | $10,288,648 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $79,926 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $500,192 | BOYAmt |
| EOY | $656,240 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,555,925 | BOYAmt |
| EOY | $22,282,548 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,488,341 | BOYAmt |
| EOY | $2,175,408 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $69,297 | BOYAmt |
| EOY | $925,541 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,714,094 | BOYAmt |
| EOY | $6,060,996 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,327,281 | BOYAmt |
| EOY | $1,045,301 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $733,664 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,599,013 | BOYAmt |
| EOY | $10,940,910 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,909,971 | BOYAmt |
| EOY | $11,292,424 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,941 | BOYAmt |
| EOY | $49,214 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,956,912 | BOYAmt |
| EOY | $11,341,638 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,555,925 | BOYAmt |
| EOY | $22,282,548 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,761,318 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | -$328,480 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | -$48,112 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| 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 B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $3,810 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $3,810 | 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 paid membership dues to Indiana Hospital Assocation "IHA and American Hospital Association "AHA". IHA attributed 5.40% ($594) and AHA attributed 21.78% of the dues to lobbying expenses to total $3,810. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $421,244 | OtherCostOrOtherBasisAmt |
| Book Value | $421,244 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $20,167,380 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,967,826 | DepreciationAmt |
| Book Value | $8,199,554 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $14,371,559 | OtherCostOrOtherBasisAmt |
| Depreciation | $12,809,656 | DepreciationAmt |
| Book Value | $1,561,903 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $105,947 | OtherCostOrOtherBasisAmt |
| Book Value | $105,947 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $10,288,648 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Estimated third-party settlements | Desc |
| Amt | $733,664 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $733,664 | 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 | Accounting principles generally accepted in the United States of America require management to evaluate tax positions taken by the Hospital and Foundation and recognize a tax liability if they have 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 Hospital, Foundation and Pain Management, 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. These entities are subject to routine audits by taxing jurisdictions; however, there are currently 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 |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 149.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $481,858 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $481,858 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01700 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,762,596 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,252,641 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,509,955 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08850 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,244,454 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,252,641 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,991,813 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10550 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,244,454 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,252,641 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,991,813 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10550 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,490,291 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $3,029,883 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,371,943 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$342,060 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 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 | Gibson General Hospital Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1808 Sherman Drive | AddressLine1Txt |
| City | princeton | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47670 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.gibsongeneral.com | WebsiteAddressTxt |
| State License | 17-005019-1 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | gibson general hospital inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | 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.gibsongeneral.com | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.gibsongeneral.com | 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 | 149.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| 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 | http://www.gibsongeneral.com/docs/GGH_Financial_Assistance_Policy_final.pdf | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | http://www.gibsongeneral.com/docs/2017_FAP_Application_Final.pdf | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | http://www.gibsongeneral.com/docs/FAP_plain_language.pdf | 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 |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| gibson general hospital inc | Part V, Section B, Line 5: Community Input: Between April and July 2015, the hospital partnered with the Indiana Rural Health Association (IRHA) to conduct a community health needs assessment to identify areas of greatest need in the Hospital's service area through the collection of health data and community input on the community's assets, values, and weaknesses. A focus group of Gibson County representatives was organized which included business owners, local officials, healthcare providers, minority leaders, clergy, student representatives, and other interested parties. Additionally, a 47-question survey was developed and disseminated to the residents of Gibson County and publically via the Hospital's website, face-to-face polling at a popular store in Princeton, Indiana, and at the Gibson County Fair. |
| gibson general hospital inc | Part V, Section B, Line 7d: CHNA Location:The CHNA reports can be located at the Hospital's website located on the "Community Health Needs Assessment" page located under "About Us". |
| gibson general hospital inc | Part V, Section B, Line 11: Significant Needs Identified:There were six significant needs identified in the 2015 CHNA: 1) fitness/activity; 2) chronic disease prevention/ treatment; 3) mental health services availability; 4) healthcare access and quality; 5) living conditions; 6) drug and tobacco misuse. Hospital leadership prioritized the needs based on several factors including community input and evaluation of resources needed to address the top community needs. Obesity and assisted living are two areas that the hospital does not have the resources currently to meet the community concerns. |
| gibson general hospital inc | Part V, Section B, Line 13h: OTHER ELIGIBLITY CRITERIA: IF AN INDIVIDUAL IS HOMELESS, DECEASED, RECENTLY FILED FOR OR COMPLETED BANKRUPTCY, OR MEETS SPECIAL CIRCUMSTANCES related to ability to pay, THE INDIVIDUAL MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. |
| gibson general hospital inc | Part V, Section B, Line 16j: Publicized Financial Assistance Policy: FAP, FAP application, and plain language summary can be located on the Hospital's website on the "Financial Assistance" page under "Patient Info drop down menu. Additionally, a spanish translation of the FAP application and plain language summary are available. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 7 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - Star One Rehab | ||||
| 1808 Sherman Drive | Princeton | IN | 47670 | Physical therapy, occupational therapy, speech therapy |
| 2 - Physician Outpatient Clinics | ||||
| 1808 Sherman Drive | Princeton | IN | 47670 | Subsidized Care Physician Practices |
| 4 - Lifestyles Diabetes Center | ||||
| 1808 Sherman Drive | Princeton | IN | 47670 | Diabetes Education Counseling |
| 5 - GGH - Skilled Nursing Facility | ||||
| 1808 Sherman Drive | Princeton | IN | 47670 | Skilled Nursing Rehab Center |
| 6 - GGH-Family Practice | ||||
| 516 N Main St | Princeton | IN | 47670 | Family Medicine |
| 7 - Brink's Family Practice | ||||
| 410 N Main St | Princeton | IN | 47670 | Family Medicine/ Hospitalist |
| 8 - Fort Branch Wellness Clinic | ||||
| 7851 S Professional DR | Fort Branch | IN | 47648 | Family Practice |
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part III, Line 2: | Methodology used to estimate bad debt: Management analyzes third-party payor sources and makes an estimate based on aging of accounts, historical losses, current economic conditions, and other factors unique to its service area. Additionally, a significant provision is estimated and recorded for self-pay payments based on past experience. |
| Part III, Line 4: | Audited Financial Statement Footnote:Footnote to organization's financial statements that describes bad debt expense is located on page 8 of the audited financial statements within the note "Allowance for Uncollectible Accounts". |
| Part III, Line 8: | Medicare Shortfall:the hospital is a critical access hospital and is reimbursed 101%, less 2% sequestration, of medicare allowance costs for inpatient services, swing bed, and outpatient part b services. the revenue shortfall is the difference between the allowable cost for the skilled nursing facility and the pps reimbursement allowed for that skilled nursing facility. 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 September 30, 2017: Hospital Statement of Reimbursable Cost. |
| Part III, Line 9b: | Collection Practices:Collection practices are applied to all patients at gibson general hospital. Once patients receive services, the patients' accounts are billed to the appropriate insurance company. Once payment is received from the insurance company, the remaining balance, if any, becomes the patient's responsibility. Notification of the balance due is sent via written correspondence. If the balance is not paid and the account does not qualify for financial assistance, the account is sent to a collection agency to continue efforts to collect the remaining balance due. If the balance due is not paid within a certain number of months, the account is returned to the hospital and the account is written off as uncollectible. |
| Part VI, Line 2: | ASSESSING COMMUNITY NEEDS:IN ADDITION TO COMPLETING A CHNA EVERY THREE YEARS, THE HOSPITAL'S Leadership is COMPRISED OF COMMUNITY MEMBERS who engage in daily conversations with other community members and leaders regarding the community they live in and its needs. These conversations supplement THE UNDERSTANDING OF THE COMMUNITY'S HEALTH NEEDS identified in the CHNA. Hospital Leadership also uses strategic planning to sponsor and engage in community activities that helps Leadership assess the health care needs of the community the hospital serves. |
| Part VI, Line 3: | Patient Education of Eligibility for Assistance: The hospital displays posters in the central registration and emergency room waiting-area notifying patients that they will be seen regardless of their ability to pay and financial assistance is available to uninsured and underinsured in compliance with emtala. The financial assistance policy (FAP), FAP application, and plain language summary are available on the hospital's website at gibsongeneral.com; available upon request, without charge, at the Business office, admissions, and via mail; Plain language summary is conspicuously displayed in the Hospital and Clinic waiting-areas; and, the plain language summary is provided to each person upon admission to the Hospital. Any patients without insurance or with a balance due after insurance is billed are provided a plain language summary, FAP application, and contact information for the Hospital's patient financial counselor by mail. |
| Part VI, Line 4: | Community Information/ Community Served:The Hospital's primary service area includes Gibson County, Southwest Pike County, and Posey County, Indiana. The counties are located in Southwestern, Indiana, and are largely rural with agriculture and coal mining as primary industries. Gibson County, Indiana, is approximately 146 miles southwest of Indianapolis and 25 miles north of Evansville, Indiana, with an estimated population of 33,700. In 2016 the population median age was 40.4 years with forty-five percent (45%) of the population age 45 and older. The poverty rate was 10.8% and the median household annual income was $54,690. Pike County, Indiana, is approximately 55 miles southwest of Indianapolis and 50 miles north of Evansville, Indiana, with an estimated population of 12,431. In 2016 the population median age was 44.1 years with forty-nine percent (49%) of the population age 45 and older. The poverty rate was 11.4% and the median household annual income was $49,578. Posey County, Indiana, is approximately 200 miles southwest of Indianapolis and 20 miles west of Evansville, Indiana, with an estimated population of 25,476. In 2016 the population median age was 42.5 years with forty-seven percent (47%) of the population age 45 and older. The poverty rate was 8.4% and the median household annual income was $61,619.Approximately 75-80% of the hospital's patient population utilizes medicare, medicaid, and/or other government-subsidized programs. Traditionally, the hospital has been relied upon as a safety net hospital for older patients, low-income patients, and patients with limited means to travel to the larger city of Evansville, Indiana. |
| Part VI, Line 5: | Community Health Promotion:the hospital participates in many organizations and activities designed to improve the health and welfare of the surrounding community. in addition to participation on various boards and civic organizations focused on economic development, the hospital's leadership participates in the indiana patient safety coalition, the department of homeland security, district 10 emergency preparedness and national incident management safety programs. as members of the indiana rural heath association and the indiana state rural health network, the hospital participates in programs designed to assist rural healthcare organizations statewide and has assisted in obtaining and implementing communication, information sharing, and other activities to improve the access to healthcare in gibson county and the surrounidng areas. |
| Part VI, Line 6: | Affiliated Health Care System:gibson general hospital became affiliated with Deaconess Health System in December 2016 cooperating to provide health care services to their communities. Additionally, the hospital does participate in several coalitions and cooperatives with other providers and often collaborates with the larger system in the evansville area to provide access to services the hospital cannot provide such as cardiac and neurological surgery. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| emmett schuster | ||||||||||||||
| chief executive officer | $200,859 | $0 | $0 | $0 | $854 | $0 | $0 | $0 | $17,855 | $0 | $219,568 | $0 | $0 | $0 |
| lori phillips | ||||||||||||||
| chief nursing officer | $151,730 | $0 | $0 | $0 | $629 | $0 | $0 | $0 | $159 | $0 | $152,518 | $0 | $0 | $0 |
| Phillip Rosett | ||||||||||||||
| Physician | $358,615 | $0 | $0 | $0 | $1,290 | $0 | $0 | $0 | $19,374 | $0 | $379,279 | $0 | $0 | $0 |
| corey a potts | ||||||||||||||
| crna | $252,362 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $18,120 | $0 | $270,482 | $0 | $0 | $0 |
| stephen r shoemaker | ||||||||||||||
| physician | $241,338 | $0 | $0 | $0 | $915 | $0 | $0 | $0 | $19,298 | $0 | $261,551 | $0 | $0 | $0 |
| richard m clark | ||||||||||||||
| physician | $241,077 | $0 | $0 | $0 | $795 | $0 | $0 | $0 | $26,239 | $0 | $268,111 | $0 | $0 | $0 |
| Kwabena Owusu-Dekyi | ||||||||||||||
| Physician | $182,418 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $19,348 | $0 | $201,766 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (3 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|
| city of princeton | |||||||
| A | 356001169 | 2005-06-01 | $7,100,000 | capital improvements | 0 | 0 | 0 |
| city of princeton | |||||||
| B | 356001169 | 2007-10-01 | $2,096,000 | energy conservation project | 0 | 0 | 0 |
| city of princeton | |||||||
| C | 356001169 | 2008-12-01 | $2,500,000 | renovations - emergency department | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (3 entries)
| Bond ReferenceBondReferenceCd | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|
| A | $7,100,000 | $55,566 | $7,044,434 | 2009 | 0 | Yes (1) | Yes (1) | Yes (1) |
| B | $2,096,000 | $2,096,000 | 2008 | 0 | 0 | Yes (1) | Yes (1) | |
| C | $2,500,000 | $31,500 | $2,468,500 | 2009 | 0 | 0 | Yes (1) | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (3 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd | Private Bus Concerning UBIPrivateBusConcerningUBIPct |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) | |
| B | 0 | 0 | 0 | 0 | 0.00000 | 0 | 0 | Yes (1) | 0.00000 | |
| C | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (3 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | Yes (1) | 0 | Yes (1) | 0 | 0 | 0 | Yes (1) |
| B | 0 | 0 | Yes (1) | 0 | Yes (1) | 0 | 0 | 0 | Yes (1) |
| C | 0 | 0 | Yes (1) | 0 | Yes (1) | 0 | 0 | 0 | Yes (1) |
Procedures Corrective Action ProceduresCorrectiveActionGrp (3 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
| C | Yes (1) |
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 | leann cooper | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | See Part V | RelationshipDescriptionTxt |
| Transaction | $52,688 | TransactionAmt |
| Transaction | compensation paid by ggh | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule L, Part IV, Line 1b | FormAndLineReferenceDesc |
| Explanation | leann cooper is the executive director of gibson general health foundation and is the daughter of board member dr. michael green. the hospital compensates for the salary of the executive director of the gibson general health foundation. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 1 | Executive Committee Delegated Authority: The Executive Committee will exercise all authority of the Board of Trustees between regular board meetings during all emergency situations (immediate action that could result in a serious negative impact upon the Organization) and/or when the non-emergency action(s) result in commitment to a capital investment or lease less than $50,000. |
| Form 990, Part VI, Section A, line 3 | Management Duties: The CEO and CFO of the Organization are employeed and provided, subject to approval of the board of Trustees, by Deaconess Hospital, Inc., an Indiana not for profit corporation as of December 2016. |
| Form 990, Part VI, Section A, line 4 | Significant Organization Document Changes During the Year: In December 2016, the Organization amended its Articles of Incorporation and Bylaws allowing for 2 elected officials of Gibson County (one county commissioner and the Mayor of Princeton, indiana), Gibson General Hospital Foundation President, the Organization's Chief of Staff, and three Deaconess Hospital delegates to serve as board trustees in addition to two medical professionals and other trustees selected for two year terms by the board. |
| Form 990, Part VI, Section A, line 7a | Power to Elect or Appoint: The organization governing documents allows for the County Commissioners of Gibson County, Indiana to select one (1) member of the board of trustees; Deaconess Hospital, INC to select three (3) members of the board of trustees; and, the Mayor of Princeton, Indiana, the President of Gibson General Hospital Foundation, and the Chief of Staff of Gibson General Hospital serve as ex-officio members. |
| Form 990, Part VI, Section B, line 11b | Form 990 Review Process: The process of review the Form 990 includes a detailed review of the form and required schedules by the Chief Financial Officer. Each voting member of the governing body receives a copy of the Form 990 including required schedules, as ultimately filed with the IRS, prior to filing. |
| Form 990, Part VI, Section B, line 12c | Conflict of Interest Policy: The conflict of interest policy is included within the Bylaw of the Organization and covers all board of trustees. The policy provides procedures to prevent those with duality of interest or possible conflicts of interest from participating in any action that could personally benefit the individual trustee. The CEO and/or Board Compliance Officer review annual written and signed conflict of interest statements that provide any duality of interest or possible conflicts of interest disclosed by all board of trustees. The Individual Trustee will again disclose to the board when the interest becomes a matter of Board action and recues himself or herself from voting on the related issue. The board meeting minutes document the disclosure made, who abstained from voting, and the quorum situation. |
| Form 990, Part VI, Section B, line 15 | Compensation Process: CEO: The CEO Evaluation Committee, consisting of four independent and board chair appointment trustee members, evalutates the performance of the CEO on an annual basis and makes compensation-related recommendations to the Board prior to the CEO's annual review date for approval. The Evaluation Committee uses a compensation consultant, compensation survey, and comparative data from simliar organization to determine the CEO's Compensation package. All deliberation and decisions are documented in the evaluation committee's minutes. Officers and/or Key Employees: Annual reviews for top management officials are conducted by the CEO. The compensation is annually reviewed and approved by the board of trustees. |
| Form 990, Part VI, Section C, line 19 | the hospital's governing documents, conflict of interest policy, and financial statements are available to the public upon written request and board of trustees approval. Written requests should be sent to Attn: James Childers, at the address listed on page 1 of the Form 990. |
| Form 990, Part VI, Line 16b, Joint Venture Policy: | The organization does not have a formal written policy on evaluating participation in a joint venture, however, the organization performs due diligence and involves legal counsel to review any partnerships including the pain management services ensuring that the joint venture would be organized and operated in a manner consistent with the hospital's exempt purpose and status. |
| Form 990, Part IX, line 11g | Purchased Services: Program service expenses 1,401,218. Management and general expenses 444,496. Fundraising expenses 0. Total expenses 1,845,714. Professional Fees - Medical: Program service expenses 874,541. Management and general expenses 277,423. Fundraising expenses 0. Total expenses 1,151,964. Other Fees: Program service expenses 223,918. Management and general expenses 71,032. Fundraising expenses 0. Total expenses 294,950. |
| Form 990, Part XI, line 9: | Change in Joint Venture -48,112. |
| Form 990, Part XII, Line 2C, Oversight of Audit: | The board of trustees assumes responsibility for oversight of the audit of the financial statements and selection of the independent accountant; and no processes have changed from prior year. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Gibson General Health Foundation Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1808 Sherman drive | AddressLine1Txt |
| City | princeton | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47670 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 350950175 | EIN |
| Primary Activities | philanthropic support of the hospital | PrimaryActivitiesTxt |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 12a, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Gibson General | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | gibson general hospital pain management llc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1808 sherman drive | AddressLine1Txt |
| City | princeton | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47670 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 472156126 | EIN |
| Primary Activities | pain management services | PrimaryActivitiesTxt |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Predominant Income Type | related | PredominantIncomeTypeTxt |
| Share Of Total Income | $36,717 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $12,281 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | 0 | GeneralOrManagingPartnerInd |
| Ownership | 0.51000 | OwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | 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 | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | 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 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Form 990, Schedule R, Part III, Line 1 | FormAndLineReferenceDesc |
| Explanation | Gibson General Hospital Pain Management, LLC was dissolved during 2017 and all amounts will be liquidated prior to September 30, 2017. | ExplanationTxt |
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