DEACONESS MEMORIAL MEDICAL CENTER INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- DEACONESS MEMORIAL MEDICAL CENTER INC (EIN 35-0985964)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-15
- IRS object ID
- 201711359349305881
- Schema version
- 2015v3.0
- 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 D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-15T12:24:10-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | 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 | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 350985964 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LITTLE COMPANY OF MARY HOSPITAL | BusinessNameLine1Txt |
| Business Name Line2 | OF INDIANA INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LITT | BusinessNameControlTxt |
| Phone | 8124822345 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 WEST NINTH STREET | AddressLine1Txt |
| City | JASPER | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47546 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RANDALL J RUSSELL | PersonNm |
| Person Title | VP OF FINANCE & CFO | PersonTitleTxt |
| Phone | 8129960507 | PhoneNum |
| Signature | 2017-05-12 | 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 | 2017-05-12 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOSPITAL & HEALTH CARE CTR | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | E KYLE BENNETT | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 WEST NINTH STREET | AddressLine1Txt |
| City | JASPER | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47546 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $210,620,468 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MHHCC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1950 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE HEALTH SERVICES CONSISTENT WITH THE NEEDS OF THE COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 1895 | TotalEmployeeCnt |
| Total Volunteers | 275 | TotalVolunteersCnt |
| Total Gross UBI | $58,758 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $33,851 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,038,890 | PYContributionsGrantsAmt |
| CY Contributions Grants | $448,677 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $190,252,351 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $202,714,833 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,815,720 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,558,372 | CYInvestmentIncomeAmt |
| PY Other Revenue | $4,954,096 | PYOtherRevenueAmt |
| CY Other Revenue | $4,223,951 | CYOtherRevenueAmt |
| PY Total Revenue | $198,061,057 | PYTotalRevenueAmt |
| CY Total Revenue | $209,945,833 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $320,904 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $723,902 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $101,757,191 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $114,036,571 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $88,491,387 | PYOtherExpensesAmt |
| CY Other Expenses | $91,875,441 | CYOtherExpensesAmt |
| PY Total Expenses | $190,569,482 | PYTotalExpensesAmt |
| CY Total Expenses | $206,635,914 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $7,491,575 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,309,919 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $238,526,688 | TotalAssetsBOYAmt |
| Total Assets EOY | $232,751,214 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $79,590,051 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $79,931,273 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $158,936,637 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $152,819,941 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | WE, THE BOARD, PHYSICIANS, STAFF, VOLUNTEERS AND AUXILIARY OF MEMORIAL HOSPITAL AND HEALTH CARE CENTER WILL PROVIDE EXCELLENT HEALTH CARE SERVICES TO THE PEOPLE OF THE COMMUNITIES WE SERVE. WE WILL PLEDGE OURSELVES TO CARE FOR EACH INDIVIDUAL IN A MANNER THAT REFLECTS THE PHYSICAL, PSYCHOLOGICAL AND SPIRITUAL HEALING MINISTRY OF JESUS CHRIST. WE WILL WORK TOGETHER TO CREATE AN ATMOSPHERE OF MUTUAL RESPECT, DIGNITY, COMPASSION AND JOY. WE WILL EFFECTIVELY AND EFFICIENTLY UTILIZE OUR RESOURCES IN PROVIDING HEALTH CARE. WE WILL BE GUIDED BY THE NEEDS OF THOSE WE SERVE AND AS NEEDS CHANGE, WE WILL CHANGE. WE WILL "BE FOR OTHERS!" | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $179,542,811 | ExpenseAmt |
| Grant | $723,902 | GrantAmt |
| Revenue | $205,476,243 | RevenueAmt |
| Desc | GENERAL PRIMARY ACUTE CARE HOSPITAL EXPENSES INCURRED IN PROVIDING EXCELLENT HEALTH CARE SERVICES CONSISTENT WITH THE NEEDS OF THE COMMUNITY. SEE FORM 990, SCHEDULE H FOR ADDITIONAL SERVICES PROVIDED TO THE COMMUNITY. | Desc |
| Total Program Service Expenses | $179,542,811 | 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 | Yes (1) | 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 | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln 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 | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 219 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1895 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| 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 | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | 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 | IN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RANDALL RUSSELL | PersonNm |
| Phone | 8129960506 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 WEST NINTH STREET | AddressLine1Txt |
| City | JASPER | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47546 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (26 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 | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| RAYMOND SNOWDEN | ||||||||
| BOARD CHAIRPERSON | 5.00 | 1.00 | Yes (X) | Yes (X) | $227,061 | $0 | $0 | |
| E KYLE BENNETT | ||||||||
| PRESIDENT & CEO | 40.00 | 1.00 | Yes (X) | Yes (X) | $469,566 | $0 | $36,376 | |
| ROBERT DISINGER | ||||||||
| BOARD VICE CHAIRPERSON | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| BRENDA STALLINGS | ||||||||
| BOARD TREASURER | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| SR RENEE CUNNINGHAM | ||||||||
| BOARD SECRETARY | 30.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $8,705 | |
| NICHOLAS WERNE MD | ||||||||
| MEDICAL STAFF PRESIDENT | 1.00 | 0.00 | Yes (X) | $380,239 | $0 | $0 | ||
| SCOTT BECKMAN MD | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| ROBERT EHRHARD MD | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JIM HUEBNER | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| SHERRIL LUEKEN | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| SOHAIL QADIR MD | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $621,699 | $0 | $19,915 | ||
| KENNETH SENDELWECK | ||||||||
| BOARD MEMBER | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JOSEPH STEURER | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL UEBELHOR | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| SR SHARON ANN WALSH | ||||||||
| PROVINCE LEADER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| RANDALL J RUSSELL | ||||||||
| VP FINANCE/CFO | 40.00 | 1.00 | Yes (X) | $272,114 | $0 | $29,913 | ||
| KELLY CLAUSS | ||||||||
| VP MEDICAL PRACTICE | 40.00 | 0.00 | Yes (X) | $208,526 | $0 | $18,125 | ||
| JOHN DILLON | ||||||||
| VP AMBULATORY SERVICES | 40.00 | 0.00 | Yes (X) | $210,231 | $0 | $29,866 | ||
| TONYA HEIM | ||||||||
| VP PATIENT SERVICES | 40.00 | 0.00 | Yes (X) | $264,543 | $0 | $30,445 | ||
| GARY LIGHT | ||||||||
| VP / CIO | 40.00 | 0.00 | Yes (X) | $228,609 | $0 | $15,377 | ||
| STANLEY TRETTER MD | ||||||||
| VP/ CMO | 40.00 | 0.00 | Yes (X) | $256,794 | $0 | $23,173 | ||
| GEOFFREY DAY MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $1,097,754 | $0 | $18,172 | Yes (X) | ||
| ADAM DAWKINS MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $1,052,715 | $0 | $17,613 | Yes (X) | ||
| WILLIAM LEHMKUHLER MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $1,043,635 | $0 | $17,224 | Yes (X) | ||
| JOSHUA LEONARD MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $1,001,706 | $0 | $17,613 | Yes (X) | ||
| BRIAN WOEBKENBERG MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $841,051 | $0 | $17,224 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $8,176,243 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $299,741 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 127 | 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 |
|---|---|---|---|---|---|
| MEMORIAL HOSPITAL OUTPATIENT SURGERY CEN | |||||
| 600 W 13TH STREET | JASPER | IN | 47546 | HEALTH SERVICES | $5,251,193 |
| STREICHER CONSTRUCTION INC | |||||
| 2296 MILL STREET | JASPER | IN | 47546 | CONSTRUCTION SERVICES | $3,972,102 |
| TOSHIBA AMERICA MEDICAL SYSTEMS INC | |||||
| PO BOX 91605 | CHICAGO | IL | 60693 | HEALTH SERVICES | $1,216,417 |
| ARUP LABORATORIES | |||||
| PO BOX 27964 | SALT LAKE CITY | UT | 84127 | HEALTH SERVICES | $918,213 |
| VANTAGE ONCOLOGY TREATMENT CENTERS | |||||
| 4972 LINCOLN AVENUE SUITE 100 | EVANSVILLE | IN | 47715 | ONCOLOGY SERVICES | $888,498 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 56 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $253,234 | RelatedOrganizationsAmt |
| All Other Contributions | $195,443 | AllOtherContributionsAmt |
| Total Contributions | $448,677 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICE REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $202,714,833 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $202,714,833 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $202,714,833 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,080,566 | TotalRevenueColumnAmt |
| Exclusion | $1,080,566 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $273,238 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $329,002 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$55,764 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$55,764 | TotalRevenueColumnAmt |
| Exclusion | -$55,764 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,823,439 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $345,011 | SecuritiesAmt |
| Other | $622 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,478,428 | SecuritiesAmt |
| Other | -$622 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,477,806 | TotalRevenueColumnAmt |
| Exclusion | $1,477,806 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|---|
| OTHER REVENUE | 900099 | $4,222,008 | $2,761,410 | $1,051 | $1,459,547 |
| MEM LAB OTHER REVENUE | 621500 | $57,707 | $57,707 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $4,279,715 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $209,945,833 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $205,476,243 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $58,758 | UnrelatedBusinessRevenueAmt |
| Exclusion | $3,962,155 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $723,902 | TotalAmt |
| Program Services | $723,902 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,880,650 | TotalAmt |
| Program Services | $1,634,097 | ProgramServicesAmt |
| Management And General | $246,553 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,129,998 | TotalAmt |
| Program Services | $80,920,655 | ProgramServicesAmt |
| Management And General | $12,209,343 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,238,718 | TotalAmt |
| Program Services | $1,076,322 | ProgramServicesAmt |
| Management And General | $162,396 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,065,706 | TotalAmt |
| Program Services | $10,483,892 | ProgramServicesAmt |
| Management And General | $1,581,814 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,721,499 | TotalAmt |
| Program Services | $4,971,410 | ProgramServicesAmt |
| Management And General | $750,089 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $121,387 | TotalAmt |
| Program Services | $105,473 | ProgramServicesAmt |
| Management And General | $15,914 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,120 | TotalAmt |
| Program Services | $60,058 | ProgramServicesAmt |
| Management And General | $9,062 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,821,614 | TotalAmt |
| Program Services | $17,223,000 | ProgramServicesAmt |
| Management And General | $2,598,614 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $406,917 | TotalAmt |
| Program Services | $353,570 | ProgramServicesAmt |
| Management And General | $53,347 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $937,581 | TotalAmt |
| Program Services | $814,664 | ProgramServicesAmt |
| Management And General | $122,917 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,003,374 | TotalAmt |
| Program Services | $10,429,732 | ProgramServicesAmt |
| Management And General | $1,573,642 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,147,363 | TotalAmt |
| Program Services | $996,944 | ProgramServicesAmt |
| Management And General | $150,419 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,614,449 | TotalAmt |
| Program Services | $2,271,695 | ProgramServicesAmt |
| Management And General | $342,754 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,078,418 | TotalAmt |
| Program Services | $11,363,837 | ProgramServicesAmt |
| Management And General | $1,714,581 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,398,131 | TotalAmt |
| Program Services | $1,214,836 | ProgramServicesAmt |
| Management And General | $183,295 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| HOSPITAL SUPPLIES AND D | $31,665,694 | $27,514,322 | $4,151,372 |
| HAF EXPENSE | $5,174,123 | $4,495,795 | $678,328 |
| DUES & SUB. | $972,154 | $844,705 | $127,449 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,465,116 | TotalAmt |
| Program Services | $2,043,902 | ProgramServicesAmt |
| Management And General | $421,214 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $206,635,914 | TotalAmt |
| Program Services | $179,542,811 | ProgramServicesAmt |
| Management And General | $27,093,103 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,080,374 | BOYAmt |
| EOY | $45,833,334 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,804,982 | BOYAmt |
| EOY | $25,077,696 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,506,435 | BOYAmt |
| EOY | $3,318,438 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,617,358 | BOYAmt |
| EOY | $3,004,734 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,689,080 | BOYAmt |
| EOY | $2,638,122 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $223,451,401 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $130,319,734 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $90,045,372 | BOYAmt |
| EOY | $93,131,667 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $63,308,299 | BOYAmt |
| EOY | $58,021,093 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $360,551 | BOYAmt |
| EOY | $342,963 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,114,237 | BOYAmt |
| EOY | $1,383,167 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $238,526,688 | BOYAmt |
| EOY | $232,751,214 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,251,842 | BOYAmt |
| EOY | $15,055,162 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $55,915,185 | BOYAmt |
| EOY | $54,241,883 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $655,624 | BOYAmt |
| EOY | $538,316 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,767,400 | BOYAmt |
| EOY | $10,095,912 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $79,590,051 | BOYAmt |
| EOY | $79,931,273 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $158,936,637 | BOYAmt |
| EOY | $152,819,941 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $158,936,637 | BOYAmt |
| EOY | $152,819,941 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $238,526,688 | BOYAmt |
| EOY | $232,751,214 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $3,309,919 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$2,540,881 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$6,885,734 | 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 D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,064,050 | OtherCostOrOtherBasisAmt |
| Book Value | $2,064,050 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $79,365,690 | OtherCostOrOtherBasisAmt |
| Depreciation | $35,970,687 | DepreciationAmt |
| Book Value | $43,395,003 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $142,021,661 | OtherCostOrOtherBasisAmt |
| Depreciation | $94,349,047 | DepreciationAmt |
| Book Value | $47,672,614 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $93,131,667 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| THIRD PARTY PAYABLE | $3,828,518 |
| PENSION LIABILITY | $6,267,394 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $10,095,912 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE CORPORATION AND RECOGNIZE A TAX LIABILITY IF THE CORPORATION 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 CORPORATION, AND HAS CONCLUDED THAT AS OF JUNE 30, 2016 AND 2015, 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. THE CORPORATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. |
| PART XI, XII, AND XIII | THESE SECTIONS ARE NOT REQUIRED AS THE ORGANIZATION IS PART OF A CONSOLIDATED FINANCIAL STATEMENT. THE CONSOLIDATED FINANCIAL STATEMENTS ARE AUDITED BY AN INDEPENDENT ACCOUNTING FIRM AND PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. |
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 |
| Percent200 | Yes (X) | Percent200Ind |
| 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) |
|---|---|---|
| Total Community Benefit Expns | $1,069,201 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,069,201 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00520 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $21,466,796 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $25,543,996 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$4,077,200 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $22,535,997 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $25,543,996 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$3,007,999 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00520 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $71,704 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $71,704 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $71,704 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $71,704 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $22,607,701 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $25,543,996 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$2,936,295 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00550 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $38,600 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $38,600 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $938,995 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $938,995 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00450 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $132,310 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $132,310 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,109,905 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,109,905 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00530 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $9,938,896 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $41,844,676 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $41,479,907 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $364,769 | 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 | MEMORIAL HOSPITAL & HEALTH CARE CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 W 9TH ST | AddressLine1Txt |
| City | JASPER | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47546 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.MHHCC.ORG | WebsiteAddressTxt |
| State License | 16-005102-1 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOSPITAL & HEALTH CARE CENTER | 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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 14 | 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.MHHCC.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 14 | ImplementationStrategyAdptYr |
| Strategy Posted Website | 0 | StrategyPostedWebsiteInd |
| Strategy Attached | 0 | StrategyAttachedInd |
| 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 | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (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.MHHCC.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.MHHCC.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.MHHCC.ORG | 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 |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| MEMORIAL HOSPITAL & HEALTH CARE CENTER | PART V, SECTION B, LINE 5: A SERIES OF FOCUS GROUP MEETINGS AND SURVEYS WERE CONDUCTED TO PROVIDE AN OPPORTUNITY AND FORUM FOR COMMUNITY REPRESENTATIVES TO PARTICIPATE IN IDENTIFYING HEALTH NEEDS. |
| MEMORIAL HOSPITAL & HEALTH CARE CENTER | PART V, SECTION B, LINE 11: THE HOSPITAL IS COMMITTEED TO THE HEALTH AND WELL-BEING OF OUR CONSTITUENTS AND OFFER NUMBEROUD SERVICES TO MEET THE NEEDS OF OUR PATIENTS AND THEIR FAMILIES. THE KEY HEALTH ISSUES BEING ADDRESSED WITH REGARDS TO THE CONDUCTED NEEDS ASSESSMENT ARE ACCESS TO PRIMARY AND AFFORDABLE HEALTH CARE WITH INITIATIVES TO DEVELOP AND IMPLEMENT AN ADVANCED PRACTICE PRACTITIONER MODEL, REDEFINE AN APPROACH AND ACTION FOR RECRUITMENT AND RETENTION, COMMIT AND CONTINUE ENGAGEMENT WITH THE GRADUATE MEDICAL EDUCATION BOARD; AFFORDABLE HEALTH CARE WITH INITIATIVES TO ADDRESSING PRIMAR CARE IMPACT, CONTINUED HEALTH EDUCATION SUPPORT, AND CONTINEUED SUPRPORT FOR EDUCATION ON HEALTHY PREGNANCIES; LACK OF SPECIALIST (SPECIFICALLY MENTAL HEALTH) WITH INTIATIVES TO PARTNER WITH LOCAL COLEGES, MENTAL HEALTH SERVICE EDUCATION, OUTREACH FOR A PSYCHIATRIST, AND DEVELOP RELATIONSHIPS WITH IU SCHOOL OF MEDICINE PSYCHIATRIC RESIDENCY. |
| MEMORIAL HOSPITAL & HEALTH CARE CENTER | PART V, SECTION B, LINE 22D: THE HOSPITAL FACILITY USED A LOOK-BACK METHOD BASED ON CLAIMS ALLOWED BY MEDICARE FEE-FOR-SERVICE AND ALL PRIVATE HEALTH INSURERS THAT PAY CLAIMS TO THE HOSPITAL FACILITY DURING A PRIOR 12-MONTH PERIOD. |
| MEMORIAL HOSPITAL & HEALTH CARE CENTER | PART V, SECTION B, LINE 24: GROSS CHARGES FOR NON-MEDICALLY NECESSARY SERVICES INCLUDING COSMETIC PROCEDURES ARE NOT ELIGIBLE FOR DISCOUNTED CHARGES OR FINANCIAL ASSISTANCE. |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | A PATIENT MAY QUALIFY FOR PARTIAL FINANCIAL ASSISTANCE IF THE PATIENT'S HOUSEHOLD INCOME IS BETWEEN 200% AND 400% OF THE FEDERAL POVERTY GUIDELINES. |
| PART I, LINE 7G: | THE ORGANIZATION DOES NOT PROVIDE ANY SUBSIDIZED HEALTH SERVICES ATTRIBUTABLE TO PHYSICIAN CLINICS. |
| PART I, LN 7 COL(F): | PART III, SECTION A. BAD DEBT EXPENSE CONSIDERED COMMUNITY BENEFIT: NO OTHER BAD DEBT AMOUNTS HAVE BEEN INCLUDED AS COMMUNITY BENEFIT. THE HOSPITAL HAS A DETAILED FINANCIAL ASSISTANCE POLICY AND EDUCATES PATIENTS WITH LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THIS REASON, THE ORGANIZATION BELIEVES 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 II, COMMUNITY BUILDING ACTIVITIES: | PROGRAMS WERE OFFERED AT LOW OR DISCOUNTED PRICES. SOME SERVICES SUCH AS SCREENING RESULT SESSIONS OR SUPPORT GROUPS WERE OFFERED FREE TO PARTICIPANTS. THE FOLLOWING IS A LIST OF SERVICES PROVIDED THROUGH THE HEALTH AND WELLNESS DEPARTMENT.HEALTH SCREENINGS INCLUDING WEIGHT, BMI, WAIST CIRCUMFERENCE, BLOOD PRESSURE, LIPID PROFILE, CHEMISTRY PANEL, TOBACCO STATUS, GLUCOSE, PSA AND COLON KITS: PSA ARE PERFORMED WHICH INCLUDED THE ANNUAL PSA SCREENING FOR MEN 50 AND OLDER AND COLON KITS WERE DISTRIBUTED. BODY FAT ANALYSES AND CARBON MONOXIDE SCREENINGS WERE PERFORMED. NICOTINE SALIVA TESTS WERE CONDUCTED. HEALTH RISK APPRAISALS WERE PROVIDED FOR PARTICIPANTS IN HEALTH SCREENINGS SCREENING RESULT SESSIONS WERE AVAILABLE TO LEARN ABOUT THE IMPORTANCE OF SCREENING RESULTS AT THE VARIOUS WORK-SITES. THE LOW-COST SCREENING FEE INCLUDES THESE GROUP RESULTS SESSIONS. SMOKING CESSATION PROGRAMS, DISPLAYS, AND PRESENTATIONS WERE PROVIDED FOR THE COMMUNITY AND COMPANY WORK-SITES AT NO COST. AMERICAN CANCER SOCIETY AND THE INDIANA TOBACCO PREVENTION AND CESSATION COUNCIL ALSO PROVIDED EDUCATION MATERIALS AT NO CHARGE. THE QUIT LINE AND QUIT NOW MATERIALS WERE ALSO PROVIDED AT ALL DISPLAYS. MEMORIAL HOSPITAL PROVIDED STAFF TO PROMOTE AND TEACH THE CLASSES AND PREPARE THE DISPLAYS. REFERRALS HAVE BEEN MADE TO THE FREE INDIANA QUIT LINE. FREE CESSATION DVDS WERE DISTRIBUTED TO INPATIENTS THAT WERE TOBACCO USERS AS WELL AS EMPLOYEES AT WORKSITES SPONSORED BY THE SUBSTANCE ABUSE COUNCIL GRANT.APPOINTMENTS WERE MADE AND KEPT FOR HOSPITAL EMPLOYEES AND LOCAL COMPANY PARTICIPANTS PARTICIPATED IN WELLNESS CHECK-INS TO MONITOR BLOOD PRESSURE AND WEIGHT ON A REGULAR BASIS AT THE WORK-SITE THROUGHOUT THE YEAR. PARTICIPANTS WERE TAUGHT ABOUT WEIGHT LOSS MANAGEMENT IN RELATION TO DISEASE PREVENTION THROUGH THE CHOOSE 8 TO LOSE WEIGHT PROGRAM.CANCER EDUCATION INFORMATION AND HEALTH EDUCATION INFORMATION WAS DISTRIBUTED AT NO COST TO PARTICIPANTS AT SCREENINGS AND THROUGH EMPLOYEE WELLNESS PROGRAMS..NUTRITION AND HEALTH DISPLAYS AND QUIZZES WERE PROVIDED WORKSITE PARTICIPANTS.THE FERTILITY CARE (NATURAL FAMILY PLANNING) PROGRAM WAS OFFERED FOR COUPLES, WITH 8 COUPLES' SESSIONS PROVIDED FOR A SMALL FEE. PROGRAMS ARE AVAILABLE AT REDUCED RATE FOR THOSE UNABLE TO PAY FOR THE SERVICES. THESE SERVICES ARE NOW BEING OFFERED THROUGH THE PARISH NURSING PROGRAM EFFECTIVE JULY 1, 2014.MEDIC FIRST AID, CPR PROGRAMS, HEARTSAVER FIRST AID, AED, AND BLOOD BORNE PATHOGENS CLASSES, WERE PROVIDED FOR INDUSTRY WORKERS, SCOUT TROUPS, SCHOOLS AND THE GENERAL PUBLIC FOR A FEE.THE LANGE-FUHS CANCER CENTER CONDUCTED THE MAN TO MAN PROGRAM, THE LOOK GOOD, FEEL BETTER PROGRAM, MEN'S GROUP AND WOMEN'S GROUP, AND THE CELEBRATE LIFE PROGRAM TO AREA CANCER PATIENTS AT NO COST.THE BARIATRIC FORUM AND SUPPORT GROUP WERE OFFERED MONTHLY AT NO COST.VARIOUS MEMORIAL HOSPITAL DEPARTMENTS PROVIDED FREE MONTHLY SUPPORT GROUPS FOR FAMILIES WITH ALZHEIMER'S DISEASE AND DEMENTIA, HEART DISEASE, AND PARKISONS DISEASE. THE DIABETES EDUCATION STAFF PROVIDED FREE MONTHLY SUPPORT GROUPS FOR THOSE WITH DIABETES. THE PASTORAL CARE DEPARTMENT PROVIDED TWO 5-WEEK FREE PROGRAMS FOR THOSE SUFFERING WITH GRIEF.SUPERSITTER (BABYSITTING) CLASSES WERE OFFERED FOR A FEE TO YOUTH TO LEARN ABOUT SAFE BABYSITTING PRACTICES. SCHOOL TEEN HEALTH FAIRS AND COMMUNITY HEALTH FAIRS PRESENTED HEALTH INFORMATION AT NO COST TO THE PUBLIC FOR YOUTH AND ADULTS, TEACHING THEM WAYS TO IMPROVE THEIR HEALTH.PARTICIPANTS ATTENDED WELLNESS CLASSES AND LUNCH AND LEARN PROGRAMS SPONSORED BY THEIR EMPLOYER, INCLUDING MEMORIAL HOSPITAL EMPLOYEES AND OTHER COMMUNITY PROGRAMS OFFERED BY THE HOSPITAL. PROGRAMS WERE FREE TO HOSPITAL EMPLOYEES. COMPANIES PAID SMALL FEES FOR PRESENTATIONS.PARTICIPATED IN WEIGHT CHALLENGES AT LOCAL COMPANIES AND AT MEMORIAL HOSPITAL. EMPLOYEES OF MEMORIAL HOSPITAL PARTICIPATED FREE. THIS INCLUDED WEIGH IN AND OUT, NUTRITION HANDOUTS, AND SOME NUTRITION CLASSES.MANY PARTICIPATED IN THE MONTHLY FITNESS CLASSES HELD AT THE HOSPITAL INCLUDING STEP CLASSES, ZUMBA CLASSES, CORE CLASSES, GET FIT 55+ CLASSES, YOGA CLASSES, JAZZERCISE CLASSES, CIRCUIT TRAINING, CORPORATE FIT IT IN CLASSES, OTHER CORPORATE AND ONSITE FITNESS CLASSES, YOGA YOUR WAY CLASSES, SHAPE IT UP CLASSES, FIT MANIA CLASSES, MONTH-LONG BOOT CAMP PROGRAM, AND STRENGTH AND ENDURANCE CLASSES. FITNESS CLASS OFFERINGS VARIED EACH MONTH AND WERE FREE FOR HOSPITAL EMPLOYEES AND A LOW COST FOR THE COMMUNITY. PARTICIPANTS RECEIVED ONE FREE CLASS FOR EVERY 8 SESSIONS ATTENDED. FREE FITNESS DEMONSTRATIONS AND FREE CLASS COUPONS WERE DISTRIBUTED AT THE SENIOR EVENT IN DUBOIS COUNTY.WELLNESS PACKETS AND FITNESS LOGS WERE COMPLETED BY PARTICIPANTS AT THE WORKSITES.TIME WAS SPENT AT COMMUNITY AND HOSPITAL COMMITTEES AND AGENCY MEETINGS TO BETTER THE HEALTH OF OUR COMMUNITY SUCH AS THE SENRIOR PARTNERSHIP, CANCER COMMITTEE, TIE TEAM, LEADESHIP DEVELOPMENT TEAM, SUBSTANCE ABUSE COUNCIL AND OTHER HOSPITAL COMMITTEES.WELLNET MEETINGS THAT EDUCATED WELLNESS LEADERS IN THE COMMUNITY ABOUT WELLNESS PLANNING.THE COMMUNITY TRANSFORMATION GRANT FROM WELBORN BAPTIST FOUNDATION PROVIDES STAFF HOURS TO ADDRESS ISSUES OF REDUCING CHRONIC DISEASE IN THE COUNTY. IN-KIND CONTRIBUTIONS INCLUDE COMPUTER AND OFFICE SPACE ALONG WITH PAPER AND OFFICE SUPPLIES, POSTAGE, AND REFRESHMENTS FOR MEETINGS. COMPANIES ATTENDED MULTIPLE CORPORATE CHAMPION MEETINGS TO LEARN ABOUT HEALTH TOPICS AND WAYS TO IMRPOVE THE HEALTH CULTURE AND POLICIES AT THEIR WORKSITES. TWELVE COMPANIES REACHED GOOD, BETTER, OR BEST TARGETS FOR THEIR COMPANY WELLNESS INITIATIVES. MANY BLOOD PRESSURE CHECKS WERE CONDUCTED WITH THE MILLION HEARTS DISPLAYS TO GENERATE HEALTH AWARENESS AT SEVERAL COMPANIES. UNDER HEALTHY LIVING ACTIVITIES, SEVERAL COMMUNITY 5K EVENTS WERE SENT TO THOSE ON THE CHAMPIONS LIST SINCE MAY 2014. COMPANIES RECEIVED THE AMERICAN HEART ASSOCIATION FIT-FRIENDLY AWARD AFTER PROMOTION OF FITNESS AT THE CORPORATE CHAMPION MEETINGS. COMPANIES RECEIVED FIT FRIENDLY TIPS OF THE MONTH FOR FREE. |
| PART II | AS A RESULT OF WELLNESS SERVICES, OTHER SUCCESSES INCLUDED INDIVIDUALS REDUCED OR ELIMINATED THE NEED FOR BLOOD PRESSURE MEDICINE, FOUND AND HAD APPOINTMENTS WITH A PHYSICIAN, GOT DIAGNOSED AND TREATED FOR HYPERTENSION, HIGH CHOLESTEROL, AND DIABETES. CHRONIC DISEASE PREVENTION IS A KEY OUTCOME OF MANY OF THE WELLNESS SERVICES. |
| PART III, LINE 4: | SECTION A. FOOTNOTE TO ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE: SEE PAGE 8 OF THE AUDITED FINANCIAL STATEMENTS FOOTNOTE 1 FOR FOOTNOTE "PATIENT ACCOUNTS RECEIVABLE, ESTIMATED THIRD-PARTY PAYROL SETTLEMENT AND NET PATIENT SERVICE REVENUE" |
| PART III, LINE 8: | 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 JUNE 30, 2016: HOSPITAL STATEMENT OF REIMBURSABLE COST. |
| PART III, LINE 9B: | THE ORGANIZATION'S WRITTEN DEBT COLLECTION POLICY INCLUDES PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED DURING THE FOLLOW-UP PERIOD AFTER A PATIENT IS DISCHARGED AND INCLUDES SPECIFIC INSTRUCTIONS FOR SELF-PAY WHO MAY QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. |
| PART VI, LINE 2: | NEEDS ASSESSED: IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED EVERY THREE YEARS. THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES THROUGH THE USE OF HOSPITAL COMMITTEES DEVELOPING STRATEGIC PLANS FOR THE HOSPITAL TO PROVIDE QUALITY CARE TO THE COMMUNITY MEMBERS. |
| PART VI, LINE 3: | PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:IF DURING PATIENT FINANCIAL SERVICES' FINANCIAL COUNSELING OR COLLECTION PROCESS, IT APPEARS THAT AN INDIVIDUAL MAY NOT HAVE THE FINANCIAL RESOURCES TO PAY FOR SERVICES NOT COVERED BY A THIRD PARTY PAYOR, THEN A FINANCIAL DISCLOSURE FORM SHOULD BE COMPLETED BY THE PATIENT. IN ADDITION, OTHER MEMBERS OF THE HOSPITAL STAFF MAY IDENTIFY INDIVIDUALS WHO MAY QUALIFY FOR CHARITY CARE. THE INFORMATION IS FORWARDED TO THE PATIENT FINANCIAL SERVICES DEPARTMENT. APPROPRIATE SIGNAGE IS VISIBLE IN THE HOSPITAL AND ALL HOSPITAL-OWNED FACILITIES, SPECIFICALLY IN PATIENT ACCESS AREAS, CREATING AWARENESS FOR THE FINANCIAL ASSISTANCE PROGRAM AND THE FINANCIAL ASSISTANCE THAT IS AVAILABLE. IN ADDITION THE HOSPITAL HAS ANNOUNCED A NEW PAYMENT PLAN WHICH ALLOWS PATIENTS TO PAY FOR THEIR HOSPITAL SERVICES AT 0% INTEREST OVER A 25-MONTH PERIOD. REGARDLESS OF INSURANCE COVERAGE, CREDIT HISTORY OR EMPLOYMENT, THE HOSPITAL WILL REFER PATIENTS AUTOMATICALLY TO THE CAREPAYMENT OPTION IF THEY HAVE A BALANCE ON THEIR HOSPITAL ACCOUNT TWO MONTHS AFTER RECEIVING THEIR FIRST STATEMENT. THROUGH A PRE-APPROVED APPLICATION PROCESS, THE PATIENT WILL RECEIVE A 0% INTEREST HOSPITAL-SPONSORED LOYALTY CARD WITH A MINIMUM OF 4% OF THE BALANCE OR $25. |
| PART VI, LINE 4: | DESCRIPTION OF COMMUNITY:AS A REGIONAL HEALTH CENTER, THE STAFF PROVIDES A COMPREHENSIVE RANGE OF MEDICAL CARE FOR RESIDENTS OF DUBOIS AND SURROUNDING COUNTIES INCLUDING MORE THAN 7,700 INPATIENTS AND 230,000 OUTPATIENTS. |
| PART VI, LINE 5: | OTHER COMMUNITY HEALTH PROMOTION:THE ORGANIZATION FURTHERS ITS EXEMPT PURPOSE BY PROMOTING HEALTH OF THE COMMUNITY THROUGH THE FOLLOWING: THE MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. ANY SURPLUS FUNDS ARE APPLIED DIRECTLY OR INDIRECTLY TO IMPROVE PATIENT CARE SERVICES. ALSO, THE ORGANIZATION OPERATES UNDER THE PREMISE OF AN OPEN MEDICAL STAFF WITH REGARD TO QUALIFIED PHYSICIANS IN THE 9 COUNTY COMMUNITY IT SERVES, HOWEVER IT DOES NOT ACTIVELY PURSUE THOSE PHYSICIANS WHO HAVE NOT APPROACHED THE ORGANIZATION REGARDING THESE PRIVILEGES. |
| PART VI, LINE 6: | AFFILIATED HEALTH CARE SYSTEM:NOT APPLICABLE. THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | IN |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (3 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Cash GrantCashGrantAmt |
|---|---|---|
| STUDENT LOAN BUY BACK PROGRAM TO OFFSET EDUCATIONAL EXPENSES FOR CRITICALLY | 50 | $62,074 |
| TUITION REIMBURSEMENT PROGRAM FOR THE COST OF TUITION AND BOOKS. | 85 | $322,207 |
| SCHOLARSHIP PROGRAM TO ASSIST STAFF MEMBERS PURSUING AN UNDERGRADUATE DEGREE TO WORK IN DEFINED CRITICAL SHORTAGE AREAS. | 50 | $17,308 |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 2: | FOR THE STUDENT LOAN BUY-BACK PROGRAM APPLICATIONS ARE SUBMITTED TO THE HUMAN RESOURCE DEPARTMENT; AND REVIEWED FOR DENIAL OR APPROVAL. FOR THE TUITION REIMBURSMENT PROGRAM APPLICATIONS MUST BE APPROVED BY THE DIRECTORS IN CHARGE OF THE EMPLOYEE BEFORE SUBMITTING TO HUMAN RESOURCE DEPARTMENT FOR APPROVAL. IN ADDITION GRADES MUST BE SUBMITTED TO THE HUMAN RESOURCE DEPARTMENT FOR GRADE VERIFICATION. FOR THE SCHOLARSHIP PROGRAM THE SCHOLARSHIP COMMITTEE EXERCISES AUTHORITY IN THE SELECTION PROCESS AND RECIPIENTS MUST RE-APPLY EACH SEMESTER. |
| PART III, ELIGIBILITY AND PROCEDURES FOR | STUDENT LOAN BUY-BACK PROGRAM - POLICY STATEMENT: MEMORIAL HOSPITAL AND HEALTH CARE CENTER STRIVES TO BE PROACTIVE IN RECRUITING, ASSISTING, AND ENCOURAGING QUALIFIED INDIVIDUALS TO ENTER INTO CRITICALLY NEEDED HEALTH CARE FIELDS. THIS PROGRAM WAS DESIGNED TO OFFSET EDUCATIONAL EXPENSES BY REIMBURSING APPROVED MONTHLY STUDENT LOAN OBLIGATIONS IN TRADE FOR TIME WORKED AT MEMORIAL HOSPITAL AND HEALTH CARE CENTER. STUDENT LOAN BUY-BACK PROGRAM - PROCEDURE: 1. THE STUDENT LOAN BUY-BACK BENEFIT IS AVAILABLE TO EMPLOYEES RECRUITED BY MEMORIAL HOSPITAL AND HEALTH CARE CENTER FOR CRITICAL SHORTAGE AREAS WHO HAVE EXISTING LOANS. THIS BENEFIT MAY NOT BE USED IN CONJUNCTION WITH THE TUITION REIMBURSEMENT PROGRAM. 2. THE STUDENT LOAN MONIES MUST BE BORROWED BY THE EMPLOYEE FOR OBTAINING A FORMALIZED DEGREE IN A CRITICAL SHORTAGE AREA AS DEFINED BY THE HOSPITAL. EACH POTENTIAL EMPLOYEE MUST HAVE MADE HIS OR HER OWN ARRANGEMENTS FOR THE STUDENT LOAN FINANCING THROUGH AN APPROPRIATE LENDING INSTITUTION. THE HOSPITAL WILL IN NO WAY BE SIGNATORY OR BE HELD RESPONSIBLE FOR THE FINANCIAL CONTRACT OBTAINED THROUGH A LENDING INSTITUTION. 3. THE APPLICATION TITLED "STUDENT BUY-BACK APPLICATION" FOR QUALIFIED INDIVIDUALS MUST BE COMPLETED AND SUBMITTED TO THE HUMAN RESOURCE DEPARTMENT. IT SHALL BE THE RESPONSIBILITY OF HUMAN RESOURCES TO NOTIFY THE EMPLOYEE OF DENIAL OR APPROVAL. 4. THE ACTIVE LOAN BALANCE AT THE TIME OF APPLICATION WILL BE USED TO CALCULATE STUDENT LOAN BUY-BACK. 5. ELIGIBILITY FOR BUY-BACK PAYMENTS COMMENCES AT THE BEGINNING OF THE MONTH FOLLOWING COMPLETION OF THE 60 DAY INTRODUCTORY PERIOD. EMPLOYEES WITH A PRN STATUS ARE NOT ELIGIBLE TO PARTICIPATE IN THE STUDENT LOAN BUY-BACK PROGRAM. BUY-BACK PAYMENTS CEASE IMMEDIATELY WITH TERMINATION. 6. SHOULD AN EMPLOYEE REDUCE TO LESS THAN FULL TIME STATUS (1.0 FTE) THEN THE EMPLOYEE'S MAXIMUM REIMBURSEMENT WILL BE REDUCED PROPORTIONATELY(I.E. A .8 FTE WILL QUALIFY FOR 80% OF THE ALLOWABLE MONTHLY AND TOTAL REIMBURSEMENT AMOUNT). THE EMPLOYEE WILL BE REQUIRED TO COMPLETE A NEW APPLICATION AT THE TIME OF STATUS CHANGE. 7. IF AN INDIVIDUAL IS GIVEN ANY DISCIPLINARY ACTION, THE LOAN BUY-BACK PAYMENT WILL NOT BE MADE FOR THE MONTH IN WHICH THE DISCIPLINARY ACTION OCCURRED AND CONTINUATION OF THE BENEFIT WILL BE REVIEWED. 8. THE MAXIMUM AMOUNT FOR LOAN BUY-BACK WILL BE $250.00 PER MONTH FOR A TOTAL OF 24 MONTHS. 9. THE CRITICAL SHORTAGE AREAS WILL BE IDENTIFIED BY THE ADMINISTRATIVE STAFF OF MEMORIAL HOSPITAL AND THE HUMAN RESOURCE DEPARTMENT WILL HAVE THE LIST AVAILABLE UPON REQUEST. 10. SHOULD A POSITION BE REMOVED FROM THE CRITICAL SHORTAGE LIST, ANY APPROVED APPLICATION FOR THE STUDENT LOAN BUY-BACK SHALL CONTINUE TO BE VALID AND APPROVED EACH YEAR SO LONG AS ALL OTHER CRITERIA ARE MET. 11. STUDENT LOAN BUY-BACK PAYMENTS WILL BE MADE DIRECTLY TO THE EMPLOYEE. THE EMPLOYEE WILL CONTINUE TO BE RESPONSIBLE FOR THEIR OWN PAYMENTS TO THE LENDING INSTITUTION(S). 12. THE EMPLOYEE IS RESPONSIBLE FOR OBTAINING A LETTER STATING THE PURPOSE OF THE LOAN, AMOUNT OF THE LOAN, THE DATE OF ISSUANCE AND THE SIGNATURE OF THE LOAN OFFICER. |
| TUITION REIMBURSEMENT PROGRAM: | TUITION REIMBURSEMENT PROGRAM - POLICY STATEMENT: MEMORIAL HOSPITAL AND HEALTH CARE CENTER STRIVES TO PROVIDE A WORKING ENVIRONMENT DESIGNED TO ATTRACT, REWARD AND RETAIN QUALIFIED PERSONNEL. TUITION REIMBURSEMENT IS DEFINED AS THE COST OF TUITION AND BOOKS ONLY FOR CLASSES TAKEN IN PURSUANCE OF AN UNDERGRADUATE DEGREE AT AN ACCREDITED INSTITUTION OF HIGHER EDUCATION. TUITION REIMBURSEMENT PROGRAM - PROCEDURE: 1. ELIGIBILITY: EMPLOYEES MUST BE EMPLOYED AS A REGULAR EMPLOYEE AUTHORIZED TO WORK WEEKEND OPTION OR AT LEAST 64 HOURS PER PAY PERIOD FOR SIX CONSECUTIVE MONTHS. THE SIX MONTH REQUIREMENT IS WAIVED FOR EMPLOYEES TAKING ACADEMIC COURSES TOWARD A DEGREE FOR A CRITICAL SHORTAGE AREA. IF ACADEMIC COURSES ARE RECOMMENDED BY THE DIRECTOR OR VICE PRESIDENT AT THE TIME OF HIRE, THE EMPLOYEE MAY ENROLL IN THE CLASS BEFORE SIX MONTHS OF EMPLOYMENT IS COMPLETED; HOWEVER, TUITION REIMBURSEMENT MAY NOT BE RECEIVED BEFORE SIX MONTHS OF EMPLOYMENT HAS BEEN COMPLETED. THE PROGRAM OF STUDY MUST: (A) BENEFIT THE HOSPITAL, AND EITHER (B) BE RELATED TO THE EMPLOYEE'S PRESENT JOB, OR (C) ENHANCE THE EMPLOYEE'S POTENTIAL FOR ADVANCEMENT TO A POSITION TO WHICH THE EMPLOYEE CAN REASONABLY BE EXPECTED TO BE PROMOTED WITHIN MEMORIAL HOSPITAL AND HEALTH CARE CENTER. TUITION REIMBURSEMENT WILL BE CONSIDERED FOR GRADUATE COURSES IF THE APPLICABLE VICE PRESIDENT OF MEMORIAL HOSPITAL AND HEALTH CARE CENTER REQUESTS THE EMPLOYEE TO CONTINUE HIS/HER EDUCATION TO MEET JOB REQUIREMENTS OF THE CURRENT JOB, TO MEET QUALIFICATIONS OF A PLANNED PROMOTION OR SERVES A BUSINESS PURPOSE OF THE HOSPITAL. INDIVIDUAL SEMINARS AND WORKSHOPS ARE NOT COVERED UNDER THIS POLICY. CERTIFICATE PROGRAMS ARE ONLY COVERED IF COLLEGE CREDIT AND LETTER GRADES ARE PROVIDED FOR CLASSES TAKEN BY THE EMPLOYEE. THE COURSE(S) MUST BE ATTENDED DURING NON-WORKING HOURS OR DIRECTOR/VICE PRESIDENT APPROVAL IS REQUIRED FOR SCHEDULE CHANGES IF NEEDED TO ATTEND CLASSES. THIS ACCOMMODATION MAY NOT BE POSSIBLE IN SOME AREAS. THE HOSPITAL EXPECTS EACH EMPLOYEE INVOLVED IN THE TUITION REIMBURSEMENT PROGRAM TO CONTINUE TO FUNCTION AT AN ACCEPTABLE LEVEL OF PERFORMANCE. A LETTER GRADE OF C (OR EQUIVALENT) OR BETTER MUST BE OBTAINED FOR UNDERGRADUATE COURSES. A GRADE OF B (OR EQUIVALENT) OR BETTER MUST BE ATTAINED FOR GRADUATE CLASSES. GRADES AND CHECK REQUESTS FOR TUITION REIMBURSEMENT MUST BE RECEIVED BY THE HUMAN RESOURCES DEPARTMENT WITHIN TWO WEEKS AFTER GRADES ARE RECEIVED. 2. BENEFITS - FOR CLASSES TAKEN FOR ALL JOB TITLES THAT ARE NOT LISTED AS CRITICAL SHORTAGE: FULL TIME (72 HOURS OR MORE PER PAY PERIOD) UNDERGRADUATE - 90% WITH A MAXIMUM OF $3,000 GRADUATE - 90% WITH A MAXIMUM OF $5,000 PART TIME (WEEKEND OPTION OR MINIMUM OF 64 HOURS PER PAY PERIOD) UNDERGRADUATE - 70% WITH A MAXIMUM OF $2,000 GRADUATE - 70% WITH A MAXIMUM OF $3,000 3. BENEFITS - FOR CLASSES TAKEN FOR JOB TITLES THAT ARE LISTED AS CRITICAL SHORTAGE: FULL TIME (MINIMUM OF 72 HOURS PER PAY PERIOD) UNDERGRADUATE - 90% WITH A MAXIMUM OF $4,000 PART TIME (WEEKEND OPTION OR MINIMUM OF 64 HOURS PER PAY PERIOD) 70% WITH A MAXIMUM OF $4,000 4. APPLICATION PROCEDURE: EMPLOYEES THAT MEET ELIGIBILITY REQUIREMENTS MUST COMPLETE A TUITION REIMBURSEMENT REQUEST FORM. ALL REQUESTS MUST INCLUDE DIRECTOR RECOMMENDATIONS. THE PRESIDENT AND THE DIRECTOR OF HUMAN RESOURCES HAVE THE AUTHORITY FOR THE FINAL APPROVAL OF EACH INDIVIDUAL REQUEST FOR TUITION REIMBURSEMENT. IN CASES WHERE EMPLOYEES HAVE HAD WRITTEN COUNSELING/DISCIPLINARY ACTION WITHIN THE LAST TWELVE MONTHS, TUITION REIMBURSEMENT MAY NOT BE APPROVED. REQUESTS RECEIVED MAY BE DENIED AND THE EMPLOYEE WILL BE ADVISED TO APPLY FOR THE NEXT CLASS SESSION. AFTER CLASS COMPLETION, VERIFICATION OF A LETTER GRADE (OR EQUIVALENT)FOR EACH CLASS MUST BE SUBMITTED TO THE HUMAN RESOURCES DEPARTMENT WITHIN TWO WEEKS OF RECEIPT OF GRADES. REIMBURSEMENT WILL NOT BE OBTAINED WITHOUT GRADE VERIFICATION. IF AN EMPLOYEE WHO HAS RECEIVED TUITION REIMBURSEMENT TERMINATES EMPLOYMENT AT MEMORIAL HOSPITAL (VOLUNTARY OR INVOLUNTARY) OR IF AN EMPLOYEE REDUCES EMPLOYMENT STATUS TO BELOW .6 FTE ALL TUITION REIMBURSEMENT RECEIVED WITHIN THE LAST 24 MONTHS PRIOR TO DATE OF TERMINATION OR STATUS REDUCTION WILL BE REPAID TO MEMORIAL HOSPITAL AND HEALTH CARE CENTER. REPAYMENT IS DUE WITHIN 30 DAYS OF TERMINATION DATE OR STATUS REDUCTION. A STATEMENT AGREEING TO THIS ARRANGEMENT WILL BE SIGNED BY EACH EMPLOYEE AT THE TIME APPLICATION IS MADE. |
| SCHOLARSHIP PROGRAM: | SCHOLARSHIP PROGRAM - POLICY STATEMENT: IN AN EFFORT TO PROMOTE PERSONAL AND PROFESSIONAL GROWTH OF STAFF, MEMORIAL HOSPITAL AND HEALTH CARE CENTER PROVIDES A SCHOLARSHIP PROGRAM TO ASSIST STAFF MEMBERS PURSUING AN UNDERGRADUATE DEGREE AT AN ACCREDITED INSTITUTION OF HIGHER EDUCATION TO WORK IN DEFINED CRITICAL SHORTAGE AREAS. SCHOLARSHIP PROGRAM - PROCEDURE: 1. ELIGIBILITY: SCHOLARSHIP APPLICANTS MUST BE EMPLOYED BY MEMORIAL HOSPITAL AND HEALTH CARE CENTER PRIOR TO APPLYING FOR THE SCHOLARSHIP. WEEKEND OPTION EMPLOYEES ARE NOT ELIGIBLE TO PARTICIPATE IN THE SCHOLARSHIP PROGRAM. EMPLOYEES WITH WRITTEN COUNSELING/DISCIPLINARY ACTION WITHIN THE LAST TWELVE MONTHS WILL NOT BE ELIGIBLE FOR THE SCHOLARSHIP PROGRAM. THE HOSPITAL EXPECTS EACH EMPLOYEE INVOLVED IN THE SCHOLARSHIP PROGRAM TO CONTINUE TO FUNCTION AT AN ACCEPTABLE LEVEL OF PERFORMANCE. THE PROGRAM OF STUDY MUST BENEFIT SPECIFICALLY DEFINED CRITICAL SHORTAGE AREAS WITHIN THE HOSPITAL, AS DETERMINED BY THE SCHOLARSHIP COMMITTEE. THE NUMBER OF SCHOLARSHIPS FOR CRITICAL SHORTAGE AREAS WILL BE DETERMINED ANNUALLY. EMPLOYEES THAT MEET ELIGIBILITY REQUIREMENTS MUST COMPLETE AN APPLICATION FORM AND SUBMIT IT TO THEIR DEPARTMENT DIRECTOR. DIRECTOR RECOMMENDATIONS MUST ACCOMPANY ALL APPLICATIONS SENT TO THE HUMAN RESOURCES DEPARTMENT. THE SCHOLARSHIP COMMITTEE WILL EXERCISE AUTHORITY IN THE SELECTION PROCESS. MEMBERS OF THIS COMMITTEE INCLUDE THE PRESIDENT/CEO, TWO VICE PRESIDENTS, THE DIRECTOR OF HUMAN RESOURCES, AND A DIRECTOR FROM ALL THREE DIVISIONS. SCHOLARSHIP RECIPIENTS ARE REQUIRED TO MAINTAIN A 0.8 FTE WORK STATUS. BENEFITS WILL BE CONSISTENT WITH EMPLOYEE STATUS. CREDIT HOURS WILL BE APPLIED WEEKLY TOWARDS THE STUDENT'S WEEKLY REQUIRED HOURS. EXAMPLE: A STUDENT WITH NINE CREDIT HOURS WEEKLY WOULD BE REQUIRED TO WORK 23 HOURS PER WEEK AT THE HOSPITAL. IN THIS EXAMPLE, THE STUDENT WOULD WORK 24 HOURS AT THE HOSPITAL, AS STAFFING WILL NOT BE ADJUSTED MID-SHIFT TO RELEASE STUDENTS EARLY FROM THEIR RESPONSIBILITIES. COURSE(S) WILL BE ATTENDED DURING NON-WORKING HOURS IN COORDINATION WITH STUDENT'S DEPARTMENT DIRECTOR WHO WILL SCHEDULE THEIR HOSPITAL HOURS AS NEEDED FOR DEPARTMENTAL COVERAGE, WHILE NOT INTERFERING WITH HOURS OF CLASS. STUDENTS MUST SUPPLY A CLASS SCHEDULE TO THEIR DIRECTOR AS SOON AS AVAILABLE TO ENABLE THE SCHEDULING PROCESS. AFTER CLASS COMPLETION, VERIFICATION OF A LETTER GRADE (OR EQUIVALENT) FOR EACH CLASS MUST BE SUBMITTED TO THE HUMAN RESOURCES DEPARTMENT WITHIN TWO WEEKS OF RECEIPT OF GRADES. A GRADE POINT AVERAGE OF 2.5 OR GREATER MUST BE MAINTAINED TO REMAIN IN GOOD STANDING. IF A STUDENT'S GPA DROPS BELOW 2.5, THE INDIVIDUAL WILL NOT BE ELIGIBLE TO REMAIN IN THE SCHOLARSHIP PROGRAM AND MUST APPLY FOR AN OPEN POSITION IN THE HOSPITAL TO CONTINUE THEIR EMPLOYMENT. SCHOLARSHIP RECIPIENTS MUST RE-APPLY FOR EACH SEMESTER TO VERIFY ELIGIBILITY BASED ON GRADES AND WORK PERFORMANCE. IF A SCHOLARSHIP RECIPIENT TERMINATES EMPLOYMENT AT MEMORIAL HOSPITAL (VOLUNTARY OR INVOLUNTARY), REDUCES EMPLOYMENT STATUS TO BELOW .8 FTE, OR DOES NOT MAINTAIN SATISFACTORY PERFORMANCE, ALL SCHOLARSHIP ASSISTANCE RECEIVED WITH THE LAST 24 MONTHS PRIOR TO DATE OF TERMINATION, STATUS REDUCTION, OR DISCIPLINARY ACTION WILL BE REPAID TO MEMORIAL HOSPITAL AND HEALTH CARE CENTER. RE-PAYMENT IS DUE WITHIN 30 DAYS OF THIS DATE. STATEMENT AGREEING TO THIS ARRANGEMENT WILL BE SIGNED BY EACH EMPLOYEE EACH TIME APPLICATION IS MADE. 2. BENEFITS: SCHOLARSHIP RECIPIENTS WILL BE PAID MINIMUM WAGE PER CREDIT HOUR TO BE APPLIED TO THEIR 0.8 FTE COMMITMENT. NO ADDITIONAL HOURS WILL BE PAID TO COMPLETE HOMEWORK, CLINICAL HOURS, OR SPECIAL ASSIGNMENTS. CORRESPONDENCE COURSES WILL BE PAID AT MINIMUM WAGE PER CREDIT HOUR FOR A MAXIMUM OF 16 WEEKS. THE STUDENT WILL BE PAID AT THEIR REGULAR HOURLY RATE FOR HOURS WORKED IN THE FACILITY. SCHOLARSHIP ASSISTANCE DOES NOT APPLY WHEN SCHOOL IS NOT IN SESSION. SCHOLARSHIP RECIPIENTS ARE ALSO ELIGIBLE TO APPLY FOR TUITION. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Discretionary Spending Acct | Yes (X) | DiscretionarySpendingAcctInd |
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| 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 | 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 | Yes (1) | 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 (15 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RAYMOND SNOWDEN | ||||||||||||||
| BOARD CHAIRPERSON | $227,061 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $227,061 | $0 | $0 | $0 |
| E KYLE BENNETT | ||||||||||||||
| PRESIDENT & CEO | $469,566 | $0 | $0 | $0 | $0 | $0 | $22,700 | $0 | $13,676 | $0 | $505,942 | $0 | $0 | $0 |
| NICHOLAS WERNE MD | ||||||||||||||
| MEDICAL STAFF PRESIDENT | $380,239 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $380,239 | $0 | $0 | $0 |
| SOHAIL QADIR MD | ||||||||||||||
| BOARD MEMBER | $621,699 | $0 | $0 | $0 | $0 | $0 | $5,300 | $0 | $14,615 | $0 | $641,614 | $0 | $0 | $0 |
| RANDALL J RUSSELL | ||||||||||||||
| VP FINANCE/CFO | $272,114 | $0 | $0 | $0 | $0 | $0 | $20,977 | $0 | $8,936 | $0 | $302,027 | $0 | $0 | $0 |
| KELLY CLAUSS | ||||||||||||||
| VP MEDICAL PRACTICE | $208,526 | $0 | $0 | $0 | $0 | $0 | $9,264 | $0 | $8,861 | $0 | $226,651 | $0 | $0 | $0 |
| JOHN DILLON | ||||||||||||||
| VP AMBULATORY SERVICES | $210,231 | $0 | $0 | $0 | $0 | $0 | $20,515 | $0 | $9,351 | $0 | $240,097 | $0 | $0 | $0 |
| TONYA HEIM | ||||||||||||||
| VP PATIENT SERVICES | $264,543 | $0 | $0 | $0 | $0 | $0 | $21,008 | $0 | $9,437 | $0 | $294,988 | $0 | $0 | $0 |
| GARY LIGHT | ||||||||||||||
| VP / CIO | $228,609 | $0 | $0 | $0 | $0 | $0 | $3,500 | $0 | $11,877 | $0 | $243,986 | $0 | $0 | $0 |
| STANLEY TRETTER MD | ||||||||||||||
| VP/ CMO | $256,794 | $0 | $0 | $0 | $0 | $0 | $4,742 | $0 | $18,431 | $0 | $279,967 | $0 | $0 | $0 |
| GEOFFREY DAY MD | ||||||||||||||
| PHYSICIAN | $1,097,754 | $0 | $0 | $0 | $0 | $0 | $5,300 | $0 | $12,872 | $0 | $1,115,926 | $0 | $0 | $0 |
| ADAM DAWKINS MD | ||||||||||||||
| PHYSICIAN | $1,052,715 | $0 | $0 | $0 | $0 | $0 | $5,300 | $0 | $12,313 | $0 | $1,070,328 | $0 | $0 | $0 |
| WILLIAM LEHMKUHLER MD | ||||||||||||||
| PHYSICIAN | $1,043,635 | $0 | $0 | $0 | $0 | $0 | $5,300 | $0 | $11,924 | $0 | $1,060,859 | $0 | $0 | $0 |
| JOSHUA LEONARD MD | ||||||||||||||
| PHYSICIAN | $1,001,706 | $0 | $0 | $0 | $0 | $0 | $5,300 | $0 | $12,313 | $0 | $1,019,319 | $0 | $0 | $0 |
| BRIAN WOEBKENBERG MD | ||||||||||||||
| PHYSICIAN | $841,051 | $0 | $0 | $0 | $0 | $0 | $5,300 | $0 | $11,924 | $0 | $858,275 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 1A | FormAndLineReferenceDesc |
| Explanation | MEMORIAL HOSPITAL HAS AN EXECUTIVE PERQUISITE PROGRAM WHICH INCLUDES REIMBURSEMENT FOR ALLOWABLE APPROVED PERQUISITE EXPENSES. REIMBURSEMENT MADE AS PART OF THE EXECUTIVE PERQUISITE PROGRAM IS REFLECTED ON THE EXECUTIVE'S W-2 FORM. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOSPITAL AUTHORITY OF THE CITY OF JASPER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 351692946 | BondIssuerEIN |
| Bond Issued | 2013-12-01 | BondIssuedDt |
| Issue Price | $56,585,000 | IssuePriceAmt |
| Purpose | SEE PART VI | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $3,480,000 | RetiredAmt |
| Total Proceeds | $56,585,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $782,751 | IssuanceCostsFromProceedsAmt |
| Other Spent Proceeds | $48,933,346 | OtherSpentProceedsAmt |
| Current Refunding | Yes (1) | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | 0 | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | Yes (1) | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | Yes (1) | MgmtContractBondFincdPropInd |
| Engage Bond Counsel Contracts | Yes (1) | EngageBondCounselContractsInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (1) | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | Yes (1) | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, COLUMN (F), DESCRIPTION OF PURPOSE: | FormAndLineReferenceDesc |
| Explanation | THE PROCEEDS OF THE SERIES 2013 BONDS WERE USED FOR THE PURPOSE OF REFUNDING THE PREVIOUSLY HELD 2002 BONDS AND THE SERIES 2008 BONDS. IN ADDITION, THE REMAINING PORTION OF THE SERIES 2013 BONDS, AS OF JUNE 30, 2015, ARE BEING HELD FOR THE PURPOSE OF FINANCING A PORTION OF THE COSTS OF CONSTRUCTION, EQUIPPING, AND RENOVATION AND IMPROVEMENT OF CERTAIN FACILITIES INCLUDING: LANGE FUHS CANCER CENTER EXPANSION, ADMINISTRATION RELOCATION, POWER PLAN MOVE, OUTPATIENT REHAB, ENDOSCOPY, DEMOLITION OF POWER PLANT, SKILLED CARING CENTER, AND SNF AREA OFFICE EXPANSION. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| MATRIX INTEGRATION | |||
| SEE PART V | $1,602,646 | SEE PART V | 0 |
| AMERICAN PROVIDENCE | |||
| SEE PART V | $286,028 | SEE PART V | 0 |
| UEBELHOR DEVELOPMENTS | |||
| SEE PART V | $128,269 | SEE PART V | 0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: | FormAndLineReferenceDesc |
| Explanation | (A) NAME OF PERSON: MATRIX INTEGRATION(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND THE HOSPITAL: COMPANY'S PRESIDENT, BRENDA STALLINGS, IS A BOARD MEMBERS OF MEMORIAL HOSPITAL.(D) DESCRIPTION OF TRANSACTION: MATRIX INTEGRATION PROVIDES PROFESSIONAL INFORMATION TECHNOLOGY (IT) SERVICES TO MEMORIAL HOSPITAL. THE HOSPITAL PAID $1,602,646 FOR SERVICES TO MATRIX INTEGRATION IN THE CURRENT YEAR.(A) NAME OF PERSON: AMERICAN PROVIDENCE OF LITTLE CO. OF MARY SISTERS (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND THE HOSPITAL: CORPORATE MEMBER OF HOSPITAL (D) DESCRIPTION OF TRANSACTION: THE HOSPITAL PAYS AMERICAN PROVIDENCE OF LITTLE COMPANY OF MARY SISTERS $286,029 AS A SPONSORSHIP FOR SISTER RENEE CUNNINGHAM. THE SISTER PROVIDES NURSING SERVICES TO THE HOSPITAL AND SERVES AS A BOARD MEMBER. THE SISTER DOES NOT ACCEPT COMPENSATION AS SHE HAS TAKEN A VOW OF POVERTY. (A) NAME OF PERSON: UEBELHOR DEVELOPMENTS(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND THE HOSPITAL: OWNER OF UEBELHOR DEVELOPMENT, MICHAEL UEBELHOR, IS A BOARD MEMBER OF MEMORIAL HOSPITAL.(D) DESCRIPTION OF TRANSACTION: MIKE UEBELHOR IS PART OWNER OF UEBELHOR DEVELOPMENTS, WHICH IS THE LESSOR OF THE ORGANIZATION'S URGENT CARE BUILDING IN HUNTINGBERG, IN. THE HOSPITAL PAID $128,269 IN LEASE PAYMENTS AND PROPERTY TAX PAYMENTS TO UEBELHOR DEVELOPMENTS IN THE CURRENT YEAR. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | MR. BENNETT, SISTER CUNNINGHAM, MR. DISINGER, MR. RUBINO, MR. RUSSELL, MR. SENDELWECK AND MR. SNOWDEN HAVE A BUSINESS RELATIONSHIP AS THEY ARE ALL BOARD MEMBERS FOR THE MEMORIAL HOSPITAL FOUNDATION. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE MEMBERS OF THE CORPORATION ARE THE PROVIDENCE LEADER AND COUNCIL MEMBERS OF THE AMERICAN PROVIDENCE OF LITTLE COMPANY OF MARY SISTERS. |
| FORM 990, PART VI, SECTION A, LINE 7A | LITTLE COMPANY OF MARY HOSPITAL BOARD MEMBERS HAS THE ABILITY TO NOMINATE AND APPROVE NEW MEMBERS TO THE BOARD. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE FOLLOWING DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY THE MEMBERS: TO ESTABLISH/APPROVE THE MISSION/PHILOSOPHY OF THE CORPORATION; TO ADOPT, AMEND OR REPEAL THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION; TO FIX THE NUMBER OF DIRECTORS OF THE CORPORATION AND APPOINT THE CORPORATION'S BOARD OF DIRECTORS; TO REMOVE ANY MEMBER OF THE BOARD OF THE CORPORATION; TO APPOINT AND REMOVE THE PRESIDENT/CEO OF THE CORPORATION; TO APPOINT AND REMOVE THE CHAIRPERSON OF THE BOARD OF DIRECTORS; TO APPROVE FOR THE CORPORATION, THE ACQUISITION OF ASSETS, THE INCURRENCE OF INDEBTEDNESS OR THE LEASE, SALE, TRANSFER, ASSIGNMENT, OR ENCUMBERING OF THE ASSETS IN AN AMOUNT SET FROM TIME TO TIME BY THE MEMBERS; TO APPROVE THE MERGER, DISSOLUTION, AFFILIATION, OR CORPORATE RESTRUCTURING OF THE CORPORATION AND ANY SUBSIDIARY OF THE CORPORATION; TO ACCEPT A GIFT OR LEGACY IMPOSING A PERMANENT OR CONTINUING OBLIGATION ON THE CORPORATION; TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS; AND TO APPOINT THE AUDITORS OF THE CORPORATION. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE PROCESS FOR REVIEWING THE FORM 990 INCLUDES A REVIEW BY THE CONTROLLER AND CHIEF FINANCIAL OFFICER. A COPY OF THE FORM 990 IS MADE AVAILABLE FOR THE BOARD OF DIRECTORS FOR REVIEW UPON REQUEST. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD CHAIRPERSON EVALUATES SITUATIONS WHERE POSSIBLE CONFLICTS MAY EXIST, BOARD MEMBERS ARE INFORMED OF ANY POTENTIAL CONFLICT OF INTEREST PRIOR TO DISCUSSIONS TAKE PLACE AT THE BOARD MEETING. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE PROCESS FOR DETERMINING THE COMPENSATION FOR ORGANIZATION'S OFFICERS IS CONDUCTED BY THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE, COMPOSED OF THE BOARD'S EXECUTIVE COMMITTEE EXCLUDING THE CEO, REVIEWS EXTERNAL SURVEY INFORMATION PROVIDED BY AN INDEPENDENT COMPENSATION CONSULTANT, AND VOTES ON ANY COMPENSATION AND BENEFIT CHANGES FOR THE CEO AND APPROVES THE SAME FOR OTHER MEMBERS OF ADMINISTRATIVE STAFF. THESE ACTIONS ARE DOCUMENTED IN MEETING MINUTES. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION DOES NOT MAKE THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. |
| FORM 990, PART XI, LINE 9: | CHANGE IN PENSION -7,541,512. CHANGE IN JOINT VENTURE 655,778. |
| PART XI, LINE 2C, OVERSIGHT OF THE AUDIT: | THE FINANCE COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS; NO PROCESSES HAVE CHANGED FROM THE PRIOR YEAR. THE AUDITORS ARE SELECTED BY THE COUNCIL MEMBERS OF THE AMERICAN PROVIDENCE OF LITTLE COMPANY OF MARY SISTERS. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BARRETT HEALTHCARE CORP OF SW INDIANA | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 WEST 9TH ST | AddressLine1Txt |
| City | JASPER | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47546 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 352039829 | EIN |
| Primary Activities | HEALTHCARE | PrimaryActivitiesTxt |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Total Income | $14,477 | TotalIncomeAmt |
| End Of Year Assets | $3,151,522 | EndOfYearAssetsAmt |
| Direct Controlling NA | N/A | DirectControllingNACd |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOSPITAL FOUNDATION INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 WEST NINTH STREET | AddressLine1Txt |
| City | JASPER | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47546 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351359445 | EIN |
| Primary Activities | BENEFIT MEMORIAL HOSPITAL & HEALTH CARE CENTER | PrimaryActivitiesTxt |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 11A, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOSPITAL AND HEALTH CARE CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | 0 | ControlledOrganizationInd |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOSPITAL OUTPATIENT SURGERY CENTER MANAGEMENT COMPANY | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 WEST 13TH STREET | AddressLine1Txt |
| City | JASPER | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47546 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 274828606 | EIN |
| Primary Activities | SURGERY CENTER MANAGEMENT | PrimaryActivitiesTxt |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Predominant Income Type | RELATED | PredominantIncomeTypeTxt |
| Share Of Total Income | $502,699 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $241,165 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | Yes (1) | GeneralOrManagingPartnerInd |
| Ownership | 0.40000 | 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 | Yes (1) | 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 | 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 |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOSPITAL FOUNDATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $253,234 | InvolvedAmt |
| Method Of Amount Determination | CASH | MethodOfAmountDeterminationTxt |
Comments