DIMMIT REGIONAL HOSPITAL: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- DIMMIT REGIONAL HOSPITAL (EIN 26-3091251)
- Tax period
- 2015-10-01 to 2016-09-30
- Filed
- 2017-08-15
- IRS object ID
- 201722279349303302
- 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 C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-08-15T15:15:26-05:00 | ReturnTs |
| Tax Period End | 2016-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14241 DALLAS PARKWAY STE 1100 | AddressLine1Txt |
| City | DALLAS | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 75254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 263091251 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Dimmit Regional Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % ALMA MELENDEZ | InCareOfNm |
| Business Name Control | DIMM | BusinessNameControlTxt |
| Phone | 8308762424 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1016 | AddressLine1Txt |
| City | Carrizo Springs | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 78834 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ERNEST FLORES JR | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 8308762424 | PhoneNum |
| Signature | 2017-08-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Jeanette Verrelli | PreparerPersonNm |
| PTIN | P00742631 | PTIN |
| Phone | 9727028262 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ERNEST FLORES JR | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1016 | AddressLine1Txt |
| City | Carrizo Springs | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 78834 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $20,567,772 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.DIMMITREGIONALHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2008 | FormationYr |
| Legal Domicile State | TX | LegalDomicileStateCd |
| Activity Or Mission | TO OPERATE AND MANAGE DIMMIT COUNTY MEMORIAL HOSPITAL; TO RAISE FUNDS ON BEHALF OF THE HOSPITAL; AND TO PROMOTE THE HEALTH OF RESIDENTS OF DIMMIT COUNTY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 270 | TotalEmployeeCnt |
| Total Volunteers | 8 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $9,227 | PYContributionsGrantsAmt |
| CY Contributions Grants | $542,625 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $21,596,944 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $19,633,585 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | -$8,041 | CYInvestmentIncomeAmt |
| PY Other Revenue | $135,937 | PYOtherRevenueAmt |
| CY Other Revenue | $341,044 | CYOtherRevenueAmt |
| PY Total Revenue | $21,742,108 | PYTotalRevenueAmt |
| CY Total Revenue | $20,509,213 | 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 | $9,276,107 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $11,511,743 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $12,442,298 | PYOtherExpensesAmt |
| CY Other Expenses | $11,956,964 | CYOtherExpensesAmt |
| PY Total Expenses | $21,718,405 | PYTotalExpensesAmt |
| CY Total Expenses | $23,468,707 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $23,703 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,959,494 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $6,420,853 | TotalAssetsBOYAmt |
| Total Assets EOY | $5,228,660 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,813,389 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,580,690 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,607,464 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,647,970 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO OPERATE AND MANAGE DIMMIT COUNTY MEMORIAL HOSPITAL; TO RAISE FUNDS ON BEHALF OF, AND CONTRIBUTE FINANCIAL SUPPORT TO, THE HOSPITAL; TO SUPPORT OTHER HEALTH-CARE DELIVERY ORGANIZATIONS THAT ARE CLOSELY RELATED TO THE HOSPITAL; AND TO PROMOTE THE HEALTH OF THE RESIDENTS OF DIMMIT COUNTY AND SURROUNDING COMMUNITIES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $18,739,087 | ExpenseAmt |
| Revenue | $19,974,629 | RevenueAmt |
| Desc | PROVIDED MEDICAL CARE TO RESIDENTS IN THE DIMMIT COUNTY AREA, INCLUDING 571 OPERATIONS; 9,300 EMERGENCY ROOM VISITS; 1,034 OBSERVATIONS VISITS; 2,133 HOME HEALTH VISITS AND 3,307 PATIENT DAYS. | Desc |
| Total Program Service Expenses | $18,739,087 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 36 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 270 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (true) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ALMA MELENDEZ | PersonNm |
| Phone | 8308762424 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 704 HOSPITAL DRIVE | AddressLine1Txt |
| City | CARRIZO SPRINGS | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 78834 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| ALFREDO CASTANEDA | ||||||||
| DIRECTOR | 0.25 | 0.0 | Yes (X) | $235 | $0 | $0 | ||
| BRUCE E LEONARD | ||||||||
| CHAIRMAN | 0.25 | 0.0 | Yes (X) | $287 | $0 | $0 | Yes (X) | |
| CLEO BUSTAMANTE JR | ||||||||
| VICE-CHAIRMAN | 0.25 | 0.0 | Yes (X) | $260 | $0 | $0 | Yes (X) | |
| MARY ALICE VALDEZ | ||||||||
| DIRECTOR | 0.25 | 0.0 | Yes (X) | $227 | $0 | $0 | ||
| AUGUST LINNARTZ JR | ||||||||
| DIRECTOR | 0.25 | 0.0 | Yes (X) | $104 | $0 | $0 | ||
| MIGUEL URIEGAS | ||||||||
| DIRECTOR | 0.25 | 0.0 | Yes (X) | $287 | $0 | $0 | ||
| SAMUEL ALLEN JR | ||||||||
| SECRETARY | 0.25 | 0.0 | Yes (X) | $235 | $0 | $0 | Yes (X) | |
| ALMA MELENDEZ | ||||||||
| CFO | 40.0 | 0.0 | $87,430 | $0 | $5,800 | Yes (X) | ||
| CARMEN P ESQUIVEL | ||||||||
| CNO | 40.0 | 0.0 | $108,164 | $0 | $12,727 | Yes (X) | ||
| JIM BUCKNER | ||||||||
| CEO | 40.0 | 0.0 | $180,719 | $0 | $13,293 | Yes (X) | ||
| ENRIQUE ITURBE | ||||||||
| ASSISTANT ADMINISTRATOR | 40.0 | 0.0 | $110,284 | $0 | $7,443 | Yes (X) | ||
| JOCELYN VALENCIA | ||||||||
| MED TECH | 40.0 | 0.0 | $116,506 | $0 | $2,074 | Yes (X) | ||
| JOSE LUNA | ||||||||
| HOME HEALTH SUPVR/DRG CODER | 40.0 | 0.0 | $110,854 | $0 | $7,471 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $715,592 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $48,808 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PHYSICAL THERAPY SYSTEMS | |||||
| 302 S 5TH STREET | CARRIZO SPRINGS | TX | 78834 | PHYSICAL THERAPY | $389,238 |
| TAB ANESTHESIA | |||||
| 20 LOU STROUP | UVALDE | TX | 78801 | HOSPITALIST SERVICE | $336,000 |
| EMCARE | |||||
| 7032 COLLECTION CENTER DRIVE | CHICAGO | IL | 60693 | 24 HR E.R. COVERAGE | $428,314 |
| TRUSTAFF TRAVEL NURSE | |||||
| PO BOX 63-8231 | CINCINNATI | OH | 45263 | E.R. & L.D. RN COVER | $613,429 |
| KHCR DBA ENDEAVOR | |||||
| 28 HUNTERS POINT | NEW BRAUNFELS | TX | 78132 | HOSPITAL BILLING | $390,434 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $350,000 | RelatedOrganizationsAmt |
| Government Grants | $9,054 | GovernmentGrantsAmt |
| All Other Contributions | $183,571 | AllOtherContributionsAmt |
| Total Contributions | $542,625 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net Patient Revenue | 621110 | $19,513,353 | $19,513,353 |
| Clinic Rent | 531390 | $120,232 | $120,232 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $19,633,585 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,819 | TotalRevenueColumnAmt |
| Exclusion | $3,819 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $46,699 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $58,559 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$11,860 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$11,860 | TotalRevenueColumnAmt |
| Exclusion | -$11,860 | ExclusionAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Miscellaneous Revenue | 900099 | $292,529 | $292,529 |
| Dietary Meals | 721210 | $39,213 | $39,213 |
| Medical Transcripts | 561000 | $9,302 | $9,302 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $341,044 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,509,213 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $19,974,629 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | -$8,041 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $410,501 | TotalAmt |
| Program Services | $309,286 | ProgramServicesAmt |
| Management And General | $101,215 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,655,023 | TotalAmt |
| Program Services | $6,523,543 | ProgramServicesAmt |
| Management And General | $2,131,480 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $252,831 | TotalAmt |
| Program Services | $189,623 | ProgramServicesAmt |
| Management And General | $63,208 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,512,340 | TotalAmt |
| Program Services | $1,134,255 | ProgramServicesAmt |
| Management And General | $378,085 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $681,048 | TotalAmt |
| Program Services | $520,383 | ProgramServicesAmt |
| Management And General | $160,665 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,758 | TotalAmt |
| Management And General | $22,758 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $152,836 | TotalAmt |
| Management And General | $152,836 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,037,813 | TotalAmt |
| Program Services | $1,450,453 | ProgramServicesAmt |
| Management And General | $587,360 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $367,974 | TotalAmt |
| Program Services | $11,098 | ProgramServicesAmt |
| Management And General | $356,876 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $338,964 | TotalAmt |
| Program Services | $94,458 | ProgramServicesAmt |
| Management And General | $244,506 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $166,875 | TotalAmt |
| Management And General | $166,875 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $455,052 | TotalAmt |
| Program Services | $233,192 | ProgramServicesAmt |
| Management And General | $221,860 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,027 | TotalAmt |
| Program Services | $53,529 | ProgramServicesAmt |
| Management And General | $44,498 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,058 | TotalAmt |
| Management And General | $2,058 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,831 | TotalAmt |
| Management And General | $41,831 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $580,550 | TotalAmt |
| Program Services | $580,550 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $82,406 | TotalAmt |
| Program Services | $82,406 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $1,847,298 | $1,847,298 | |
| Dues and Subscriptions | $104,536 | $58,410 | $46,126 |
| Bad Debt Expense | $5,650,603 | $5,650,603 | |
| . | $0 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,383 | TotalAmt |
| Management And General | $7,383 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,468,707 | TotalAmt |
| Program Services | $18,739,087 | ProgramServicesAmt |
| Management And General | $4,729,620 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $771,995 | BOYAmt |
| EOY | $476,062 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $882,255 | BOYAmt |
| EOY | $223,115 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $100,000 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,523,700 | BOYAmt |
| EOY | $1,211,629 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $67,822 | BOYAmt |
| EOY | $61,741 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,636 | BOYAmt |
| EOY | $55,318 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $4,802,916 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,253,437 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,608,373 | BOYAmt |
| EOY | $2,549,479 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,537,072 | BOYAmt |
| EOY | $551,316 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,420,853 | BOYAmt |
| EOY | $5,228,660 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,187,454 | BOYAmt |
| EOY | $1,687,671 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $625,935 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $280,924 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $1,612,095 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,813,389 | BOYAmt |
| EOY | $3,580,690 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,607,464 | BOYAmt |
| EOY | $1,547,970 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $100,000 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,607,464 | BOYAmt |
| EOY | $1,647,970 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,420,853 | BOYAmt |
| EOY | $5,228,660 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$2,959,494 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | 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) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $1,550 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,550 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1I | FormAndLineReferenceDesc |
| Explanation | OTHER ACTIVITIES: HOSPITAL PAID DUES TO ORGANIZATIONS, A PORTION OF WHICH IS DESIGNATED FOR LOBBYING EXPENSES. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp | |
| Land | LandGrp |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $474,274 | OtherCostOrOtherBasisAmt |
| Depreciation | $58,570 | DepreciationAmt |
| Book Value | $415,704 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,276,509 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,194,867 | DepreciationAmt |
| Book Value | $2,081,642 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $52,133 | OtherCostOrOtherBasisAmt |
| Book Value | $52,133 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,549,479 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Other Assets | $192,830 |
| Est amounts from 3rd party | $179,079 |
| Due from District | $179,407 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $551,316 | TotalBookValueOtherAssetsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| EST AMOUNTS DUE TO 3RD PARTY | $421,354 |
| EST SELF-INSURANCE COSTS | $151,824 |
| CAPITAL LEASE OBLIGATION | $1,038,917 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,612,095 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $16,794,165 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $1,977,386 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | -$5,692,434 | OtherRevenueAmt |
| Revenue Not Reported | -$3,715,048 | RevenueNotReportedAmt |
| Revenue Subtotal | $20,509,213 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $20,509,213 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $19,753,659 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $1,977,386 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $1,977,386 | ExpensesNotReportedAmt |
| Expenses Subtotal | $17,776,273 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $5,692,434 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $5,692,434 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $23,468,707 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PART X, LINE 2 | LIABILITY FOR UNCERTAIN TAX POSITIONS: AS AN ESSENTIAL GOVERNMENT FUNCTION, THE DISTRICT IS GENERALLY EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 115 OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. HOWEVER, THE DISTRICT IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE HOSPITAL HAS BEEN RECOGNIZED AS EXEMPT FROM INCOME TAXES UNDER SECTION 501 OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. HOWEVER, THE HOSPITAL IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE HOSPITAL FILES TAX RETURNS IN THE U.S. FEDERAL JURISDICTION. IN 2012, THE HOSPITAL RECEIVED NOTICE FROM THE IRS THAT ITS TAX-EXEMPT STATUS HAD BEEN AUTOMATICALLY REVOKED, EFFECTIVE FEBRUARY 15, 2011. THE HOSPITAL BELIEVES THE REVOCATION TO BE AN ERROR AND FILED AN APPLICATION FOR RETROACTIVE REINSTATEMENT OF ITS TAX-EXEMPT STATUS WITH REASONABLE CAUSE. THE HOSPITAL RECEIVED A DETERMINATION OF EXEMPT STATUS EFFECTIVE NOVEMBER 5, 2012, THE DATE OF FILING OF THE NEW APPLICATION. THE HOSPITAL MAY BE ASSESSED PENALTIES, INTEREST AND TAX FOR THE TIME PERIOD BETWEEN FEBRUARY 15, 2011 AND NOVEMBER 4, 2012 IF THE REQUEST FOR RETROACTIVE REINSTATEMENT WITH REASONABLE CAUSE IS NOT APPROVED. HOWEVER, THE HOSPITAL BELIEVES IT IS PROBABLE THAT THE PENALTIES, INTEREST AND TAX WILL BE ABATED WITH THE RETROACTIVE REINSTATEMENT, WHICH IS CURRENTLY UNDER REVIEW BY THE INTERNAL REVENUE SERVICE. MANAGEMENT CURRENTLY ESTIMATES THE AMOUNT OF TAX OWED FOR THE TIME PERIOD BETWEEN FEBRUARY 15, 2011 AND NOVEMBER 4, 2012 TO BE $95,000 TO $237,000, HOWEVER, THE HOSPITAL BELIEVES IT IS MORE-LIKELY-THAN-NOT THAT ITS TAX-EXEMPT STATUS WILL BE RETROACTIVELY REINSTATED AND NO PROVISION IS MADE IN THESE FINANCIAL STATEMENTS. |
| SCHEDULE D, PART XI, LINE 2D | RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS WITH RETURN: BAD DEBT EXPENSE $(5,650,603) INTEREST EXPENSE (41,831) ------------ TOTAL $(5,692,434) |
| SCHEDULE D, PART XII, LINE 4B | RECONCILIATION OF EXPENSE PER AUDITED FINANCIAL STATEMENTS WITH RETURN: BAD DEBT EXPENSE $5,650,603 INTEREST EXPENSE 41,831 ----------- TOTAL $5,692,434 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,653,667 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,653,667 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09280 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,048,844 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,324,636 | DirectOffsettingRevenueAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,702,511 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,324,636 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,653,667 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09280 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $62,581 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $62,581 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00350 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $62,581 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $62,581 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00350 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,765,092 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,324,636 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,716,248 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09630 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $5,650,603 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $2,677,225 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,335,072 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$657,847 | 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 (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | false | 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 | DIMMIT REGIONAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 704 HOSPITAL DRIVE | AddressLine1Txt |
| City | CARRIZO SPRINGS | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 78834 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.DIMMITREGIONALHOSPITAL.COM | WebsiteAddressTxt |
| State License | 100175 | 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 | DIMMIT REGIONAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | 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 | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION C | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION C | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200. | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V, SECTION C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, SECTION C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, SECTION C | 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 |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | 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 (true) | NondisEmergencyCarePolicyInd |
| Medicare Rates | Yes (X) | MedicareRatesInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART V, SECTION B, LINE 5 | INPUT FROM THE COMMUNITY: THE ORGANIZATION CONDUCTED INTERVIEWS AND FOCUS GROUPS WITH BUSINESS LEADERS, MEMBERS OF THE HISPANIC COMMUNITY, ELECTED OFFICIALS, SENIOR CITIZENS, THE HOSPITAL AUXILIARY, THE CHAMBER OF COMMERCE, AND MINISTERS. |
| SCHEDULE H, PART V, SECTION B, LINE 11 | IDENTIFIED NEEDS ADDRESSED AND NOT ADDRESSED: THE IMPLEMENTATION STRATEGY ADDRESSED THE FOLLOWING NEEDS IDENTIFIED IN THE CHNA: 1. HOSPITAL OPERATION ISSUES - THERE IS A LACK OF CUSTOMER SERVICE TRAINING, AND THE LENGTH OF TIME TO FILE A PATIENT'S CLAIMS IS TOO LONG. THE HOSPITAL ALSO WANTS TO ENFORCE THE PERCEPTION THAT PERSONAL HEALTH INFORMATION IS NOT SHARED IN THE COMMUNITY. THE HOSPITAL PLANS TO ENFORCE HIPAA REQUIREMENTS AND FOLLOW THE PRINCIPLES SET FORTH IN "HARDWIRING EXCELLENCE: PURPOSE, WORTHWHILE WORK, MAKING A DIFFERENCE." THE HOSPITAL HAS ALSO INTENSIFIED STAFF TRAINING AROUND SERVICE EXCELLENCE. 2. COMMUNITY OUTREACH - THE HOSPITAL WANTS TO INCREASE VISIBILITY IN THE COMMUNITY AND INCREASE ACCESS TO SPECIALTY PHYSICIAN SERVICES. THE HOSPITAL HAS WORKED ON MEETING THIS NEED DURING THE 2016 FISCAL YEAR THROUGH THE FOLLOWING ACTIONS: - NEW ECHOCARDIOGRAPHY EQUIPMENT HAS BEEN PURCHASED TO HELP MANAGE PATIENTS IN HEART FAILURE. - THE HOSPITAL HAS A CAPITAL CAMPAIGN FOR MAMMOGRAPHY SERVICES IN PROGRESS. THE FUNDS FROM THIS CAMPAIGN HAS HELPED CREATE THE WOMAN'S IMAGING CENTER WHICH IS SET TO OPEN OCTOBER OF 2017. - THE FQHC IN CRYSTAL CITY AND THE HOSPITAL HAVE WORKED TOGETHER IN PRIMARY CARE RECRUITMENT. - STAFF TRAINED AS EDUCATORS IN BASIC LIFE SUPPORT AND ADVANCED CARDIAC LIFE SUPPORT AND ARE MAKING EDUCATION AVAILABLE TO THE CITY, COUNTY AND AREA EMPLOYERS AND THE COMMUNITY. - A NEW BREASTFEEDING CAMPAIGN IS UNDERWAY. - TWO NEW FAMILY PRACTICE PHYSICIANS STARTED IN 2015 BY RECRUITMENT EFFORT OF THE HOSPITAL. IN 2016, THE PHYSICIANS LEFT, AND WE ARE LOOKING TO RECRUIT A FAMILY PRACTICE PHYSICIAN BY OCTOBER 2017. - A NEW CARDIOLOGIST NOW PRACTICES PART-TIME IN CARRIZO SPRINGS. - THE HOSPITAL IS LOOKING INTO PROVIDING INTERVENTIONAL RADIOLOGY SERVICES BY 2017 AND MORE SPECIALTY SERVICES FOR ENT, ONCOLOGY AND MENTAL HEALTH. THE ORGANIZATION'S CHNA IDENTIFIED SOME NEEDS THAT ARE BEYOND THEIR RESOURCES OR CAPABILITIES. SOME NEEDS ARE BEING ADDRESSED BY OTHER AGENCIES, PROVIDERS, OR ORGANIZATIONS. THESE NEEDS INCLUDE CHRONIC DISEASES (SUCH AS RENAL, CANCER, RESPIRATORY, AND SUBSTANCE ABUSE), TEEN PREGNANCY, INDUSTRIAL ACCIDENTS, HIGHWAY TRAUMA AND SPECIALTY PHYSICIAN ACCESS. |
| SCHEDULE H, PART V, SECTION B, LINE 7 | AVAILABILITY OF CHNA: THE CHNA IS AVAILABLE UPON REQUEST OR AT THE FOLLOWING ADDRESS: http://www.dimmitregionalhospital.com/getpage.php?name=Community_Health_Ne eds_Assessment&sub=Community+Health+Needs+Assessment |
| SCHEDULE H, PART V, section b, LINES 16A, 16B, & 16C | AVAILABILITY OF FINANCIAL ASSISTANCE PROGRAM POLICY: THE FAP, FAP APPLICATION, AND FINANCIAL ASSISTANCE PLAIN LANGUAGE SUMMARY ARE AVAILABLE UPON REQUEST OR AT THE FOLLOWING ADDRESS: http://www.dimmitregionalhospital.com/getpage.php?name=Patient_Financial_S ervices&sub=Patient+Financial+Services |
| Schedule H, Part V, Section B, Line 10a | AVAILABILITY OF IMPLEMENTATION STRATEGY: THE HOSPITAL'S IMPLEMENTATION STRATEGY IS AVAILABLE AT THE FOLLOWING ADDRESS: http://www.dimmitregionalhospital.com/getpage.php?name=Implementation_Plan &sub=Implementation+Plan |
| SCHEDULE H, PART V, SECTION B, LINES 18, 19, & 20 | BILLING AND COLLECTIONS: NEITHER DIMMIT REGIONAL HOSPITAL, NOR THIRD PARTIES AUTHORIZED BY DIMMIT REGIONAL HOSPITAL, TAKE ANY ACTIONS UPON NON-PAYMENT FROM A PATIENT BEFORE MAKING A REASONABLE EFFORT TO DETERMINE IF THE PATIENT IS ELIGIBLE FOR THE FACILITY'S FINANCIAL ASSISTANCE POLICY. |
| SCHEDULE H, PART V, SECTION B, LINE 22 | DETERMINATION OF AMOUNTS BILLED: BEGINNING IN TAX YEAR 2016, THE HOSPITAL ADOPTED THE LOOK-BACK METHOD TO ESTABLISH THE AMOUNTS GENERALLY BILLED (AGB) TO INDIVIDUALS WHO HAD INSURANCE COVERING SUCH CARE. THE HOSPITAL WILL LIMIT THE AMOUNT CHARGED FOR CARE IT PROVIDES TO ANY INDIVIDUAL WHO IS ELIGIBLE FOR ASSISTANCE TO NOT MORE THAN AGB. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SURECARE CLINIC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 SOUTH 8TH STREET | AddressLine1Txt |
| City | CARRIZO SPRINGS | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 78834 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | FAMILY MEDICINE | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART III, SECTION A, LINE 2 | METHODOLOGY TO ESTIMATE BAD DEBT EXPENSE: THE AMOUNT ON LINE 2 IS BASED ON BAD DEBTS PER THE AUDITED FINANCIAL STATEMENTS. |
| SCHEDULE H, PART III, SECTION A, LINE 3 | BAD DEBT AS A COMMUNITY BENEFIT: THE ORGANIZATION IS UNABLE TO ESTIMATE THE AMOUNT FOR LINE 3 AND HAS ELECTED TO LEAVE IT BLANK. |
| SCHEDULE H, PART III, SECTION A, LINE 4 | BAD DEBT FOOTNOTE: The Hospital reports patient accounts receivable for services rendered at net realizable amounts from third-party payers, patients and others. The Hospital provides an allowance for uncollectible accounts based upon a review of outstanding receivables, historical collection information, and existing economic conditions. |
| SCHEDULE H, PART III, SECTION B, LINE 8 | COSTING METHODOLOGY: THE MEDICAL CENTER USES COST REPORT METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS BASED ON MEDICARE OR MEDICAID DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. IN ADDITION, THE STATE OF TEXAS TREATS MEDICARE SHORTFALL AS COMMUNITY BENEFIT FOR MEETING STATUTORY REQUIREMENTS FOR CHARITY CARE AND COMMUNITY BENEFIT. |
| SCHEDULE H, PART III, SECTION C, LINE 9B | COLLECTION PRACTICES: THE COLLECTION POLICY CURRENTLY DOES NOT CONTAIN EXPLICIT PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. THE HOSPITAL IS IN THE PROCESS OF AMENDING ITS COLLECTIONS POLICY TO INCLUDE THE PRACTICES TO BE FOLLOWED FOR PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE. |
| SCHEDULE H, PART VI, LINE 2 | NEEDS ASSESSMENT: COMMUNITY ASSESSMENT IS CONDUCTED THROUGH TELEPHONE AND PERSONAL MEETINGS. COMMUNITY LEADERS, BUSINESS LEADERS AND COMMUNITY MEMBERS ARE INTERVIEWED CONCERNING THE NEEDS OF THE COMMUNITY. THE RESULTS ARE THEN PRESENTED TO THE BOARD OF MANAGERS AND A PLAN IS DEVELOPED TO ADDRESS THOSE NEEDS. |
| SCHEDULE H, PART VI, LINE 3 | PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS GIVEN TO ALL PATIENTS. CHARITY CARE APPLICATIONS ARE GIVEN TO E.R. PATIENTS THAT WILL BE SELF PAYING. A LETTER IS MAILED WITH A CHARITY CARE APPLICATION TO THESE PATIENTS. FOLLOW-UP CALLS ARE THEN MADE TO THE PATIENTS THAT WERE SENT APPLICATIONS TO EXPLAIN AND ASK IF THEY NEED HELP IN COMPLETING THESE FORMS. AT REGISTRATION OR ADMISSION, CHARITY CARE APPLICATIONS ARE GIVEN TO INPATIENTS AND OUTPATIENTS THAT WILL BE SELF PAYING. WE ALSO HAVE AVAILABLE AN INDIGENT COORDINATOR, MONDAY THRU FRIDAY, 8AM TO 5PM, THAT WILL TALK TO THESE PATIENTS AND EXPLAIN WHAT ASSISTANCE WE HAVE AVAILABLE. IF AN APPLICATION IS REQUESTED LATER, IT IS SENT TO THE PATIENT. |
| SCHEDULE H, PART VI, LINE 4 | COMMUNITY INFORMATION: DIMMIT COUNTY'S ESTIMATED POPULATION IS 10,794 WITH A TOTAL SERVICE AREA OF 24,100 PEOPLE. THE GENDER COMPOSITION IS 49.2% MALE AND 50.80% FEMALE. THE POVERTY RATE IS 24.45% AND THE MEDIAN INCOME PER HOUSEHOLD IS $36,825. |
| SCHEDULE H, PART VI, LINE 5 | PROMOTION OF COMMUNITY HEALTH: A SPECIALTY CLINIC WAS STARTED AND CURRENTLY SERVICES PODIATRY, ONCOLOGY, DENTAL AND ENT SERVICES. DIMMIT REGIONAL HOSPITAL (DRH) IS CURRENTY RECRUITING FOR ORTHOPEDIC AND DERMATOLOGY. THIS WILL HELP ALLEVIATE FINANCIAL STRAIN FOR PATIENTS WHO NEED SPECIALTY CARE AND HAVE TO TRAVEL TO OBTAIN IT. EDUCATION PROGRAMS ARE ALSO PROVIDED TO PROMOTE HEALTHCARE HABITS. ADDITIONALLY, TRAINING IS PROVIDED TO NEW PARENTS ON CAR SAFETY SEATS. SEATS ARE PROVIDED TO THOSE WHO CANNOT AFFORD THEM. HEALTH FAIRS ARE ALSO HELD AND SCHOLARSHIPS ARE AWARDED TO STUDENTS THAT ARE INTERESTED IN NURSING CAREERS. THE HOSPITAL HAS ALSO STARTED A TELEMEDICINE PROJECT WITH METHODIST HOSPITAL IN SAN ANTONIO TO PROVIDE STROKE ALERT SERVICES IN THE EMERGENCY ROOM. |
| SCHEDULE H, PART VI, LINE 6 | AFFILIATED HEALTH CARE SYSTEM: N/A |
| SCHEDULE H, PART VI, LINE 7 | STATE FILING OF COMMUNITY BENEFIT REPORT: TEXAS |
| SCHEDULE H, PART I, LINE 3C | FACTORS OTHER THAN FPG DETERMINING FREE OR DISCOUNTED CARE: THE HOSPITAL USES THE FOLLOWING CRITERIA TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE: - MEDICAL INDIGENCY |
| SCHEDULE H, PART I, LINE 7, COLUMN F | PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990 WAS REDUCED BY BAD DEBT EXPENSE, TOTALING $5,650,603. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JIM BUCKNER | PersonNm |
| Title | CEO | TitleTxt |
| Base Compensation Filing Org | $168,891 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $11,828 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $8,445 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $4,848 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $194,012 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | PROCESS TO REVIEW FORM 990: THE FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM FOLLOWING THE COMPLETION OF AN AUDIT OF THE FINANCIAL STATEMENTS. AN OFFICER REVIEWS THE RETURN PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: EACH DIRECTOR, PRINCIPAL OFFICER AND BOARD COMMITTEE MEMBER ANNUALLY SIGNS A STATEMENT WHICH AFFIRMS THAT THEY AGREE TO COMPLY WITH THE CONFLICT OF INTEREST POLICY. WHEN A POSSIBLE CONFLICT OF INTEREST ARISES, THE DIRECTOR OR OFFICER MUST DISCLOSE THE INTEREST AND RELATED FACTS. THE PERSON MUST LEAVE THE MEETING AND THE REST OF THE BOARD MUST DECIDE IF A CONFLICT OF INTEREST EXISTS. IF IT IS DECIDED THAT A CONFLICT OF INTEREST EXISTS, THE INTERESTED PERSON IS NOT ALLOWED TO PARTICIPATE IN DISCUSSION OR VOTE ON THE TRANSACTION OR ARRANGEMENT INVOLVED. |
| FORM 990, PART VI, SECTION B, LINE 15A | REVIEW OF CEO OR TOP MGMT OFFICIAL COMPENSATION: THE COMPENSATION OF THE CEO INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DECISION. THE MOST RECENT REVIEW WAS CONDUCTED IN JANUARY OF 2016 BY THE BOARD OF DIRECTORS. THE REVIEW WAS DOCUMENTED IN THE HUMAN RESOURCE FILES. |
| FORM 990, PART VI, SECTION B, LINE 15B | REVIEW OF COMPENSATION OF OTHER OFFICERS: THE CEO COMPLETES AN EVALUATION FORM FOR ALL OTHER OFFICERS AND MEETS WITH EACH INDIVIDUAL TO DISCUSS. THE SCORE OR POINTS ON THE EVALUATION DETERMINES THE PERCENTAGE OF ANY COMPENSATION ADJUSTMENTS. THE MOST RECENT REVIEW WAS CONDUCTED IN NOVEMBER 2015 AND DOCUMENTED IN THE HUMAN RESOURCE FILES. |
| FORM 990, PART VI, SECTION C, LINE 19 | AVAILABILITY OF DOCUMENTS: THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART VI, SECTION A, LINE 4 | SIGNIFICANT CHANGES TO GOVERNING DOCUMENTS: THE BYLAWS WERE RESTATED ON AUGUST 3, 2016. THE MOST SIGNIFICANT CHANGE INDICATES THAT "IN NO EVENT SHALL A MAJORITY OF THE BOARD OF DIRECTORS OF DIMMIT REGIONAL HOSPITAL BE MEMBERS OF THE BOARD OF DIRECTORS OF DIMMIT REGIONAL HOSPITAL DISTRICT." THE RESTATED BYLAWS WERE ALSO AMENDED TO READ THAT IF THE BOARD OF DIRECTORS CONSISTS OF LESS THAN NINE MEMBERS, THE BOARD WILL NOT HAVE STANDING COMMITTEES UNLESS A MAJORITY OF THE DIRECTORS RESOLVE TO DO SO. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIMMIT REGIONAL HOSPITAL DISTRICT | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1016 | AddressLine1Txt |
| City | CARRIZO SPRINGS | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 78834 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 271613078 | EIN |
| Primary Activities | LEASING | PrimaryActivitiesTxt |
| Legal Domicile State | TX | LegalDomicileStateCd |
| Exempt Code Section | GOVT | ExemptCodeSectionTxt |
| Public Charity Status | N/A | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (true) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |