BOONE MEMORIAL HOSPITAL INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- BOONE MEMORIAL HOSPITAL INC (EIN 55-0477361)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-12
- IRS object ID
- 201741329349303364
- 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 G
- Schedule H
- Schedule I
- Schedule J
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-12T11:27:22-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 550486667 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Arnett Carbis Toothman LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O Box 2629 | AddressLine1Txt |
| City | Charleston | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25329 | 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 | 550477361 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Boone Memorial Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BOON | BusinessNameControlTxt |
| Phone | 3043691230 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 701 Madison Avenue | AddressLine1Txt |
| City | Madison | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25130 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Randell Foxx | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3043691230 | PhoneNum |
| Signature | 2017-05-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Tessa W Carr | PreparerPersonNm |
| PTIN | P01291277 | PTIN |
| Phone | 3043460441 | 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 | Virgil Underwood | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 701 Madison Avenue | AddressLine1Txt |
| City | Madison | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25130 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $28,645,835 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.bmh.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2010 | FormationYr |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Activity Or Mission | Boone Memorial hospital strives to supply a comprehensive range of inpatient and outpatient services, including prevention, guidance, diagnosis, treatment, restoration, rehabilitation and other efforts to enable patients to lead healthy, productive lives, as may be needed by its community, and as its resources will permit. In carrying out its programs, Boone Memorial Hospital recognizes its responsibility to make services available to all persons who can benefit from them and to provide these in an economical manner in compliance with high professional standards. The hospital further recognizes responsibility to develop an organizational environment in which physicians, employees, volunteers and other individuals constituting its staff are stimulated to high standards of performance and can find maximum satisfaction, achievement and opportunity. As an equal opportunity employer it will not permit discrimination because of race, color, religion, sex, age, national origin or handicap. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 228 | TotalEmployeeCnt |
| Total Volunteers | 40 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $480,271 | PYContributionsGrantsAmt |
| CY Contributions Grants | $664,861 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $27,143,518 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $27,436,501 | CYProgramServiceRevenueAmt |
| PY Investment Income | $102,551 | PYInvestmentIncomeAmt |
| CY Investment Income | $180,906 | CYInvestmentIncomeAmt |
| PY Other Revenue | $713,167 | PYOtherRevenueAmt |
| CY Other Revenue | $342,299 | CYOtherRevenueAmt |
| PY Total Revenue | $28,439,507 | PYTotalRevenueAmt |
| CY Total Revenue | $28,624,567 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $45,097 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $53,417 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $10,544,537 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $11,521,189 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $50,051 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $21,044 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $16,250,120 | PYOtherExpensesAmt |
| CY Other Expenses | $15,704,957 | CYOtherExpensesAmt |
| PY Total Expenses | $26,889,805 | PYTotalExpensesAmt |
| CY Total Expenses | $27,279,563 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,549,702 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,345,004 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $26,881,258 | TotalAssetsBOYAmt |
| Total Assets EOY | $48,592,181 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $18,315,928 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $38,681,847 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $8,565,330 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,910,334 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | The basic mission of Boone Memorial Hospital is to create an environment in which qualified physicians and other health care personnel can work together to provide high quality health care service, in an atmosphere of brotherly love and concern, to the residents of Boone County and surrounding areas. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $22,073,578 | ExpenseAmt |
| Revenue | $27,744,482 | RevenueAmt |
| Desc | In performing its mission, Boone Memorial Hospital had 413 acute care admissions and 113 skilled nursing care admissions. The Hospital also had 3 respite care patients, 12,350 emergency room visits, 20,057 out-patient visits and 24,535 visits in its two rural health clinics. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $15,202 | ExpenseAmt |
| Revenue | $15,998 | RevenueAmt |
| Desc | Boone Memorial Hospital conducts an annual health fair. The Hospital uses the local Madison Civic Center and offers very low cost blood work to the community. Approximately 475 community members attended the health fair and approximately 182 received low cost blood work. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $125,860 | ExpenseAmt |
| Revenue | $34,998 | RevenueAmt |
| Desc | BMH Respite Care Program. The Hospital had 3 respite care admissions and 12 respite days for its 6/30/16 fiscal year. The respite care program is a cash only program. It is not billed to insurance, but the rate is only $116 per day. We offer this as a community benefit. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $53,417 | ExpenseAmt |
| Grant | $53,417 | GrantAmt |
| Desc | The hospital provided 7 student loan forgiveness grants during the year. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $53,417 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $53,417 | TotalOtherProgSrvcGrantAmt |
| Total Program Service Expenses | $22,268,057 | 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 | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | 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 | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 52 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 228 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| 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 | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WV | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Randell D Foxx | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3043691230 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 701 Madison Avenue | AddressLine1Txt |
| City | Madison | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25130 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| Robert Brown | |||||||
| President | 1.30 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| James Hensley | |||||||
| Vice President | 1.30 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Thomas Bias | |||||||
| Secretary | 1.30 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Douglas Bell | |||||||
| Board Member | 1.30 | Yes (X) | $0 | $0 | $0 | ||
| William Stone | |||||||
| Board Member | 1.30 | Yes (X) | $0 | $0 | $0 | ||
| Shawn Miller | |||||||
| Board Member | 1.30 | Yes (X) | $0 | $0 | $0 | ||
| James Gore | |||||||
| Board Member | 1.30 | Yes (X) | $0 | $0 | $0 | ||
| Nada Woodie | |||||||
| Board Member | 1.30 | Yes (X) | $0 | $0 | $0 | ||
| Virgil Underwood | |||||||
| CEO as of 2/2015 | 40.00 | Yes (X) | $157,704 | $0 | $11,109 | ||
| Randell D Foxx | |||||||
| CFO, Interim Co-CEO until 2/2015 | 40.00 | Yes (X) | $169,414 | $0 | $17,736 | ||
| Mark Linville | |||||||
| COO, Interim Co-CEO until 2/2015 | 40.00 | Yes (X) | $126,250 | $0 | $15,955 | ||
| Ziad Chanaa | |||||||
| Physician | 21.00 | $141,320 | $0 | $80,561 | Yes (X) | ||
| Kevin Hill | |||||||
| PA | 47.00 | $183,686 | $0 | $18,149 | Yes (X) | ||
| Tarah Hager | |||||||
| PA | 45.00 | $132,445 | $0 | $10,205 | Yes (X) | ||
| David Gresham | |||||||
| CDO | 40.00 | $130,000 | $0 | $0 | Yes (X) | ||
| Kristina Stover | |||||||
| PA | 44.00 | $113,535 | $0 | $7,636 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,154,354 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $161,351 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 13 | 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 |
|---|---|---|---|---|---|
| Neighborgall Construction Co | |||||
| 1216 Seventh Avenue | Huntington | WV | 25701 | General Contractor-New Hospital | $10,463,059 |
| Rehab One Ltd | |||||
| 1834 Park Avenue | Belle | WV | 25015 | Physical Therapy Services | $1,049,500 |
| CPSI | |||||
| PO Box 850309 | Mobile | AL | 36685 | System Software Vendor | $1,022,791 |
| Cherry River Construction LLC | |||||
| 85 Legacy Ridge | Red House | WV | 25168 | General Contractor-New Hospital | $806,388 |
| Pharmacy Management and Consulting Servi | |||||
| 928 Helene Street | St Albans | WV | 25177 | Pharmacy Management | $659,602 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 21 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $55,811 | FundraisingAmt |
| All Other Contributions | $609,050 | AllOtherContributionsAmt |
| Total Contributions | $664,861 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Service Revenue | 622110 | $26,198,089 | $26,198,089 |
| 340B Program Revenue | 900099 | $1,238,412 | $1,238,412 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $27,436,501 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $180,906 | TotalRevenueColumnAmt |
| Exclusion | $180,906 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $50 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $50 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $50 | TotalRevenueColumnAmt |
| Exclusion | $50 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $4,540 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $55,811 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $21,268 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$16,728 | TotalRevenueColumnAmt |
| Exclusion | -$16,728 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Pharmacy | 446110 | $114,093 | $114,093 |
| EHR Incentive Revenue | 900099 | $96,000 | $96,000 |
| Dietary Sales | 900099 | $80,803 | $80,803 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $68,081 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $68,081 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $358,977 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $28,624,567 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $27,795,478 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $164,228 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,417 | TotalAmt |
| Program Services | $53,417 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $340,913 | TotalAmt |
| Program Services | $245,355 | ProgramServicesAmt |
| Management And General | $95,558 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,419,071 | TotalAmt |
| Program Services | $6,059,205 | ProgramServicesAmt |
| Management And General | $2,359,866 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $117,824 | TotalAmt |
| Program Services | $84,798 | ProgramServicesAmt |
| Management And General | $33,026 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,982,905 | TotalAmt |
| Program Services | $1,427,097 | ProgramServicesAmt |
| Management And General | $555,808 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $660,476 | TotalAmt |
| Program Services | $475,345 | ProgramServicesAmt |
| Management And General | $185,131 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,934 | TotalAmt |
| Management And General | $52,934 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $143,201 | TotalAmt |
| Management And General | $143,201 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,119,609 | TotalAmt |
| Program Services | $7,683,527 | ProgramServicesAmt |
| Management And General | $436,082 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $147,977 | TotalAmt |
| Management And General | $147,977 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,012,281 | TotalAmt |
| Program Services | $1,448,239 | ProgramServicesAmt |
| Management And General | $564,042 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,766 | TotalAmt |
| Program Services | $30,779 | ProgramServicesAmt |
| Management And General | $11,987 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $242,578 | TotalAmt |
| Program Services | $174,583 | ProgramServicesAmt |
| Management And General | $67,995 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,035 | TotalAmt |
| Program Services | $8,662 | ProgramServicesAmt |
| Management And General | $3,373 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,489 | TotalAmt |
| Program Services | $27,701 | ProgramServicesAmt |
| Management And General | $10,788 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,703 | TotalAmt |
| Program Services | $1,226 | ProgramServicesAmt |
| Management And General | $477 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $354,919 | TotalAmt |
| Program Services | $255,435 | ProgramServicesAmt |
| Management And General | $99,484 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $418,863 | TotalAmt |
| Program Services | $301,456 | ProgramServicesAmt |
| Management And General | $117,407 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Medical supplies | $1,744,546 | $1,744,546 |
| Bad debt expense | $1,072,618 | $1,072,618 |
| Provider tax | $663,643 | $663,643 |
| Charity Care Expense | $238,687 | $238,687 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $398,108 | TotalAmt |
| Program Services | $271,738 | ProgramServicesAmt |
| Management And General | $105,326 | ManagementAndGeneralAmt |
| Fundraising | $21,044 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,279,563 | TotalAmt |
| Program Services | $22,268,057 | ProgramServicesAmt |
| Management And General | $4,990,462 | ManagementAndGeneralAmt |
| Fundraising | $21,044 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,714,898 | BOYAmt |
| EOY | $3,036,781 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,348,912 | BOYAmt |
| EOY | $6,043,822 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,360 | BOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,830,681 | BOYAmt |
| EOY | $2,797,384 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $61,929 | BOYAmt |
| EOY | $27,775 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $310,245 | BOYAmt |
| EOY | $430,546 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $144,502 | BOYAmt |
| EOY | $107,256 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $38,088,609 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,447,357 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,088,363 | BOYAmt |
| EOY | $35,641,252 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $191,255 | BOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,181,113 | BOYAmt |
| EOY | $507,365 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,881,258 | BOYAmt |
| EOY | $48,592,181 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,569,688 | BOYAmt |
| EOY | $5,866,777 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $383,595 | BOYAmt |
| EOY | $96,000 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,835,974 | BOYAmt |
| EOY | $29,321,918 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,526,671 | BOYAmt |
| EOY | $3,397,152 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,315,928 | BOYAmt |
| EOY | $38,681,847 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,160,858 | BOYAmt |
| EOY | $8,843,961 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $404,472 | BOYAmt |
| EOY | $1,066,373 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,565,330 | BOYAmt |
| EOY | $9,910,334 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,881,258 | BOYAmt |
| EOY | $48,592,181 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,345,004 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
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
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $404,472 | BeginningYearBalanceAmt |
| Contributions | $661,901 | ContributionsAmt |
| End Year Balance | $1,066,373 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributions | $404,472 | ContributionsAmt |
| End Year Balance | $404,472 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Endowment Balance EOY | 1.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $216,178 | OtherCostOrOtherBasisAmt |
| Book Value | $216,178 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $27,948,497 | OtherCostOrOtherBasisAmt |
| Depreciation | $421,500 | DepreciationAmt |
| Book Value | $27,526,997 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,633,551 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,025,857 | DepreciationAmt |
| Book Value | $4,607,694 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,290,383 | OtherCostOrOtherBasisAmt |
| Book Value | $3,290,383 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $35,641,252 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Third Party Payor Settlements | $3,205,949 |
| Deferred revenue, net of current portion | $191,203 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,397,152 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $27,334,530 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $21,268 | OtherRevenueAmt |
| Revenue Not Reported | $21,268 | RevenueNotReportedAmt |
| Revenue Subtotal | $27,313,262 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,311,305 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,311,305 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $28,624,567 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $25,989,526 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $21,268 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $21,268 | ExpensesNotReportedAmt |
| Expenses Subtotal | $25,968,258 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,311,305 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,311,305 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $27,279,563 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | The funds are to be used for capital improvements. |
| Part XI, Line 2d - Other Adjustments: | Direct fundraising expense netted against fundraising income 21,268. |
| Part XI, Line 4b - Other Adjustments: | Bad debt expense netted with revenue on financial statements 1,072,618. Charity care expense netted with revenue on financial statements 238,687. |
| Part XII, Line 2d - Other Adjustments: | Direct fundraising expense netted against fundraising income 21,268. |
| Part XII, Line 4b - Other Adjustments: | Bad debt expense netted with revenue on financial statements 1,072,618. Charity care expense netted with revenue on financial statements 238,687. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Golf Tournament | Event1Nm |
| Gross Receipts Event1 | $57,611 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $55,811 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $1,800 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $5,000 | CashPrizesEvent1Amt |
| Non Cash Prizes Event1 | $1,006 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $6,711 | RentFacilityCostsEvent1Amt |
| Other Direct Expenses Event1 | $8,551 | OtherDirectExpensesEvent1Amt |
| Event2 | 2016 5k Run | Event2Nm |
| Gross Receipts Event2 | $2,740 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $2,740 | GrossRevenueEvent2Amt |
| Gross Receipts Total | $60,351 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $55,811 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $4,540 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $5,000 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $1,006 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $6,711 | RentFcltyCostsTotalEventsAmt |
| Oth Direct Expnss Total Events | $8,551 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $21,268 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$16,728 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 240.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $84,526 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $84,526 | DirectOffsettingRevenueAmt |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,819,012 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,819,012 | DirectOffsettingRevenueAmt |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,903,538 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,903,538 | DirectOffsettingRevenueAmt |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $141,062 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $50,996 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $90,066 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00340 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $141,062 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $50,996 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $90,066 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00340 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,044,600 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,954,534 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $90,066 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00340 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $379,847 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $5,083,208 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,083,208 | CostOfCareReimbursedByMedcrAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Boone Memorial Hospital Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 701 Madison Avenue | AddressLine1Txt |
| City | Madison | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25130 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.bmh.org | WebsiteAddressTxt |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | Two rural health clinics, SNF/NF beds | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Boone Memorial Hospital Inc | 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 |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | http://media.wix.com/ugd/3f447f_3fce1182086a48f7bc4b2649bdd7e2ca.pdf | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | http://media.wix.com/ugd/3f447f_3fce1182086a48f7bc4b2649bdd7e2ca.pdf | StrategyWebsiteURLTxt |
| 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 | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 240.000000000000 | 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 |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | http://media.wix.com/ugd/3f447f_7f16f4d8221b4aeb80861e83adf1f875.pdf | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | http://media.wix.com/ugd/3f447f_f78c6d10ee0d43d8915549467626c606.pdf | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | http://media.wix.com/ugd/3f447f_d54b7cf9599d4b35b28620aa527b698f.pdf | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| 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 |
|---|---|
| Boone Memorial Hospital, Inc. | Part V, Section B, Line 5: Assembled an Advisory Panel comprised of representatives from community leaders, health care providers, and local citizens to assist with the assessment process. |
| Boone Memorial Hospital, Inc. | Part V, Section B, Line 11: Boone Memorial Hospital developed an implementation plan that addressed the majority of the significant community needs identified in the CHNA. The areas addressed included alcohol and drug abuse, drunk driving and lack of recreational programs. The Hospital sponsored multiple community events/educational seminars that included health fairs, monthly diabetic educational classes, drug and alcohol abuse prevention forums and a low cost fitness center program for the community. As with most health care facilities, we have limited financial resources to address all issues. |
| Boone Memorial Hospital, Inc. | Part V, Section B, Line 16i: MEASURES TO PUBLICIZE THE FINANCIAL ASSISTANCE POLICYThe following measures are used to publicize the financial assistance available from BMH to the community and patients in accordance with Federal and State law: a. Providing information when a patient calls BMH at (304) 369-1230;b. Annually posting an article in a newspaper of local circulation and/or other means as deemed reasonably necessary;d. Posting of a notice in the emergency department admitting areas and business offices at BMH; and/ore. Financial Counselors visiting with BMH inpatients. |
| Boone Memorial Hospital, Inc. | Part V, Section B, Line 22d: FAP eligible individuals are billed using the gross charges method. The gross charges are stated on the billing statement reduced by average contractual allowances; eligible discounts; and other deductions. |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | Patients must provide their "Total Yearly Income" in order to be considered for financial assistance.a. Adults: If the patient is an adult, the term "Total Yearly Income" means the sum of the total yearly gross income of the patient and the patient's spouse.b. Minors: If the patient is a minor, the term "Total Yearly Income" means the sum of the total yearly gross income of the patient, the patient's mother and the patient's father.The patient, immediate family member or patient representative shall verify the patient's reported Total Yearly Income, as provided on the Application. The Total Yearly Income may be verified through any of the following mechanisms:a. Income Indicators. By the provision of third party financial documentation including IRS Form W-2, Wages and Tax Statement; pay check remittance; individual tax return; telephone verification by employer; bank statements; Social Security payment remittance; Worker's Compensation payment remittance; unemployment insurance payment notice; Unemployment Compensation Determination Letters; or other appropriate indicators of the patient's Total Yearly Income.b. Participation in a Benefit Program. By the provision of documentation showing current participation in a public benefit program such as Medicaid; Food Stamps; WIC; or other similar means tested programs. Proof of Participation in any of the above programs indicates that the patient has been deemed Financially Indigent and therefore, is not required to provide his or her income on the Assistance Application.c. In cases where the patient or responsible party is unable to provide third party verification of patient's Total Yearly Income, verification of the patient's Total Yearly Income can be done in either of the following ways:1. Obtaining the patient's or responsible party's Written Attestation. By obtaining an Application signed by the patient or responsible party attesting to the veracity of the patient's Total Yearly Income information provided: or2. Obtaining the patient's or responsible party's Verbal Attestation. Through the written attestation of the BMH employee completing the Assistance Application that the patient or responsible party verbally verified the patient's Total Yearly Income information provided.3. In instances where the patient or responsible party is unable to provide the requested third party verification of patient's Total Yearly Income, the patient or responsible party is required to provide a reasonable explanation of why the patient or responsible party is unable to provide the required third party verification. Sound business practices will be employed to verify patient's attestation and supporting information.Unmarried expired patients may be deemed to have no income for purposes of calculation of Total Yearly Income. Documentation of Total Yearly Income is not required for expired patients; however, documentation of estate assets may be required. If an expired patient is married, the surviving spouse may apply for financial assistance.Patients, immediate family members or patient representatives applying for financial assistance must verify the number of people in the patient's household ("Number in Household").a. Adults: In calculating the Number in Household, include the patient, the patient's spouse, and any dependents (as defined by the Internal Revenue Code).b. Minors: In calculating the Number in Household, include the patient, the patient's mother, the patient's father, dependents of the patient's mother, and dependents of the patient's father.During the verification process, while information to determine a patient's Total Yearly Income is being collected, the patient may be treated as a private pay patient. |
| Part I, Line 7, Column (f): | The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 1,072,618. |
| Part III, Line 2: | The cost of bad debts was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions. |
| Part III, Line 4: | Patient accounts receivable are carried at the original charge less an estimate made for doubtful or uncollectible accounts. The allowance is based upon a review of the outstanding balances aged by financial class. Management uses collection percentages based upon historical collection experience to determine collectibility. Management also reviews troubled, aged accounts to determine collection potential. Patient accounts receivable are written off when deemed uncollectible. Recoveries of accounts previously written off are recorded as a reduction to bad debt expense when received. Interest is not charged on patient accounts receivable. |
| Part III, Line 8: | Medicare allowable costs were derived from the Medicare care cost report for the period ended 6/30/16. |
| Part III, Line 9b: | After the patient's account is reduced by the discounts based on the Financial Assistance Eligibility Discount Guidelines, the patient is responsible for the remainder of their outstanding account. Patients will be invoiced for any remaining amounts in accordance with other BMH Debt Collection Policies regarding this matter. |
| Part VI, Line 2: | The BMH project team completed the community needs assessment using the following strategies:-Assembled an Advisory Panel comprised of representatives from community including business leaders, health care providers, teachers, students and other local citizens to assist with the assessment process.-Conducted primary data collection through surveys of providers, key informants, and the general population. Phone interviews were also conducted as well as online survey requests.-Collected secondary data sources such as information from the US Census Data; state health statistics and behavioral risk assessments; and Centers for Disease Control statistics and data.-Held several focus groups to obtain a diverse range of responses in an open discussion format. Focus group 1 inlcuded medical and business professionals and Boone Memorial Hospital staff; Focus groups 2 and 3 included senior citizens from two county senior nutrition programs; and Focus group 4 included teens from the local 4-H Club. |
| Part VI, Line 3: | Measures to publicize the Financial Assistance Policy:The following measures are used to publicize the financial assistance available from BMH to the community and patients in accordance with Federal and State law: a. Posting on the BMH website at the following location: www.bmh.org; b. Providing information when a patient calls BMH at (304) 369-1230; c. Annually posting an article in a newspaper of local circulation and/or other means as deemed reasonably necessary; d. Posting of a notice in the emergency department admitting areas and business offices at BMH; and/or e. Financial Counselors visiting with BMH inpatients. |
| Part VI, Line 4: | BMH serves primarily Boone County, WV and portions of Logan and Lincoln Counties in WV. Boone County had an estimated population of 23,372 in 2015. The median household income was $41,359 with 18.9% below the federal poverty guideline; 17.4% of the population is over 65; 50.4% of the population is female; and 22.3% is below 18. Median household income in 2014 dollars was $42,740 and persons in poverty was 22.1%. |
| Part VI, Line 5: | Each member of the Board of Trustees is a local, lifelong Boone County resident. The ER is always available to all patients, regardless of ability to pay. Boone Memorial has made the most recent Community Needs Assessment report available on its website for all patients to have easy access to read. BMH offers patients access to our own MRI seven days a week instead of having to travel to other larger hospitals in Charleston or Logan. Most other Critical Access Hospitals in WV only offer a mobile MRI service one or two days a week. We have a fully digital radiology department with a PACS system. Our lab has just recently expanded to incorporate additional testing equipment. We also operate two RHCs with extended hours (one has Saturday hours) to help serve the community. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | Student Loan Assistance | GrantTypeTxt |
| Recipient | 7 | RecipientCnt |
| Cash Grant | $53,417 | CashGrantAmt |
| Valuation Method Used | Cash - FMV | ValuationMethodUsedDesc |
| Non Cash Assistance | Student loan assistance to professional employees | NonCashAssistanceDesc |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Virgil Underwood | ||||||||||||||
| CEO as of 2/2015 | $153,898 | $0 | $0 | $0 | $3,806 | $0 | $0 | $0 | $12,120 | $0 | $169,824 | $0 | $0 | $0 |
| Randell D Foxx | ||||||||||||||
| CFO, Interim Co-CEO until 2/2015 | $163,109 | $0 | $0 | $0 | $6,305 | $0 | $6,305 | $0 | $12,585 | $0 | $188,304 | $0 | $0 | $0 |
| Ziad Chanaa | ||||||||||||||
| Physician | $141,320 | $0 | $0 | $0 | $0 | $0 | $66,000 | $0 | $14,561 | $0 | $221,881 | $0 | $0 | $0 |
| Kevin Hill | ||||||||||||||
| PA | $174,547 | $0 | $0 | $0 | $9,139 | $0 | $3,588 | $0 | $16,839 | $0 | $204,113 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section B, line 11 | Randell Foxx, CFO will review the Form 990 for accuracy prior to filing with the IRS. A copy of the final Form 990 will be provided to the Board of Directors prior to filing with the IRS. |
| Form 990, Part VI, Section B, line 12c | Compliance is enforced and monitored when trustees recuse themselves on conflict of interest issues. |
| Form 990, Part VI, Section B, line 15a | An outside firm (Yaffe & Company) is consulted. The CEO presents recommendations to the board. The board will hold an executive session and decide the CEO's compensation. |
| Form 990, Part VI, Section C, line 19 | Financial statements are published annually in the local newspaper. The governing documents and conflict of interest policy are available upon request. |
| Form 990, Part IX, line 11g | Surgery: Program service expenses 555,075. Management and general expenses 0. Fundraising expenses 0. Total expenses 555,075. Radiology: Program service expenses 544,235. Management and general expenses 0. Fundraising expenses 0. Total expenses 544,235. Pharmacy: Program service expenses 660,487. Management and general expenses 0. Fundraising expenses 0. Total expenses 660,487. Physicians: Program service expenses 2,840,220. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,840,220. Lab: Program service expenses 644,364. Management and general expenses 0. Fundraising expenses 0. Total expenses 644,364. Emergency room: Program service expenses 143,610. Management and general expenses 0. Fundraising expenses 0. Total expenses 143,610. Physical therapy: Program service expenses 1,175,849. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,175,849. Administrative: Program service expenses 745,791. Management and general expenses 290,461. Fundraising expenses 0. Total expenses 1,036,252. All other: Program service expenses 373,896. Management and general expenses 145,621. Fundraising expenses 0. Total expenses 519,517. |