GEISINGER JERSEY SHORE HOSPITAL: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- GEISINGER JERSEY SHORE HOSPITAL (EIN 24-0792115)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-15
- IRS object ID
- 201741359349310174
- 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 G
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-15T14:14:14-07:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 240792115 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JERSEY SHORE HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | JERS | BusinessNameControlTxt |
| Phone | 5703980100 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1020 Thompson St | AddressLine1Txt |
| City | Jersey Shore | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17740 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVID SHANNON | PersonNm |
| Person Title | PRESIDENT & CEO | PersonTitleTxt |
| Phone | 5703983101 | PhoneNum |
| Signature | 2017-05-15 | SignatureDt |
| 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 | David A Shannon | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1020 Thompson St | AddressLine1Txt |
| City | Jersey Shore | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17740 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $26,047,658 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.jsh.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1922 | FormationYr |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | Provide Inpatient, Outpatient, and Emergency Care Services for Residents of Jersey Shore Area. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 57 | TotalEmployeeCnt |
| Total Volunteers | 12 | TotalVolunteersCnt |
| Total Gross UBI | $643,891 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $56,249 | PYContributionsGrantsAmt |
| CY Contributions Grants | $75,845 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $27,917,299 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $24,963,411 | CYProgramServiceRevenueAmt |
| PY Investment Income | $29,686 | PYInvestmentIncomeAmt |
| CY Investment Income | $39,058 | CYInvestmentIncomeAmt |
| PY Other Revenue | $791,006 | PYOtherRevenueAmt |
| CY Other Revenue | $902,285 | CYOtherRevenueAmt |
| PY Total Revenue | $28,794,240 | PYTotalRevenueAmt |
| CY Total Revenue | $25,980,599 | 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 | $14,917,043 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,583,473 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $14,644,686 | PYOtherExpensesAmt |
| CY Other Expenses | $13,873,531 | CYOtherExpensesAmt |
| PY Total Expenses | $29,561,729 | PYTotalExpensesAmt |
| CY Total Expenses | $26,457,004 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$767,489 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$476,405 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $23,748,049 | TotalAssetsBOYAmt |
| Total Assets EOY | $20,821,259 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $22,145,857 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $23,326,144 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,602,192 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$2,504,885 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO BE THE COMMUNITIES FOUNDATION FOR INNOVATIVE PATIENT-CENTERED CARE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $22,517,864 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $24,959,082 | RevenueAmt |
| Desc | AS A RURAL HEALTHCARE FACILITY AND DEDICATED COMMUNITY HOSPITAL WITH A COMMITMENT TO PROVIDING A HIGH QUALITY CIRCLE OF CARE, JERSEY SHORE HOSPITAL HAS DEVELOPED DELIVERY SYSTEMS THAT PROVIDE AN EFFICIENT BALANCE OF OUTPATIENT CARE, ACUTE AND SUB-ACUTE INPATIENT CARE, PRIMARY CARE, AND OUTREACH SERVICES. THE HOSPITAL MAXIMIZES THE EFFECTIVENESS OF ITS PROGRAMS FOR QUALITY, EFFICIENCY, AND ACCESSIBILITY BY INTEGRATING WITH OTHER PROVIDERS AND ALTERNATIVE CARE ORGANIZATIONS IN THE SERVICE COMMUNITY TO ASSURE THE COMMUNITY ACCESS TO A BROAD ARRAY OF SERVICE OPTIONS. THE HOSPITAL PROVIDES AN ENVIRONMENT OF CARE THAT IS COMPASSIONATE, HIGHLY-PERSONALIZED, AND FOCUSED ON THE PHYSICAL, PSYCHO-SOCIAL, AND SPIRITUAL NEEDS OF ITS PATIENTS THROUGH THE USE OF SKILLED NURSES, PHYSICIANS, TECHNICAL AND SUPPORT STAFF, MANAGEMENT, AND COMMUNITY LEADERS. THE HOSPITAL ALSO PROVIDES HEALTH EDUCATION, PROGRAMS IN PREVENTION, AND RELATED SUPPORT SERVICES TO THE COMMUNITY WITH THE GOAL OF IMPROVING THE OVERALL WELLNESS OF ITS RESIDENTS. THE HOSPITAL ENSURES THAT THE NECESSARY RESOURCES ARE AVAILABLE TO PROVIDE THE MOST COST EFFECTIVE MANNER WHILE MAINTAINING A SAFE, PLEASANT, AND MEANINGFUL WORK AND PATIENT CARE ENVIRONMENT. THE HOSPITAL PROVIDES CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. CHARGES FORGONE FOR SERVICES RENDERED AND SUPPLIES FURNISHED UNDER THE CHARITY CARE POLICY AMOUNTED TO APPROXIMATELY $439,000 DURING THE YEAR ENDED JUNE 30, 2015. | Desc |
| Total Other Prog Srvc Expense | $0 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $0 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $0 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $22,517,864 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 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 | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 35 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 57 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 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 |
| Form8899 Filedind | 0 | Form8899Filedind |
| Form1098 C Filed | 0 | Form1098CFiledInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | 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 | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | PA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARK RICE-CFO | PersonNm |
| Phone | 5703985280 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1020 Thompson St | AddressLine1Txt |
| City | Jersey Shore | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17740 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| DAVID A SHANNON | ||||||||
| PRESIDENT & CEO (NONVOTING) | 39 | 1 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| SEAN SIMCOX | ||||||||
| CHAIRPERSON | 1 | 1 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JAMES ELY | ||||||||
| VICE CHAIRPERSON | 1 | 1 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| LEROY H KEILER III | ||||||||
| SECRETARY | 1 | 1 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| WILLIAM R CAMERER III | ||||||||
| TREASURER | 1 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| STEPHEN GOYKOVICH DO | ||||||||
| MEDICAL STAFF PRESIDENT | 1 | 39 | Yes (X) | $0 | $159,912 | $11,542 | ||
| WALTER EISENHAUER | ||||||||
| MEMBER | 1 | 0 | Yes (X) | $0 | $0 | $0 | ||
| CRAIG HARRIS | ||||||||
| MEMBER | 1 | 0 | Yes (X) | $0 | $0 | $0 | ||
| STEPHEN P NEUN PH D | ||||||||
| MEMBER | 1 | 0 | Yes (X) | $0 | $0 | $0 | ||
| CARMEN SPINNEY MD | ||||||||
| MEMBER | 1 | 0 | Yes (X) | $0 | $0 | $0 | ||
| RICHARD DELANEY | ||||||||
| MEMBER (ENDED 10.1.16) | 1 | 0 | Yes (X) | $0 | $0 | $0 | ||
| BETSY CROSSLEY | ||||||||
| MEMBER | 1 | 0 | Yes (X) | $0 | $0 | $0 | ||
| BARBARA KOZLOWSKI | ||||||||
| MEMBER | 1 | 1 | Yes (X) | $0 | $0 | $0 | ||
| MARK RICE | ||||||||
| CFO | 39 | 1 | Yes (X) | $98,603 | $0 | $24,019 | ||
| THEORDORE FEDEROFF | ||||||||
| PHYSICIAN | 40 | 0 | $298,133 | $0 | $22,491 | Yes (X) | ||
| SHAIRKO MISSOURI | ||||||||
| ANESTHESOLOGIST | 40 | 0 | $290,014 | $0 | $16,157 | Yes (X) | ||
| MICHAEL GERST | ||||||||
| PHYSICIAN | 40 | 0 | $222,553 | $0 | $13,659 | Yes (X) | ||
| TAMAR BAITEL | ||||||||
| PHYSICIAN | 40 | 0 | $204,211 | $0 | $10,819 | Yes (X) | ||
| DANIEL STAIRS | ||||||||
| CRNA | 40 | 0 | $150,048 | $0 | $13,837 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,263,562 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $159,912 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $112,524 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 14 | 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 | Address Line2ContractorAddress/USAddress/AddressLine2Txt |
|---|---|---|---|---|---|---|
| JERSEY SHORE RADIOLOGY | ||||||
| 302 N THIRD STREET | LEWISBURG | PA | 17837 | RADIOLOGY TESTS INTREPRETATIONS | $946,868 | |
| QUORUM HEALTH RESOURCES | ||||||
| 105 CONTINENTAL PLACE | BRENTWOOD | TN | 370271018 | MANAGEMENT FEES | $723,880 | ATTENTION DEPT 9100 |
| EMERGENCY PHYSICIAN ASSOC INC | ||||||
| PO BOX 634850 | CINCINNATI | OH | 452634850 | ER PHYSICIAN LOCUMS | $345,671 | |
| DELL MARKETING | ||||||
| PO BOX 416634 | BOSTON | MA | 022416634 | COMPUTER SERVICE | $245,783 | |
| GULFSTREAM ANESTHESIA CONSULTANTS | ||||||
| 11440 OKEECHOBEE BLVD | ROYAL PALM BEACH | FL | 33411 | ANESTHESIOLOGIST SERVICES | $163,770 | SUITE 215 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $0 | FederatedCampaignsAmt |
| Membership Dues | $0 | MembershipDuesAmt |
| Fundraising | $4,625 | FundraisingAmt |
| Related Organizations | $0 | RelatedOrganizationsAmt |
| Government Grants | $53,785 | GovernmentGrantsAmt |
| All Other Contributions | $17,435 | AllOtherContributionsAmt |
| Noncash Contributions | $0 | NoncashContributionsAmt |
| Total Contributions | $75,845 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REV | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $24,963,411 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $24,319,520 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $643,891 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $24,963,411 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $27,655 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $27,655 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $84,923 | RealAmt |
| Personal | $0 | PersonalAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $59,020 | RealAmt |
| Personal | $0 | PersonalAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $25,903 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,903 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $25,903 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $11,403 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $11,403 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,403 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $11,403 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $20,583 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $4,625 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $8,039 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,544 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $12,544 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|---|
| LHU CLINIC REVENUE | 900099 | $342,788 | $342,788 | $0 | $0 |
| MEANING USE | 622000 | $296,774 | $296,774 | $0 | $0 |
| CAFETERIA/VENDING REVENUE | 722210 | $88,962 | $0 | $0 | $88,962 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $135,314 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $135,314 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $863,838 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,980,599 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $24,959,082 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $643,891 | UnrelatedBusinessRevenueAmt |
| Exclusion | $301,781 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $294,076 | TotalAmt |
| Program Services | $255,846 | ProgramServicesAmt |
| Management And General | $38,230 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,547 | TotalAmt |
| Program Services | $37,016 | ProgramServicesAmt |
| Management And General | $5,531 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,466,798 | TotalAmt |
| Program Services | $8,040,160 | ProgramServicesAmt |
| Management And General | $1,426,638 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $415,453 | TotalAmt |
| Program Services | $361,444 | ProgramServicesAmt |
| Management And General | $54,009 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,546,623 | TotalAmt |
| Program Services | $1,345,562 | ProgramServicesAmt |
| Management And General | $201,061 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $817,976 | TotalAmt |
| Program Services | $711,639 | ProgramServicesAmt |
| Management And General | $106,337 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $723,880 | TotalAmt |
| Program Services | $629,773 | ProgramServicesAmt |
| Management And General | $94,107 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,499 | TotalAmt |
| Management And General | $35,499 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,297 | TotalAmt |
| Management And General | $47,297 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,472 | TotalAmt |
| Program Services | $2,472 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,434,294 | TotalAmt |
| Program Services | $3,236,725 | ProgramServicesAmt |
| Management And General | $1,197,569 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $91,733 | TotalAmt |
| Program Services | $91,733 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $447,660 | TotalAmt |
| Program Services | $290,538 | ProgramServicesAmt |
| Management And General | $157,122 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $558,892 | TotalAmt |
| Program Services | $353,796 | ProgramServicesAmt |
| Management And General | $205,096 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $538,236 | TotalAmt |
| Program Services | $498,321 | ProgramServicesAmt |
| Management And General | $39,915 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,960 | TotalAmt |
| Program Services | $42,611 | ProgramServicesAmt |
| Management And General | $10,349 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,898 | TotalAmt |
| Program Services | $4,590 | ProgramServicesAmt |
| Management And General | $12,308 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $758,067 | TotalAmt |
| Program Services | $758,067 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,921,282 | TotalAmt |
| Program Services | $1,921,282 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $393,414 | TotalAmt |
| Program Services | $393,414 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| BAD DEBT EXPENSE | $1,683,812 | $1,683,812 | $0 | $0 |
| MEDICAL SUPPLIES | $1,172,188 | $1,172,188 | $0 | $0 |
| NONCHARGE SUPPLIES | $367,986 | $366,086 | $1,900 | $0 |
| CHARGEABLE SUPPLIES | $163,813 | $163,813 | $0 | $0 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $463,148 | TotalAmt |
| Program Services | $156,976 | ProgramServicesAmt |
| Management And General | $306,172 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,457,004 | TotalAmt |
| Program Services | $22,517,864 | ProgramServicesAmt |
| Management And General | $3,939,140 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,435 | BOYAmt |
| EOY | $1,420 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,162,103 | BOYAmt |
| EOY | $1,594,442 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,538,484 | BOYAmt |
| EOY | $2,229,325 | 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 | $33,333 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $200,067 | BOYAmt |
| EOY | $252,192 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $193,326 | BOYAmt |
| EOY | $152,857 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $37,838,648 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $25,550,221 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,191,840 | BOYAmt |
| EOY | $12,288,427 | 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 | $5,427,461 | BOYAmt |
| EOY | $4,302,596 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,748,049 | BOYAmt |
| EOY | $20,821,259 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,314,749 | BOYAmt |
| EOY | $4,334,478 | 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 | $13,944,273 | BOYAmt |
| EOY | $13,682,329 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,886,835 | BOYAmt |
| EOY | $5,309,337 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,145,857 | BOYAmt |
| EOY | $23,326,144 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,542,765 | BOYAmt |
| EOY | -$2,564,809 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,427 | BOYAmt |
| EOY | $59,924 | 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 | $1,602,192 | BOYAmt |
| EOY | -$2,504,885 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,748,049 | BOYAmt |
| EOY | $20,821,259 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$476,405 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $0 | NetUnrlzdGainsLossesInvstAmt |
| Donated Services And Use Fclts | $0 | DonatedServicesAndUseFcltsAmt |
| Investment Expense | $0 | InvestmentExpenseAmt |
| Prior Period Adjustments | $0 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | -$3,630,672 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $2,472 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $2,472 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule C, Part II-B, Line 1 | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE HOSPITAL ASSOCIATION OF PENNSYLVANIA (HAP). A PORTION OF THE DUES PAID TO THESE TWO ORGANIZATIONS ($2472 DURING YEAR ENDED JUNE 30, 2016) WAS USED FOR LOBBYING PURPOSES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $154,956 | OtherCostOrOtherBasisAmt |
| Book Value | $154,956 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $18,195,149 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,622,497 | DepreciationAmt |
| Book Value | $9,572,652 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $0 | OtherCostOrOtherBasisAmt |
| Depreciation | $0 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $18,817,024 | OtherCostOrOtherBasisAmt |
| Depreciation | $16,580,438 | DepreciationAmt |
| Book Value | $2,236,586 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $671,519 | OtherCostOrOtherBasisAmt |
| Depreciation | $347,286 | DepreciationAmt |
| Book Value | $324,233 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $12,288,427 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (5 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DUE TO AFFILIATES | $3,791,692 |
| SETTLEMENTS | $185,122 |
| INVESTMENT CHART | $117,478 |
| LIMITED ASSETS | $112,832 |
| DEFERRED FINANCING NET | $95,472 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $4,302,596 | TotalBookValueOtherAssetsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| ACCRUED PENSION COST | $4,394,513 |
| OBLIGATIONS UNDER CAPITAL | $532,860 |
| DEFERRED REVENUE | $381,964 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $5,309,337 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $26,047,658 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $0 | NetUnrealizedGainsInvstAmt |
| Donated Services And Use Fclts | $0 | DonatedServicesAndUseFcltsAmt |
| Recoveries Prior Year Grants | $0 | RecoveriesPriorYearGrantsAmt |
| Other Revenue | $0 | OtherRevenueAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $26,047,658 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $0 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | -$67,059 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$67,059 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $25,980,599 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $26,524,063 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $0 | DonatedServicesUseFcltsAmt |
| Prior Year Adjustments | $0 | PriorYearAdjustmentsAmt |
| Losses Reported | $0 | LossesReportedAmt |
| Other Expenses Included | $67,059 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $67,059 | ExpensesNotReportedAmt |
| Expenses Subtotal | $26,457,004 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $0 | InvestmentExpensesNotIncld2Amt |
| Other Expenses Not Included | $0 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $26,457,004 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule D, Part X, Line 2 | THE HOSPITAL ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD IS MET. MANAGEMENT DETERMINED THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2016 AND 2015. THE HOSPITAL'S FEDERAL RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX AND EXEMPT ORGANIZATION BUSINESS TAX RETURN FOR THE YEAR ENDED PRIOR TO JUNE 30, 2014 NO LONGER REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. |
| Schedule D, Part XI, Line 4b | RENTAL EXPENSE-(59,020) PLUS FUNDRAISING EXPENSE-(8,039) EQUALS TOTAL SCHEDULED D, PART XI, LINE 4B-(67,059) |
| Schedule D, Part XII, Line 2d | RENTAL EXPENSES-59,020 PLUS FUNDRAISING EXPENSE-8,039 TOTAL TO SCHEDULE D, PART XII,LINE 2D-67,059 |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF TOURNAMENT | Event1Nm |
| Gross Receipts Event1 | $25,208 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $4,625 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $20,583 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $195 | CashPrizesEvent1Amt |
| Non Cash Prizes Event1 | $780 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $4,340 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $12 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $0 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $2,712 | OtherDirectExpensesEvent1Amt |
| Food And Beverage Other Events | $0 | FoodAndBeverageOtherEventsAmt |
| Entertainment Other Events | $0 | EntertainmentOtherEventsAmt |
| Gross Receipts Total | $25,208 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $4,625 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $20,583 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $195 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $780 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $4,340 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $12 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $0 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $2,712 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $8,039 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $12,544 | 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 |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | 0 | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $127,161 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $127,161 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0047 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,291,892 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,513,768 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $778,124 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0289 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $3,419,053 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,513,768 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $905,285 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0336 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $82,526 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $19,588 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $102,114 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0039 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,780 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,780 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0001 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $84,306 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $19,588 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $103,894 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0040 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $3,503,359 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,533,356 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,009,179 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0376 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $635,481 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,803,617 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,881,242 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$77,625 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JERSEY SHORE HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1020 THOMPSON ST | AddressLine1Txt |
| City | JERSEY SHORE | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17740 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | HTTP://WWW.JSH.ORG | WebsiteAddressTxt |
| State License | 101401 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JERSEY SHORE HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | http://www.jsh.org | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.JSH.ORG | 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 | 200 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 250 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| 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 Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part V, Section B, Line 3a-JERSEY SHORE HOSPITAL | JERSEY SHORE HOSPITAL IN CONJUNCTION WITH QUORUM, DEFINES ITS SERVICE ARE AS CLINTON AND LYCOMING COUNTY IN PENNSYLVANIA. IN 2014, THE HOSPITAL RECEIVED 85% OF ITS PATIENTS FROM THIS AREA. |
| Schedule H, Part V, Section B, Line 3b-JERSEY SHORE HOSPITAL | DEMOGRAPHICS OF THE COMMUNITY ARE AS FOLLOWS: 2016 POPULATION WAS 155,153. 91,7% WAS WHITE, NON-HISPANIC, 3.9% WAS BLACK, NON-HISPANIC. 40.2 WAS THE MEDIAN AGE, $49,146 IS THE MEDIAN HOUSEHOLD INCOME. UNEMPLOYMENT RATE IS 5.5. 18.2% OF THE POPULATION IS LESS THAN AGE 65 AND 18.8% WERE WOMEN OF CHILDBEARING AGE. |
| Schedule H, Part V, Section B, Line 3c-JERSEY SHORE HOSPITAL | FACILITIES AND RESOURCES AVAILABLE TO RESPOND TO THE HEALTH NEEDS OF THE COMMUNITY ARE AS FOLLOWS: SUSQUEHANNA HEALTH, LYCOMING & CLINTON COUNTIES MHID, THE MEADOWS, MOUNT NITTANY HEALTH SYSTEM, GEISINGER HEALTH SYSTEM. OTHER FACILITIES AND ORGANIZATIONS SUCH AS SUSAN G KOMEN FOUNDATION, AMERICAN CANCER SOCIETY (RELAY FOR LIFE). OTHER LOCAL RESOURCES THAT ARE AVAILABLE TO RESPOND ARE SUSQUEHANNA HEALTH SYSTEM, CANCER CARE OF CENTRAL PA, CANCER CENTERS OF AMERICAN, GEISINGER HEALTH SYSTEM, AND MOUNT NITTANY HOSPITAL. |
| Schedule H, Part V, Section B, Line 3d-JERSEY SHORE HOSPITAL | MOST DATA USED IN THE ANALYSIS IS AVAILABLE FROM PUBLIC INTERNET SOURCES AND QUORUM PROPRIETARY DATA FROM TRUVEN. ANY CRITICAL DATA NEEDED TO ADDRESS SPECIFIC REGULATIONS OR DEVELOPED BY THE LOCAL EXPERT ADVISOR INDIVIDUALS COOPERATING WITH IS IN THE STUDY AND THEY ARE AS FOLLOWS: WWW.COUNTYHEALTHRANKINGS.ORG-ASSESSMENT OF HEALTH NEEDS OF CLINTON COUNTY AND WESTERN LYCOMING COUNTY COMPARED TO ALL STATE COUNTIES. WWW.COMMUNITYHEALTH.HHS.GOV-ASSESSMENT OF HEALTH NEEDS OF CLINTON COUNTY AND WESTERN LYCOMING COUNTY COMPARED TO ITS NATIONAL SET OF 'PEER COUNTIES'. TRUVEN MARKET (FORMERLY KNOWN AS THOMPSON)-ASSESS CHARACTERISTICS OF THE HOSPITAL'S PRIMARY SERVICE AREA, AT A ZIP CODE LEVEL BASED ON CLASSIFYING THE POPULATION INTO VARIOUS SOCIO-ECONOMIC GROUPS, DETERMINING THE HEALTH AND MEDICAL TENDENCIES OF EACH GROUP AND CREATING AN AGGREGATE COMPOSITION OF THE SERVICE AREA ACCORDING TO THE PROPORTION OF EACH GROUP IN THE ENTIRE AREA; AND, TO ACCESS POPULATION SIZE, TRENDS, AND SOCIO-ECONOMIC CHARACTERISTICS. WWW.CAPC.ORG AND WWW.GETPALLIATIVE.ORG-TO IDENTIFY THE AVAILABILITY OF PALLIATIVE CARE PROGRAMS AND SERVICES IN THE AREA. WWW.CARINGINFO,ORG AND IWEB.NHPCO.ORG-TO IDENTIFY THE AVAILABILITY OF HOSPICE PROGRAMS IN THE COUNTY. WWW,HEALTHMETRICSANDEVALUATION.ORG-TO EXAMINE THE PREVALENCE OF DIABETIC CONDITIONS AND CHANGE IN LIFE EXPECTANCY. |
| Schedule H, Part V, Section B, Line 3e-JERSEY SHORE HOSPITAL | WE USED PRIORITY RANKING OF AREA HEALTH NEEDS BY LOCAL EXPERT ADVISORS TO ORGANIZE THE SEARCH FOR LOCALLY AVAILABLE RESOURCES AS WELL AS THE RESPONSE TO THE NEEDS BY JSH. THE FOLLOWING LIST: IDENTIFIES THE RANK OF EACH SIGNIFICANT NEED, PRESENTS THE FACTOR CONSIDERED IN DEVELOPING THE RANKING, ESTABLISHES A PROBLEM STATEMENT TO SPECIFY THE PROBLEM INDICATED BY USE OF THE SIGNIFICANT NEED TERM, IDENTIFIES JSH CURRENT EFFORTS RESPONDING TO THE NEED INCLUDING ANY WRITTEN COMMENTS RECEIVED REGARDING PRIOR JSH IMPLEMENTATION ACTIONS, ESTABLISHES THE IMPLEMENTATION STRATEGY PROGRAMS AND RESOURCES JSH WILL DEVOTE TO ATTEMPT TO ACHIEVE IMPROVEMENTS, DOCUMENTS THE LEADING INDICATORS JSH WILL USE TO MEASURE PROGRESS, PRESENTS THE LAGGING INDICATORS JSH BELIEVES THE LEADING INDICATORS WILL INFLUENCE IN A POSITIVE FASHION, AND PRESENTS THE LOCALLY AVAILABLE RESOURCES NOTED DURING THE DEVELOPMENT OF THIS REPORT AS BELIEVED TO BE CURRENTLY AVAILABLE TO RESPOND TO THIS NEED. |
| Schedule H, Part V, Section B, Line 3f-JERSEY SHORE HOSPITAL | INFORMATION ANALYSIS AUGMENTED BY LOCAL OPINIONS SHOWED HOW CLINTON COUNTY AND WESTERN LYCOMING COUNTY RELATE TO PEERS IN TERMS OF PRIMARY AND CHRONIC NEEDS AND OTHER ISSUES OF UNINSURED PERSONS, LOW-INCOME PERSONS AND MINORITY GROUPS, RESPONDENTS COMMENTED ON WHETHER THEY BELIEVE CERTAIN POPULATION GROUPS ("PRIORITY POPULATIONS) NEED HELP TO IMPROVE THEIR CONDITION, AND IF SO, WHO NEEDS TO DO WHAT TO IMPROVE THE CONDITIONS OF THE GROUPS. |
| Schedule H, Part V, Section B, Line 3g-JERSEY SHORE HOSPITAL | LOCAL EXPERTS OFFERING SOLICITED WRITTEN COMMENTS ON 2013 PRIORITIES AND IMPLEMENTATION SURVEY. THEY RANKED THE FOLLOWING: PUBLIC HEALTH EXPERTISE, DEPARTMENTS AND AGENCIES WITH RELEVANT DATA/INFORMATION REGARDING HEALTH NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL, PRIORITY POPULATIONS, REPRESENTATIVE/MEMBER OF CHRONIC DISEASE GROUP OR ORGANIZATION, AND REPRESENTS THE BOARD INTEREST OF THE COMMUNITY. |
| Schedule H, Part V, Section B, Line 3h-JERSEY SHORE HOSPITAL | THE FINAL REGULATIONS PROVIDE THAT CHNA (COMMUNITY HEALTH NEEDS ASSESSMENT) REPORT DOES NOT NEED TO NAME OR OTHERWISE IDENTIFY ANY SPECIFIC INDIVIDUAL PROVIDING INPUT ON THE CHNA, WHICH WOULD INCLUDE PROVIDED BY INDIVIDUALS IN THE FORM OF WRITTEN COMMENTS. THE "LOCAL EXPERT" IS AN ADVISORY GROUP OF AT LEAST 15 LOCAL RESIDENTS, INCLUSIVE OF AT LEAST ONE MEMBER SELF-IDENTIFYING WITH OF THE THE FIVE QHR WRITTEN COMMENTS SOLICITATION CLASSIFICATIONS, WITH WHOM THE HOSPITAL SOLICITED TO PARTICIPATE IN QHR/HOSPITAL CHNA PROCESS, |
| Schedule H, Part V, Section B, Line 3i-JERSEY SHORE HOSPITAL | QUORUM ALSO TAKES A COMPREHENSIVE APPROACH TO ASSESS HEALTH NEEDS. WE PREFORM SEVERAL INDEPENDENT DATA INCONSISTENCY OR DISCREPANCIES BY REVIEWING THE COMBINES OPTIONS FORMED FROM LOCAL EXPERTS. WE RELY ON SECONDARY SOURCE DATA, AND MOST SECONDARY SOURCE USE THE COUNTY AS THE SMALLEST UNIT ANALYSIS. WE ASKED OUR LOCAL EXPERT ARE RESIDENTS TO NOTE IF THEY PERCEIVED THE PROBLEMS OR NEEDS IDENTIFIED BY SECONDARY SOURCES EXISTED IN THEIR PROPORTION OF THE COUNTY. WHEN THE ANALYSIS WAS COMPLETE, WE PUT THE INFORMATION AND SUMMARY CONCLUSION BEFORE OUR LOCAL EXPERT AD VISOR WHO WERE ASKED TO AGREE OR DISAGREE WITH THE SUMMARY CONCLUSION, THEY WERE FREE TO AUGMENT POTENTIAL CONCLUSIONS WITH ADDITIONAL COMMENTS OF NEED AND NEW NEEDS DID EMERGE FROM THIS EXCHANGE. |
| Schedule H, Part V, Section B, Line 5-JERSEY SHORE HOSPITAL | HAVING TAKEN THE STEPS TO IDENTIFY POTENTIAL COMMUNITY NEEDS, THE LOCAL EXPERTS THAN PARTICIPATED IN A STRUCTURED COMMUNICATION TECHNIQUE CALLED 'WISDOM CROWDS' METHOD. THE PREMISE OF THIS APPROACH RELIES ON A PANEL OF EXPERTS WITH THE ASSUMPTION THAT THE COLLECTIVE WISDOM OF PARTICIPANTS IS SUPERIOR TO THE OPINION OF ANY ONE INDIVIDUAL, REGARDLESS OF THEIR PROFESSIONAL CREDENTIALS. HOSPITAL SOLICITED WRITTEN COMMENTS ABOUT ITS 2012 CHNA. 16 INDIVIDUALS RESPONDED TO THE REQUEST FOR COMMENTS. |
| Schedule H, Part V, Section B, Line 6a-JERSEY SHORE HOSPITAL | JSH PARTNERED WITH QUORUMS HEALTH RESOURCES |
| Schedule H, Part V, Section B, Line 8a-JERSEY SHORE HOSPITAL | SIGNIFICANT NEEDS WHERE HOSPITAL HAS IMPLEMENTATION RESPONSIBILITY ARE CANCER, OBESITY/OVERWEIGHT HEART DISEASE, AND EDUCATION/PREVENTION. SIGNIFICANT NEEDS WHERE HOSPITAL DID NOT IMPLEMENTATION STRATEGY WAS MENTAL HEALTH/SUBSTANCE ABUSE. |
| Schedule H, Part V, Section B, Line 11-JERSEY SHORE HOSPITAL | OTHER LOCAL RESOURCES IDENTIFIED DURING CHNA PROCESS THAT ARE BELIEVE AVAILABLE TO RESPOND TO THIS NEED ARE SUSQUEHANNA HEALTH, LYCOMING & CLINTON COUNTIES MHID SERVICES, THE MEADOWS, MOUNT NITTANY HEALTH SYSTEM, AND GEISINGER HEALTH SYSTEM. |
| Schedule H, Part V, Section B, Line 16i-JERSEY SHORE HOSPITAL | JERSEY SHORE HOSPITAL-POLICY REFERENCED ON INVOICES AND VERBALLY DISCUSSED WITH PATIENTS. |
| Schedule H, Part V, Section B, Line 22d-JERSEY SHORE HOSPITAL | JERSEY SHORE HOSPITAL-AS SOON AS THE PATIENT IS DEEMED ELIGIBLE FOR FINANCIAL ASSISTANCE, THE HOSPITAL RECORDS THE DISCOUNT AND BILLS THE PATIENT THE AMOUNT THAT THEY ARE RESPONSIBLE FOR UNDER THEIR FAP POLICY. THE DISCOUNT CHARGED IS IN LINE WITH THE COMMERCIAL PAYOR RATE. |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part I, Line 7 | THE HOSPITAL USED THE COST TO CHARGE RATIO |
| Schedule H, Part I, Line 7, Column f | AMOUNT OF BAD DEBT FROM PART IX SUBSTRACTED IN ORDER TO CALCULATE PERCENT OF TOTAL EXPENSE IN PART I LINE 7 COLUMN F WAS $ |
| Schedule H, Part III, Section A, Line 4 | BAD DEBT EXPENSE IS CALCULATED BASED ON ACTUAL WRITE-OFFS THROUGHOUT THE YEAR AND IS ESTIMATED AT COST USING THE RATIO OF PATIENT CARE COST TO CHARGE. PATIENT ACCOUNTS RECEIVABLE ARE REPORTED AT NET REALIZABLE VALUE. ACCOUNTS ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE BASED UPON MANAGEMENT'S ASSESSMENT OF INDIVIDUAL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE. THE CORPORATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE. THE CORPORATION ANALYZES CONTRACTUAL AMOUNTS DUE AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS. THE CORPORATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCES, WHICH INDICATED THAT MANY PATIENTS ARE UNABLE TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE BILLED RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. BAD DEBT EXPENSE IS BASED ON THE NECESSARY ALLOWANCE AT THE END OF EACH MONTH. PATIENT DISCOUNTS ARE NOT INCLUDED IN THE ALLOWANCE FOR BAD DEBT. THE HOSPITAL IS DILIGENT IN THE CLASSIFICATION OF AMOUNTS AS CHARITY CARE OF BAD DEBT. WE BELIEVE NONE OF THE AMOUNTS IN BAD DEBT WOULD BE RECLASSIFIED TO CHARITY CARE GIVE ADDITIONAL INFORMATION. |
| Schedule H, Part III, Section B, Line 8 | THERE IS NO MEDICARE SHORTFALL-AS A CRITICAL ACCESS HOSPITAL, WE ARE REIMBURSED AT 101% OF COST FROM MEDICARE. ALLOWANCE COSTS WERE DETERMINED USING THE COST-TO-CHARGE RATIO FROM MEDICARE COST REPORT. |
| Schedule H, Part III, Section C, Line 9b | COLLECTIONS ARE PURSUED UP TO THE POINT THAT A PATIENT COMPLETES AND IS APPROVED FOR CHARITY CARE. ONCE CHARITY CARE IS APPROVED, NO FURTHER COLLECTION EFFORTS ARE MADE. |
| Schedule H, Part VI, Line 2 | JERSEY SHORE HOSPITAL (JSH) HAS PERFORMED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO DETERMINE THE HEALTH NEEDS OF THE LOCAL COMMUNITY, DEVELOP AN IMPLEMENTATION PLAN TO OUTLINE AND ORGANIZE HOW TO MEET THOSE NEEDS AND FULFILL FEDERAL REQUIREMENTS. DATA WERE GATHERED FROM MULTIPLE WELL-RESPECTED SECONDARY SOURCES TO BUILD AN ACCURATE PICTURE OF THE CURRENT COMMUNITY AND HEALTH NEEDS. A SURVEY OF A SELECT GROUP OF LOCAL EXPERTS WAS PERFORMED TO REVIEW THE PRIOR CHNA AND PROVIDE FEEDBACK, AND TO ASCERTAIN WHETHER THE PREVIOUSLY IDENTIFIED NEEDS ARE STILL PRIORITY, A SECOND SURVEY WAS DISTRIBUTED TO THE DAME GROUP THAT REVIEWED THE DATA GATHERED FROM THE SECONDARY SOURCES AND DETERMINED THE SIGNIFICANT NEEDS FOR THE COMMUNITY. THE SIGNIFICANT HEALTH NEEDS FOR CLINTON COUNTY AND LYCOMING COUNTY ARE MENTAL HEALTH/SUBSTANCE ABUSE, CANCER, OBESITY/OVERWEIGHT, HEART DISEASE, EDUCATION/PREVENTION. THE HOSPITAL HAS DEVELOPED IMPLEMENTATION STRATEGIES FOR FOUR OF THE FIVE NEEDS INCLUDING CANCER, OBESITY/OVERWEIGHT, HEART DISEASE, AND EDUCATION/PREVENTION/ THE STRATEGIES INCLUDE ACTIVITIES TO CONTINUE/PURSUE, COMMUNITY PARTNERS TO WORK ALONGSIDE, AND LEADING AND LAGGING INDICATORS TO TRACK. THE HOSPITAL IS NOT PLANNING TO ADDRESS MENTAL HEALTH/SUBSTANCE ABUSE AT THIS TIME DUE TO RESOURCE CONSTRAINTS, RELATIVE LACK OF EXPERTISE/COMPETENCY TO EFFECTIVELY ADDRESS THE NEED, AND THE AVAILABILITY OF OTHER RESOURCES TO ADDRESS THE NEED. IT IS BELIEVED THAT THE COMMUNITY WILL SEE MORE BENEFIT IF TIME AND RESOURCES ARE DEVOTED TO THE OTHER FOUR NEEDS. |
| Schedule H, Part VI, Line 3 | PATIENTS ARE COUNSELED ON AN INDIVIDUAL BASIS IN PERSON OR PHONE CONVERSATION AS TO THE AVAILABILITY OF STATE OR CORPORATE PROGRAMS. AT THE TIME OF REGISTRATION SELF-PAY PATIENTS ARE INFORMED OF ASSISTANCE AVAILABLE. PATIENTS STATEMENTS INDICATE ASSISTANCE THAT IS AVAILABLE. THERE IS ALSO SIGNAGE INDICATING THAT ASSISTANCE PROGRAMS ARE AVAILABLE AND PATIENTS ARE PROVIDED A PAMPHLET AT REGISTRATION WITH THIS INFORMATION. PATIENTS ARE INFORMED OR WHAT CHARITY CARE IS AND THAT IS EXISTS. IF THE PATIENT IS INTERESTED THE PROCESS IS EXPLAINED. |
| Schedule H, Part VI, Line 4 | JERSEY SHORE HOSPITAL'S PRIMARY SERVICE AREA (PSA) COVERS EASTERN CLINTON COUNTY AND WESTERN LYCOMING COUNTY-AN AREA WITH POPULATION OF APPROXIMATELY 42,000. THE PSA FOR JERSEY SHORE HOSPITAL CONSISTS OF FIVE ZIP CODES: 17721-AVIS, 17740-JERSEY SHORE, 17745-LOCK HAVEN, 17779-WOOLRICH, AND 17751-MILL HALL. JERSEY SHORE HOSPITAL IS CONSIDERED TO BE MEDICALLY UNDERSERVED AREA (MUA). JERSEY SHORE AND JERSEY SHORE HOSPITAL IS LOCATED IN LYCOMING COUNTY, WHICH HAS AN AREA OF 1,244 SQUARE MILES. IT IS THE LARGEST COUNTY IN PENNSYLVANIA AND OCCUPIES A HILLY AND HEAVILY FORESTED PART OF THE STATE. THE WEST BRANCH OF THE SUSQUEHANNA RIVER FLOWS THROUGH THE SOUTHERN PART OF THE COUNTY. JERSEY SHORE IS APPROXIMATELY 45 MILES NORTHEAST OF STATE COLLEGE, PENNSYLVANIA AND APPROXIMATELY 15 MILES WEST OF WILLIAMSPORT, PENNSYLVANIA. ABOUT SIXTEEN PERCENT (16%) OF INPATIENT STAYS IN THE PSA OCCUR AT JERSEY SHORE HOSPITAL. ABOUT FORTY PERCENT (40%) OF OUTPATIENT VISITS IN THE PSA OCCUR AT JERSEY SHORE HOSPITAL. JERSEY SHORE HOSPITAL RELIES UPON A RELATIVELY SMALL GEOGRAPHIC AREA TO SUPPORT THE HOSPITAL. THE SSA (SECONDARY SERVICE AREA) CONSISTS OF 20 ADDITIONAL ZIP CODES WHICH ARE IMPORTANT TO THE HOSPITAL. THESE ZIP CODES ARE PRIMARY TO THE WEST AND NORTH OF THE PSA. ABOUT TWO PERCENT (2%) OF INPAITENT STAYS IN THE SSA OCCUR AT JERSEY SHORE HOSITPAL. ABOUT ELEVEN (11%) PERCENT OF OUTPATIENT VISITS IN THE SSA OCCUR AT JERSEY SHORE HOSPITAL. WITHIN THE PSA, THE TOTAL POPULATION IS EXPECTED TO INCREASE BY 1% BY 2019. A MAJOR DEMOGRAPHIC ISSUE AFFECTING JERSEY SHORE HOSPITAL IS THE AGING POPULATION. THE NUMBER OF INDIVIDUALS LIVING IN THE PSA OVER THE AGE OF 65 IS EXPECTED TO INCREASE 13.7% BY 2019. THIS AGE GROUP CURRENTLY MAKE UP OVER 16% OF THE POPULATION IN THE PSA COMPARED TO ABOUT 14% FOR THE U.S. THIS GROWING ELDERLY SEGMENT SHOULD GENERATE A FUTURE DEMAND FOR HEALTH CARE SERVICES. SINCE INDIVIDUALS OVER AGE 65 USE HEALTHCARE AND HOSPITAL SERVICES 2.7 TIMES THE RATE OF THE UNDER AGE 65 POPULATION. A DEMOGRAPHIC REALITY IS THE LOW INCOME LEVEL OF AREA HOUSEHOLDS. CURRENTLY, THE MEDIAN HOUSEHOLD INCOME IN THE PSA IS $47,303 COMPARED TOE PA ($53,115) AND THE U.S. ($53,482). THE MEDIAN HOUSEHOLD INCOME IN THE SSA IS $41,085. THE SERVICE AREA IS NOT RACIALLY DIVERSIFIED TO A SIGNIFICANT DEGREE, WITH 98.6% OF THE POPULATION CONSIDERED WHITE. THE EDUCATIONAL PROFILE OF THE SERVICE AREA DEMONSTRATES THAT 40.8% OF THE POPULATION HAS A HIGH SCHOOL EDUCATION AND 9.4% OF THE POPULATION HAS AN ASSOCIATE DEGREE. THE PERCENTAGE ACHIEVING A BACHELOR OR PROFESSIONAL DEGREE IS 11.6% WHICH IS LESS THAN PENNSYLVANIA OR THE U.S. AS A WHOLE. A HIGHER PERCENTAGE OF THE LABOR FORCE IN THE AREA IS ENGAGED IN MANUFACTURING/CONSTRUCTION WHEN COMPARED TO THE STATE AND U.S. AS A WHOLE IN TERMS OF PATIENTS SERVED. COMBINED INPATIENT AND OUTPATIENT PAYER MIX IN 2014 REMAINED FAIRLY CONSISTENT/ MEDICARE AND MEDICARE ADVANTAGE MAKE UP ABOUT 44% OF OUR PAYERS IN TERMS OF GROSS CHARGES. MEDICAL ASSISTANCE BUSINESS CONTINUED TO HAVE A SIGNIFICANT IMPACT ON JERSEY SHORE HOSPITAL. AS A CRITICAL ACCESS HOSPITAL. MEDICAL ASSISTANCE CHARGES ACCOUNT FOR ABOUT 11% OF OUR PAYERS. SELF-PAY CHARGES ACCOUNTED FOR ABOUT 4% OF OUR PAYERS. |
| Schedule H, Part VI, Line 5 | ALL OF THE PERSONS SERVING ON OUR BOARD LIVE IN THE PRIMARY COMMUNITIES BEING SERVED BY THE HOSPITAL. THE BOARD CONSISTS OF SOME PHYSICIANS WHO ARE EMPLOYEES OF A RELATED ENTITY, A FEW CONTRACTORS, AND SEVERAL OTHER COMMUNITY MEMBERS. THE HOSPITAL EXTENDS STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE AREA. AS APPLICABLE, THE HOSPITAL APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE THROUGH NEW AND UPDATED EQUIPMENT, MAJOR FACILITY IMPROVEMENTS, AND COMMUNITY HEALTH PROGRAMS. THE HOSPITAL PARTICIPATES IN MEDICARE, MEDICAID, CHAMPUS, AND TRICARE. |
| Schedule H, Part VI, Line 6 | THE HOSPITAL IS PART OF JERSEY SHORE HOSPITAL FOUNDATION, INC. THIS AFFILIATION INCLUDES A NON-PROFIT PHYSICIAN PRACTICE WITH FAMILY PRACTICE PHYSICIANS AND SURGEONS, AS WELL AS AN URGENT CARE CENTER. |
| Schedule H, Part VI, Line 7 | PA |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 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 (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| THEORDORE FEDEROFF | ||||||||||||||
| PHYSICIAN | $298,133 | $0 | $0 | $0 | $0 | $0 | $0 | $2,856 | $0 | $19,635 | $298,133 | $22,491 | $0 | $0 |
| SHAIRKO MISSOURI | ||||||||||||||
| ANESTHESOLOGIST | $289,378 | $0 | $0 | $0 | $0 | $636 | $0 | $11,684 | $0 | $4,473 | $289,378 | $16,793 | $0 | $0 |
| MICHAEL GERST | ||||||||||||||
| PHYSICIAN | $176,452 | $0 | $0 | $0 | $0 | $46,101 | $0 | $5,922 | $0 | $7,736 | $176,452 | $59,759 | $0 | $0 |
| TAMAR BAITEL | ||||||||||||||
| PHYSICIAN | $174,900 | $0 | $0 | $0 | $0 | $29,310 | $0 | $3,201 | $0 | $7,618 | $174,900 | $40,129 | $0 | $0 |
| DANIEL STAIRS | ||||||||||||||
| CRNA | $174,900 | $0 | $0 | $0 | $0 | $0 | $0 | $3,918 | $0 | $9,919 | $174,900 | $13,837 | $0 | $0 |
| STEPHEN GOYKOVICH DO | ||||||||||||||
| MEDICAL STAFF PRESIDENT | $159,912 | $0 | $0 | $0 | $0 | $0 | $0 | $5,220 | $0 | $82 | $159,912 | $5,302 | $0 | $0 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | James Ely | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | Board Member and brother | RelationshipDescriptionTxt |
| Transaction | $42,547 | TransactionAmt |
| Transaction | James Ely is a board member | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, Line 3 | THE HOSPITAL UTILIZES THE MANAGEMENT SERVICES OF QUORUM HEALTH RESOURCES. |
| Form 990, Part VI, Section B, Line 11b | THE FORM 990 WAS REVIEWED IN DETAIL BY MANAGEMENT BEFORE FILING WITH THE IRS. A COPY OF THE 990 WAS PROVIDED TO ALL BOARD MEMBERS PRIOR TO ISSUANCE. |
| Form 990, Part VI, Section B, Line 12c | ALL BOARD MEMBERS AND EMPLOYEES ARE REQUIRED TO ANNUALLY COMPLETE A CONFLICT OF INTEREST STATEMENT. THE CEOS OFFICE MONITORS THE PROCESS AND COMPLETION OF THE STATEMENTS. THE COMPLETED STATEMENTS ARE REVIEWED BY MANAGEMENT. BOARD MEMBERS ARE REQUIRED TO RECUSE THEMSELVES FROM VOTING ON MATTERS THAT ARE RELATED TO ANY POTENTIAL CONFLICTS. THESE HAS NEVER BEEN AM ISSUE INVOLVING CONFLICTS OF INTEREST. |
| Form 990, Part VI, Section B, Line 15 | ON AN ANNUAL BASIS, THE PERSONNEL SALARY COMMITTEE AND QUORUM (MANAGEMENT COMPANY) REVIEWS AN EXECUTIVE COMPENSATION STUDY PERFORMED BY YAFFE, AN INDEPENDENT THIRD PARTY WHO IS EMPLOYED BY HOSPITAL ASSOCIATION OF PENNSYLVANIA TO CONDUCT A COMPENSATION STUDY. HUMAN RESOURCES ALSO PROVIDES A COMPENSATION STUDY FROM ACRS WHICH IS BASED ON THE APPALACHIAN REGION. THESE TWO STUDIES ARE USED TO DETERMINE FMV. THE RECOMMENDATIONS FOR COMPENSATION LEVELS ARE PASSED ON TO THE BOARD FOR THEIR APPROVAL. APPROVAL IS DOCUMENTED IN THE MINUTES. THE ACTUAL AMOUNT OF COMPENSATION IS NOT INCLUDED IN THE MINUTES FOR PRIVACY PURPOSED. |
| Form 990, Part VI, Section C, Line 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| Form 990, Part VII, Section A, Line 1a | THE PRESIDENT/CEO IS AN EMPLOYEE OF QUORUM (MANAGEMENT COMPANY). THE HOSPITAL PAYS QUORUM FOR THE PRESIDENT/CEO'S SALARY. FOR FISCAL YEAR 2016 HIS COMPENSATION WAS $233,625. |
| Form 990, Part IX, Line 11g | LAUNDRY-PROGRAM SERVICE EXPENSES: 80,395 MANAGEMENT AND GENERAL EXPENSES: 0 FUNDRAISING EXPENSES: 0 TOTAL EXPENSES: 80,395, OTHER-PROGRAM SERVICE EXPENSES: 25,318 MANAGEMENT AND GENERAL EXPENSES: 531,689 FUNDRAISING EXPENSES: 0 TOTAL EXPENSES: 555,007, CONTRACT SERVICES-PROGRAM SERVICE EXPENSES: 343,712 MANAGEMENT AND GENERAL EXPENSES: 447,183 FUNDRAISING EXPENSES: 0 TOTAL EXPENSES: 790,895, MEDICAL-PROGRAM SERVICE EXPENSES: 79,928 MANAGEMENT AND GENERAL EXPENSES: 0 FUNDRAISING EXPENSES: 0 TOTAL EXPENSES: 79,928, MEDICAL LAB-PROGRAM SERVICE EXPENSES: 206,267 MANAGEMENT AND GENERAL EXPENSES: 0 FUNDRAISING EXPENSES: 0 TOTAL EXPENSES: 206,267, TRANSPORTATION-PROGRAM SERVICE EXPENSES: 2,908 MANAGEMENT AND GENERAL EXPENSES: 0 FUNDRAISING EXPENSES: 0 TOTAL EXPENSES: 2,908, COLLECTIONS-PROGRAM SERVICE EXPENSES: 44,299 MANAGEMENT AND GENERAL EXPENSES: 0 FUNDRAISING EXPENSES: 0 TOTAL EXPENSES: 44,299, CONSULTING-PROGRAM SERVICE EXPENSES: 99,400 MANAGEMENT AND GENERAL EXPENSES: 2,945 FUNDRAISING EXPENSES: 0 TOTAL EXPENSES: 102,345,BIOHAZARDOUS MATERIALS-PROGRAM SERVICE EXPENSES: 30,632 MANAGEMENT AND GENERAL EXPENSES: 0 FUNDRAISING EXPENSES: 0 TOTAL EXPENSES: 30,632, MAINTENANCE AND REPAIRS-PROGRAM SERVICE EXPENSES: 434,670 MANAGEMENT AND GENERAL EXPENSES: 215,751 FUNDRAISING EXPENSES: 0 TOTAL EXPENSES: 650,421, PROFESSIONAL FEES-PROGRAM SERVICE EXPENSES: 1,889,195 MANAGEMENT AND GENERAL EXPENSES: 0 FUNDRAISING EXPENSES: 0 TOTAL EXPENSES: 1,889,195, TOTAL OTHER FEES: 4,434,294 |
| Form 990, Part XI, Line 9 | TRANSFER TO OTHER ORGANIZATION |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JERSEY SHORE HOSPITAL FOUNDATION INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1020 THOMPSON ST | AddressLine1Txt |
| City | JERSEY SHORE | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17740 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 240792115 | EIN |
| Primary Activities | HEALTHCARE | PrimaryActivitiesTxt |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | 3 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JERSEY SHORE HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JERSEY SHORE HOSPITAL FOUNDATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | e | TransactionTypeTxt |
| Involved | $3,791,692 | InvolvedAmt |
| Method Of Amount Determination | CASH | MethodOfAmountDeterminationTxt |
Comments