NEWMAN MEMORIAL HOSPITAL INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- NEWMAN MEMORIAL HOSPITAL INC (EIN 73-0570773)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-15
- IRS object ID
- 201623209349317362
- Schema version
- 2015v2.1
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-11-15T18:26:51-06:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14241 DALLAS PARKWAY SUITE 1100 | AddressLine1Txt |
| City | DALLAS | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 75254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 730570773 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Newman Memorial Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % GERARD BREEN | InCareOfNm |
| Business Name Control | NEWM | BusinessNameControlTxt |
| Phone | 5809382551 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 905 South Main | AddressLine1Txt |
| City | Shattuck | CityNm |
| State Abbreviation | OK | StateAbbreviationCd |
| ZIP | 73858 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVID WANGER | PersonNm |
| Person Title | INTERIM CEO | PersonTitleTxt |
| Phone | 5809382551 | PhoneNum |
| Signature | 2016-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Jeanette Verrelli | PreparerPersonNm |
| PTIN | P00742631 | PTIN |
| Phone | 9727028262 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DAVID WANGER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 905 South Main | AddressLine1Txt |
| City | Shattuck | CityNm |
| State Abbreviation | OK | StateAbbreviationCd |
| ZIP | 73858 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $7,159,828 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.NEWMANMEMORIALHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1907 | FormationYr |
| Legal Domicile State | OK | LegalDomicileStateCd |
| Activity Or Mission | NEWMAN MEMORIAL HOSPITAL'S MISSION IS TO SERVE THE COMMUNITY BY PROVIDING HEALTHCARE SERVICE AND HEALTHCARE EDUCATION. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 102 | TotalEmployeeCnt |
| Total Volunteers | 13 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $1,267,855 | PYContributionsGrantsAmt |
| CY Contributions Grants | $759,303 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $7,946,185 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $5,694,930 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,576 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,314 | CYInvestmentIncomeAmt |
| PY Other Revenue | $95,374 | PYOtherRevenueAmt |
| CY Other Revenue | $703,281 | CYOtherRevenueAmt |
| PY Total Revenue | $9,310,990 | PYTotalRevenueAmt |
| CY Total Revenue | $7,159,828 | 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 | $3,812,708 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $3,942,980 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,293,045 | PYOtherExpensesAmt |
| CY Other Expenses | $5,672,020 | CYOtherExpensesAmt |
| PY Total Expenses | $10,105,753 | PYTotalExpensesAmt |
| CY Total Expenses | $9,615,000 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$794,763 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,455,172 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $12,638,067 | TotalAssetsBOYAmt |
| Total Assets EOY | $10,571,226 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $7,081,290 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,978,541 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,556,777 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,592,685 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | PROVIDE THE COMMUNITY WITH HEALTHCARE SERVICE AND HEALTHCARE EDUCATION. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | Yes (true) | SignificantChangeInd |
| Expense | $7,631,302 | ExpenseAmt |
| Revenue | $6,288,822 | RevenueAmt |
| Desc | NEWMAN MEMORIAL HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, DISABILITY, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF NEWMAN MEMORIAL HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. OUR MISSION IS TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTHCARE SERVICES AND HEALTHCARE EDUCATION. THEREFORE, IN KEEPING WITH THIS HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF ITS COMMUNITY, FREE CARE AND/OR SUBSIDIZED CARE, CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST, HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR AN INDIVIDUAL'S INABILITY TO PAY COEXISTS. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, SPECIAL PROGRAMS FOR THE ELDERLY, DISABLED, MEDICALLY UNDER SERVED, AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. NEWMAN MEMORIAL HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, NEWMAN MEMORIAL HOSPITAL RECOGNIZES THESE AMOUNTS AS CHARITY CARE IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY. CHARITY CARE IS ALSO PROVIDED THROUGH MANY REDUCED PRICE SERVICES AND FREE PROGRAMS OFFERED THROUGHOUT THE YEAR BASED UPON ACTIVITIES AND SERVICES WHICH NEWMAN MEMORIAL HOSPITAL BELIEVES WILL SERVE A BONA FIDE COMMUNITY HEALTH NEED. THESE INCLUDE: -BEING CALLED UPON TO SPEAK BEFORE COMMUNITY ORGANIZATIONS ON A VARIETY OF HEALTHCARE TOPICS -PROVIDING ASSISTANCE TO EDUCATORS THROUGH OUR WORK WITH STUDENT NURSES, AND -PROVIDING MEETING FACILITIES FOR THE MINISTERIAL ALLIANCE. FACILITIES ARE USED FOR THIS PURPOSE ONCE A MONTH. DURING 2015, THEY ALSO PROVIDED NURSING SCHOLARSHIPS TO AREA STUDENTS AND FREE FINGER BLOOD STICK SUGARS AND BLOOD PRESSURE CHECKS TO SENIOR CITIZEN CENTERS. | Desc |
| Total Program Service Expenses | $7,631,302 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 7 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 102 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OK | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GERARD BREEN | PersonNm |
| Phone | 5809382551 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 905 SOUTH MAIN STREET | AddressLine1Txt |
| City | SHATTUCK | CityNm |
| State Abbreviation | OK | StateAbbreviationCd |
| ZIP | 73858 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 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 |
|---|---|---|---|---|---|---|---|
| ANGELA PRATHER | |||||||
| SECRETARY | 0.5 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| BRENDA HUENERGARDT MD | |||||||
| DIRECTOR | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| BRIDGET COSBY | |||||||
| DIRECTOR | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| DAVID DERSCH | |||||||
| DIRECTOR | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| GREG HUENERGARDT | |||||||
| PRESIDENT | 2.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| RHONDA WAYLAND | |||||||
| DIRECTOR | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| TED MILLER | |||||||
| VICE PRESIDENT | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| TODD COOK | |||||||
| DIRECTOR | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| DANNA STUART MD | |||||||
| DIRECTOR | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| Terri Wheeler | |||||||
| Director | 0.5 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| JEFFREY SHELTON | |||||||
| CEO Term: AUGUST 2015 | 40.0 | 0.0 | Yes (X) | $152,310 | $0 | $4,905 | |
| RILEY CASPER | |||||||
| CNO | 40.0 | 0.0 | Yes (X) | $68,233 | $0 | $2,734 | |
| GERARD BREEN | |||||||
| CFO/CONTROLLER | 40.0 | 0.0 | Yes (X) | $67,694 | $0 | $0 | |
| Bonnie Frawley | |||||||
| CFO/Controller | 40.0 | 0.0 | Yes (X) | $8,972 | $0 | $641 | |
| Terry Amstutz | |||||||
| CEO Start: December 2015 | 40.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $297,209 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $8,280 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CONCORD MEDICAL GROUP | |||||
| 3004 50TH STREET SUITE D | LUBBOCK | TX | 79413 | ER PHYSICIANS | $253,239 |
| ST ANTHONY HOSPITAL | |||||
| PO BOX 205 | OKLAHOMA CITY | OK | 73101 | CLINICAL RESOURCES | $106,009 |
| HMS | |||||
| PO BOX 205 | OKLAHOMA CITY | OK | 73101 | BIO-MEDICAL ENGINEER | $174,000 |
| NORTHWEST PT | |||||
| 2630 Oklahoma Ave | WOODWARD | OK | 73801 | PHYSICAL THERAPY | $109,791 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $752,169 | GovernmentGrantsAmt |
| All Other Contributions | $7,134 | AllOtherContributionsAmt |
| Total Contributions | $759,303 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621300 | $5,241,288 | $5,241,288 |
| EHR INCENTIVE REVENUE | 900099 | $453,642 | $453,642 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $5,694,930 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $814 | TotalRevenueColumnAmt |
| Exclusion | $814 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $70,444 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $70,444 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $70,444 | TotalRevenueColumnAmt |
| Exclusion | $70,444 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,500 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,500 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,500 | TotalRevenueColumnAmt |
| Exclusion | $1,500 | ExclusionAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| CAFETERIA MEALS | 722514 | $38,808 | $38,808 | |
| VENDING SALES | 722514 | $137 | $137 | |
| MEDICAL RECORDS | 900099 | $582,558 | $582,558 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,334 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,334 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $632,837 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,159,828 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $6,288,822 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $111,703 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $305,489 | TotalAmt |
| Program Services | $239,343 | ProgramServicesAmt |
| Management And General | $66,146 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,105,946 | TotalAmt |
| Program Services | $2,433,431 | ProgramServicesAmt |
| Management And General | $672,515 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,027 | TotalAmt |
| Program Services | $10,990 | ProgramServicesAmt |
| Management And General | $3,037 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $324,959 | TotalAmt |
| Program Services | $254,597 | ProgramServicesAmt |
| Management And General | $70,362 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $192,559 | TotalAmt |
| Program Services | $150,865 | ProgramServicesAmt |
| Management And General | $41,694 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $92,000 | TotalAmt |
| Management And General | $92,000 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,794 | TotalAmt |
| Management And General | $48,794 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,733 | TotalAmt |
| Management And General | $22,733 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $892,928 | TotalAmt |
| Program Services | $892,928 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,949 | TotalAmt |
| Program Services | $141 | ProgramServicesAmt |
| Management And General | $12,808 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $101,228 | TotalAmt |
| Program Services | $52,452 | ProgramServicesAmt |
| Management And General | $48,776 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $197,348 | TotalAmt |
| Management And General | $197,348 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,042 | TotalAmt |
| Program Services | $27,455 | ProgramServicesAmt |
| Management And General | $7,587 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $291,971 | TotalAmt |
| Management And General | $291,971 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $793,687 | TotalAmt |
| Program Services | $621,834 | ProgramServicesAmt |
| Management And General | $171,853 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $149,492 | TotalAmt |
| Program Services | $149,492 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT EXPENSE | $1,287,896 | $1,287,896 | |
| EQUIPMENT RENTAL & MAINTENANCE | $784,029 | $614,267 | $169,762 |
| MEDICAL SUPPLIES | $721,427 | $721,427 | |
| DUES & SUBSCRIPTIONS | $36,899 | $28,909 | $7,990 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $203,597 | TotalAmt |
| Program Services | $145,275 | ProgramServicesAmt |
| Management And General | $58,322 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,615,000 | TotalAmt |
| Program Services | $7,631,302 | ProgramServicesAmt |
| Management And General | $1,983,698 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,016,678 | BOYAmt |
| EOY | $94,740 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $408,912 | BOYAmt |
| EOY | $7,201 | 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 | $1,051,983 | BOYAmt |
| EOY | $735,941 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $390,519 | BOYAmt |
| EOY | $153,688 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $107,714 | BOYAmt |
| EOY | $54,545 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $23,096,611 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $14,171,500 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,662,261 | BOYAmt |
| EOY | $8,925,111 | 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 | $0 | BOYAmt |
| EOY | $600,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,638,067 | BOYAmt |
| EOY | $10,571,226 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $437,254 | BOYAmt |
| EOY | $1,320,902 | 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 | $6,644,036 | BOYAmt |
| EOY | $6,657,639 | 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 | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,081,290 | BOYAmt |
| EOY | $7,978,541 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,850,769 | BOYAmt |
| EOY | $2,443,236 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $706,008 | BOYAmt |
| EOY | $149,449 | 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 | $5,556,777 | BOYAmt |
| EOY | $2,592,685 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,638,067 | BOYAmt |
| EOY | $10,571,226 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$2,455,172 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | -$508,920 | PriorPeriodAdjustmentsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | false | FSAuditedInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $41,025 | OtherCostOrOtherBasisAmt |
| Book Value | $41,025 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,490,198 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,592,712 | DepreciationAmt |
| Book Value | $7,927,486 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $38,745 | OtherCostOrOtherBasisAmt |
| Depreciation | $38,745 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,525,710 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,570,043 | DepreciationAmt |
| Book Value | $955,667 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $933 | OtherCostOrOtherBasisAmt |
| Book Value | $933 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,925,111 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | EST DUE FROM 3RD PARTY PAYERS | Desc |
| Book Value | $600,000 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $600,000 | TotalBookValueOtherAssetsAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 180. | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | false | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $16,796 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $16,796 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00200 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $805,198 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $343,479 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $461,719 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05540 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $821,994 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $343,479 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $478,515 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05740 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $821,994 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $343,479 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $478,515 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05740 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,287,896 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $1,309,115 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $2,303,558 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$994,443 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | 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 | NEWMAN MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 905 SOUTH MAIN | AddressLine1Txt |
| City | SHATTUCK | CityNm |
| State Abbreviation | OK | StateAbbreviationCd |
| ZIP | 73858 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.newmanmemorialhospital.org | WebsiteAddressTxt |
| State License | 2243 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NEWMAN MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION C | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION C | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 180. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300. | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | Yes (true) | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Medicare Rates | Yes (X) | MedicareRatesInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART V, SECTION B, LINE 5 | CHNA INPUT FROM REPRESENTATIVES OF THE COMMUNITY: A SURVEY WAS DESIGNATED TO GAUGE HOSPITAL USAGE, SATISFACTION AND COMMUNITY HEALTH NEEDS. THE SURVEYS WERE DISTRIBUTED AT THE HOSPITAL AND DURING THE FIRST COMMUNITY MEETING ON AUGUST 21, 2013. COMMUNITY MEMBERS PRESENT AT THE HOSPITAL EACH TOOK A SURVEY. A TOTAL OF 162 SURVEYS WERE COMPLETED. THE HOSPITAL ALSO HOSTED FOUR COMMUNITY MEETINGS FROM AUGUST 21, 2013 THRU OCTOBER 24, 2013. COMMUNITY MEMBERS IN ATTENDANCE AT THESE MEETINGS INCLUDED FROM THE FOLLOWING ORGANIZATIONS OR PROFESSIONS: NEWMAN MEMORIAL HOSPITAL REPRESENTATIVES, ELLIS COUNTY COOPERATIVE EXTENSION SERVICE, PHARMACISTS, LOCAL MINISTERS, COUNSELORS, BANKERS, RANCHERS, LOCAL EMS, FUNERAL DIRECTORS, DENTISTS, RETIRED INDIVIDUALS, AND THE LOCAL ECONOMIC DEVELOPMENT ORGANIZATION. THE MEETINGS ALLOWED THOSE IN ATTENDANCE TO DISCUSS THE HEALTH NEEDS OF THE HOSPITAL'S COMMUNITY. |
| SCHEDULE H, PART V, SECTION B, LINES 7A & 10A | AVAILABILITY OF CHNA & IMPLEMENTATION STRATEGY: THE HOSPITALS MOST RECENT CHNA AND IMPLEMENTATION STRATEGY CAN BE FOUND AT THE FOLLOWING ADDRESS: http://www.newmanmemorialhospital.org/getpage.php?name=chna&sub=About+Us |
| SCHEDULE H, PART V, SECTION B, LINE 11 | IDENTIFIED NEEDS ADDRESSED AND NOT ADDRESSED: THERE WERE SEVERAL HEALTH NEEDS IDENTIFIED THRU THE SURVEY PROCESS AND THE COMMUNITY MEETINGS. NEWMAN MEMORIAL IDENTIFIED SEVERAL KEY HEALTH CONCERNS IN ITS SERVICE AREA INCLUDING: -LACK OF DOCTORS/SPECIALISTS -DIFFICULTY TO GET AN APPOINTMENT -QUALITY OF CARE AND LACK OF SERVICES -DISTANCE TO SERVICES -TRAFFIC ACCIDENTS AND FATALITIES -TEENAGE DRINKING -MENTAL HEALTH -INCREASING SHARE OF UNINSURED CHILDREN -PAIN MANAGEMENT THE MOST COMMONLY IDENTIFIED ADDITIONAL SERVICE NEEDED WAS THE OFFERING OF A SPECIALIST; THE SPECIALISTS MOST ASKED FOR THROUGH THE PROCESS APPEAR TO BE ORTHOPEDISTS AND DERMATOLOGISTS. THE OTHER TOP HEALTH CONCERNS TO BE ADDRESSED WERE: -TRAFFIC ACCIDENTS AND FATALITIES: THERE IS A VERY INCREASED CONCERN FOR CONTINUED ACCIDENTS RESULTING IN FATALITIES DUE IN PART TO ROAD CONDITIONS AND CELL PHONE USAGE/INATTENTIVE DRIVING. THE DEPARTMENT OF TRANSPORTATION HAS PLANS TO IMPROVE ROAD CONDITIONS IN THEIR CURRENT 8 YEAR PLAN. THERE IS ALSO A PROGRAM THAT FOCUSES ON YOUTH DRIVING AS A PARTNERSHIP WITH THE COUNTY SHERIFFS OFFICE. -TEENAGE DRINKING: THE PREVALENCE OF ALCOHOL USAGE AMONG MINORS IS A CONCERN ALONG WITH A LACK OF ACTIVITIES FOR WHICH YOUTH CAN PARTICIPATE. THE ROLE OF STRONG YOUTH PROGRAMS AT CHURCHES WAS NOTED AS A PLAN TO PROVIDE MORE ACTIVITIES. -MENTAL HEALTH: THE LIMITED AMOUNT OF SERVICES RELATED TO MENTAL HEALTH IS A CONCERN ALONG WITH THE LINKAGE BETWEEN MENTAL HEALTH, SUBSTANCE ABUSE, AND PRISON ENTRY. THE HOSPITAL IS COMMITTED TO EXAMINING MORE OPTIONS OF AVAILABILITY TO SEE MENTAL HEALTH PROFESSIONALS. -PAIN MANAGEMENT: THE COMMUNITY WISHES TO ADDRESS WITH ISSUE WITH MORE THAN SIMPLY WRITING PRESCRIPTIONS. THE HOSPITAL CONTRACTED A CRNA WITH PAIN MANAGEMENT EXPERIENCE IN 2013. WHILE SERVICES ARE STILL LIMITED, THIS AVAILABILITY WILL HELP PATIENTS WITH DIFFICULTIES WITH PAIN MANAGEMENT. WHILE NOT ALL NEEDS IDENTIFIED WITHIN THE CHNA WERE ADDRESSED, THE HOSPITAL FEELS THE TOP HEALTH NEEDS OF THE COMMUNITY WERE INCLUDED IN THE CURRENT IMPLEMENTATION STRATEGY. |
| SCHEDULE H, PART V, SECTION B, LINE 15E | METHOD FOR APPLYING FINANCIAL ASSISTANCE: THE PATIENTS ARE PROVIDED LITERATURE AT TIME OF REGISTRATION AND THEN ARE CONTACTED BY THE FINANCIAL COUNSELOR AFTER THEY RECEIVE A STATEMENT. |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART III, SECTION A, LINE 2 | BAD DEBT EXPENSE: THE AMOUNT REPORTED ON LINE 2 IS BASED ON ACTUAL ACCOUNTS WRITTEN OFF AND AN ESTIMATED AMOUNT FOR ACCOUNTS OVER 180 DAYS OLD. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT AS A COMMUNITY BENEFIT: THE ORGANIZATION IS UNABLE TO ESTIMATE THE AMOUNT FOR LINE 3 AND HAS ELECTED TO LEAVE IT BLANK. BAD DEBT EXPENSE SHOULD BE CONSIDERED COMMUNITY BENEFIT BECAUSE THIS IS UNCOMPENSATED HEALTHCARE PROVIDED TO RESIDENTS OF THE COMMUNITY. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT FOOTNOTE: The Hospital reports patient accounts receivable for services rendered at net realizable amounts due from patients, third-party payers and others. The Hospital provides an allowance for uncollectible accounts based upon a review of outstanding receivables, historical collection information and existing economic conditions. |
| SCHEDULE H, PART III, SECTION B, LINE 8 | COSTING METHODOLOGY: THE HOSPITAL USES MEDICARE COST REPORT METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS BASED ON MEDICARE OR MEDICAID DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. THE HOSPITAL HAS A MEDICARE SHORTFALL OF $994,443, AND IT SHOULD BE TREATED AS A COMMUNITY BENEFIT IN THAT THE HOSPITAL TREATS PATIENTS REGARDLESS OF THE REIMBURSEMENT BY MEDICARE. SCHEDULE H, PART III, SECTION B, LINE 9B COLLECTION POLICY: ONCE A PATIENT HAS BEEN DETERMINED TO QUALIFY FOR THE HOSPITALS CHARITY ASSISTANCE POLICY, NO ADDITIONAL COLLECTION EFFORTS WILL BE MADE ON THAT ACCOUNT. |
| SCHEDULE H, PART VI, LINE 2 | NEEDS ASSESSMENT: THE HOSPITAL PROVIDES ALL THE SERVICES THAT IT IS CAPABLE OF PROVIDING. THERE IS A PACKET ABOUT SERVICES AND PROGRAMS THE HOSPITAL OFFERS. ONE BROCHURE IS AN APPLICATION FOR CHARITY CARE FOR PATIENTS TO FILL OUT. THE COLLECTION CLERK ALSO CONTACTS ALL SELF-PAY PATIENTS TO SET UP PAYMENT ARRANGEMENTS. IF THE PATIENT FEELS THEY CAN NOT PAY, THEY ARE ADVISED OF THE HOSPITAL CHARITY CARE AND APPLICATIONS ARE MAILED AT THAT TIME. |
| SCHEDULE H, PART VI, LINE 3 | PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: THE PATIENTS ARE PROVIDED LITERATURE AT TIME OF REGISTRATION AND THAN ARE CONTACTED BY THE FINANCIAL COUNSELOR AFTER THEY RECEIVE A STATEMENT. THE HEALTH CARE NEEDS OF ALL INDIVIDUALS RESIDING IN THE IMMEDIATE AND ADJACENT COMMUNITIES ARE CONSIDERED. NO INDIVIDUAL WILL BE DEPRIVED OF EMERGENCY OR CRITICAL CARE BECAUSE OF THEIR INABILITY TO PAY; HOWEVER, EVERY EFFORT WILL BE MADE TO COLLECT FUNDS OWED TO THE HOSPITAL FOR ELECTIVE CARE SINCE THE ABILITY TO CONTINUE TO PROVIDE AND IMPROVE SERVICES TO THE COMMUNITIES SERVED DEPENDS ON FINANCIAL STABILITY. |
| SCHEDULE H, PART VI, LINE 4 | COMMUNITY INFORMATION: SHATTUCK IS A VERY RURAL TOWN APPROXIMATELY 3 HOURS FROM ANY METROPOLITAN AREA WITH A POPULATION OF APPROXIMATELY 1,385. THE MEDIAN INCOME IN THE TOWN IS APPROXIMATELY $44,750 FOR A HOUSEHOLD. ABOUT 22.9% OF THE POPULATION IS BELOW THE POVERTY LINE. |
| SCHEDULE H, PART VI, LINE 5 | PROMOTION OF COMMUNITY HEALTH: NEWMAN MEMORIAL HOSPITAL PROVIDES HEALTH COUNCILING AT AS MANY LOCAL HEALTH FAIRS AS POSSIBLE. THE HOSPITAL PARTICIPATES IN VARIOUS COMMUNITY ACTIVITIES TO INCREASE THEIR PRESENCE IN THE COMMUNITY, INCLUDING THE FOLLOWING: CHRISTMAS PARADE, MARCH OF DIMES, COUNTY STOCK SHOWS, NATIONAL WEAR RED DAY, NATIONAL DOCTORS DAY, VOLUNTEER APPRECIATION WEEK, ANNUAL PIE & CAKE AUCTION NEWMAN MEMORIAL HOSPITAL RUNS 3 BLOOD DRIVES DURING THE YEAR. THEY ALSO HELD 4 FLU SHOT CLINICS, WITH 3 BEING AT LOCAL SENIOR CITIZEN CENTERS. IN ADDITION TO CLINICS AND EVENTS, THE HOSPITAL ALSO PLACES NOTICES AND ADVERTISEMENTS IN THE LOCAL YEARBOOKS, FOOTBALL PROGRAMS, SOCIAL MEDIA, AND PHYSICIAN SCHEDULES IN THE COUNTY NEWSPAPERS. |
| SCHEDULE H, PART VI, LINE 6 | AFFILIATED HEALTH CARE SYSTEM: N/A |
| SCHEDULE H, PART VI, LINE 7 | STATE FILING OF COMMUNITY BENEFIT REPORT: THE HOSPITAL HAS NOT FILED A COMMUNITY BENEFIT REPORT FOR THE CURRENT YEAR. |
| SCHEDULE H, PART I, LINE 7 COLUMN F | PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990 WAS REDUCED BY BAD DEBT EXPENSE, TOTALING $1,287,896. |
| SCHEDULE H, PART I, LINE 3C | FACTORS OTHER THAN FPG DETERMINING FREE OR DISCOUNTED CARE: THE HOSPITAL USES THE FOLLOWING FACTORS IN ITS DETERMINATION: - ASSET LEVEL - MEDICARE INDIGENCY - INSURANCE STATUS - UNDERINSURANCE STATUS - RESIDENCY |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEFFREY SHELTON | PersonNm |
| Title | CEO Term: AUGUST 2015 | TitleTxt |
| Base Compensation Filing Org | $152,310 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $4,905 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $157,215 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | FAMILY RELATIONSHIPS: DAVID DERSCH IS THE FATHER OF DR. DANNA STUART WHO IS THE CHIEF OF THE MEDICAL STAFF AND ALSO A BOARD MEMBER. FORM 990, PART VI, SECTION A, LINE 3 DELEGATION OF CONTROL OVER MANAGEMENT DUTES: IN 2015, THE HOSPITAL ENTERED INTO A MANAGEMENT CONTRACT WITH NEWLIGHT HEALTHCARE, LLC (NEWLIGHT). THE CONTRACT REQUIRED NEWLIGHT TO PROVIDE MANAGEMENT SERVICES OVER THE OPERATIONS OF THE HOSPITAL. PER IRS GUIDANCE, NO COMPENSATION IS SHOWN ON FORM 990, PART VII, FOR THIS INDIVIDUAL: TERRY AMSTUTZ $16,500 |
| FORM 990, PART VI, SECTION B, LINE 11B | PROCESS TO REVIEW FORM 990: THE 990 WAS PREPARED BY AN OUTSIDE ACCOUNTING FIRM WITH THE ASSISTANCE OF THE CFO. AFTER COMPLETION, THE RETURN WAS REVIEWED BY THE CEO PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | PROCESS TO MONITOR COMPLIANCE WITH CONFLICT OF INTEREST POLICY: ANNUAL REAFFIRMATION IS RECEIVED FROM THE BOARD OF DIRECTORS THAT THEY HAVE NOT ENTERED INTO ANY ACTIVITY THAT WOULD PUT THEM INTO CONFLICT WITH THE HOSPITAL. |
| FORM 990, PART VI, SECTION B, LINES 15A & 15B | PROCESS FOR DETERMINING COMPENSATION: THE BOARD MEETS AND REVIEWS THE COMPENSATION OF THE CEO OF THE HOSPITAL ANNUALLY. THE MEETING IS DOCUMENTED IN THE BOARD OF DIRECTORS' MEETING MINUTES. THE BOARD AND THE CEO WORK TOGETHER TO ANNUALLY REVIEW THE COMPENSATION OF THE OTHER OFFICERS OF THE ORGANIZATION. THE REVIEWS ARE DOCUMENTED IN THE MEETING MINUTES. |
| FORM 990, PART VI, SECTION C, LINE 19 | AVAILABILITY OF DOCUMENTS: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IV, LINE 12 & PART XII, LINE 2 | AUDITED FINANCIAL STATEMENTS: THE ORGANIZATION HAS ANSWERED "NO" TO THE QUESTIONS REGARDING AN AUDIT IN PART XII AND PART IV, LINE 12B. THE ORGANIZATION IS IN THE PROCESS OF AN AUDIT OF THE FINANCIAL STATEMENTS FOR THE YEAR ENDED 12/31/2015. HOWEVER, AT THE TIME OF FILING THIS RETURN, THE AUDIT IS NOT YET COMPLETE. THE ORGANIZATION HAS ATTACHED A COPY OF ITS MOST RECENT AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 2012 AND DECEMBER 31, 2013 TO THE FORM 990 AND ANSWERED "YES" TO PART IV, LINE 20B. |
| FORM 990, PART III, LINE 3 | CEASE CONDUCTING OR MAKE SIGNIFICANT CHANGES TO PROGRAM SERVICES: THE HOSPITAL CLOSED ITS OPERATING ROOM AND OBSTETRIC SERVICE LINES IN 2015. |