POWELL VALLEY HEALTH CARE INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- POWELL VALLEY HEALTH CARE INC (EIN 83-0300467)
- Tax period
- 2013-07-01 to 2014-06-30
- Filed
- 2015-05-12
- IRS object ID
- 201511329349301496
- Schema version
- 2013v4.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-05-12T09:46:50-05:00 | ReturnTs |
| Tax Period End | 2014-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Eide Bailly LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 Nicollet Mall Ste 1300 | AddressLine1 |
| City | Minneapolis | City |
| State | MN | State |
| ZIP Code | 554027033 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 830300467 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Powell Valley Health Care Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | POWE | BusinessNameControlTxt |
| Phone | 3077542267 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 777 Avenue H | AddressLine1 |
| City | Powell | City |
| State | WY | State |
| ZIP Code | 82435 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Terry Odom | PersonNm |
| Person Title | Interim CEO | PersonTitleTxt |
| Phone | 3077542267 | PhoneNum |
| Signature | 2015-05-07 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kim Hunwardsen CPA | PreparerPersonNm |
| PTIN | P00484560 | PTIN |
| Phone | 6122536500 | PhoneNum |
| Preparation | 2015-05-06 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Powell Valley Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Terry Odom | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 777 Avenue H | AddressLine1 |
| City | Powell | City |
| State | WY | State |
| ZIP Code | 82435 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $48,241,876 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.pvhc.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1992 | FormationYr |
| Legal Domicile State | WY | LegalDomicileStateCd |
| Activity Or Mission | Provision of healthcare services. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 556 | TotalEmployeeCnt |
| Total Volunteers | 110 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $215,501 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,574,807 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $49,739,884 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $45,589,281 | CYProgramServiceRevenueAmt |
| PY Investment Income | $48,844 | PYInvestmentIncomeAmt |
| CY Investment Income | $35,403 | CYInvestmentIncomeAmt |
| PY Other Revenue | $25,928 | PYOtherRevenueAmt |
| CY Other Revenue | $20,552 | CYOtherRevenueAmt |
| PY Total Revenue | $50,030,157 | PYTotalRevenueAmt |
| CY Total Revenue | $47,220,043 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $11,251 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $25,769 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $28,104,482 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $28,053,031 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $73,608 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $22,414,249 | PYOtherExpensesAmt |
| CY Other Expenses | $20,508,010 | CYOtherExpensesAmt |
| PY Total Expenses | $50,529,982 | PYTotalExpensesAmt |
| CY Total Expenses | $48,586,810 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$499,825 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,366,767 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $18,732,691 | TotalAssetsBOYAmt |
| Total Assets EOY | $18,940,169 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $7,377,345 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $8,952,488 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $11,355,346 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,987,681 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Our Mission: To improve quality of life through excellent health care. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $40,915,271 | ExpenseAmt |
| Grant | $25,769 | GrantAmt |
| Revenue | $45,589,281 | RevenueAmt |
| Desc | Powell Valley Health Care, Inc. (Hospital) provides quality care regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation of the Hospital, it is recognized that not all individuals possess the ability to purchase these essential services. It is the Hospital's mission to serve the surrounding area by providing health care services and health care education to all community members.During the year ended June 30, 2014, the Hospital provided $928,245 of medical services, based on the amounts of charges foregone, to individuals who were determined unable to purchase such services under the Hospital's charity care policy and guidelines. In addition to free care and/or subsidized care, care is also provided at below cost rates to persons covered by governmental programs. Recognizing its mission to the community, services are provided to both Medicare and Medicaid patients. The unreimbursed value of providing care to all patients was $14,340,310 for the year ended June 30, 2014.During the fiscal year ended June 30, 2014, the Hospital provided 2,461 days of hospital services. The nursing home provided 30,103 days of resident services, and the assisted living facility provided 9,580 days of resident services during the year.The Hospital also provides community care and services through many health activities and programs provided to support the community. These activities include: support to the Heart Mountain Volunteer Medical Clinic, wellness programs, community education programs, special programs for specific purposes, and a variety of community supported activities. | Desc |
| Total Program Service Expenses | $40,915,271 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | Yes (1) | 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 | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 46 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 556 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | 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 | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | 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 | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Joy Coulston Controller | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3077547722 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 777 Avenue H | AddressLine1 |
| City | Powell | City |
| State | WY | State |
| ZIP Code | 82435 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 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 |
|---|---|---|---|---|---|---|---|---|
| Mark Wurzel MD | ||||||||
| President/Physician | 40.00 | 0.00 | Yes (X) | Yes (X) | $158,213 | $0 | $30,300 | |
| Jim Beukelman | ||||||||
| Vice President | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Larry Parker | ||||||||
| Treasurer | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Jim Carlson | ||||||||
| Secretary | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Sandra Ehman | ||||||||
| Director/CFO(thru 12/2013) | 1.00 | 1.00 | Yes (X) | Yes (X) | $147,878 | $0 | $0 | |
| Bonita Katz | ||||||||
| Director | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Valerie Lengfelder MD | ||||||||
| Director, Chief of Staff | 40.00 | 0.00 | Yes (X) | $169,589 | $0 | $34,968 | ||
| RJ Kost | ||||||||
| Director | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Deb Kleinfeldt | ||||||||
| Director | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Mike Tracy MD | ||||||||
| Director | 40.00 | 0.00 | Yes (X) | $302,641 | $0 | $63,918 | ||
| Bill Patten | ||||||||
| CEO | 40.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Mike Long | ||||||||
| CFO (Starting March 2014) | 40.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Jeffrey Hansen | ||||||||
| Physician-Orthopedic Surge | 40.00 | 0.00 | $1,406,706 | $0 | $78,343 | Yes (X) | ||
| Kelly Christensen | ||||||||
| Physician-Family Practice: | 40.00 | 0.00 | $410,926 | $0 | $70,676 | Yes (X) | ||
| Sarah Durney | ||||||||
| Physician-Family Practice: | 40.00 | 0.00 | $337,147 | $0 | $40,019 | Yes (X) | ||
| Paul Laveau | ||||||||
| Physician-Cardiology | 40.00 | 0.00 | $440,033 | $0 | $28,537 | Yes (X) | ||
| Michael Bohlman | ||||||||
| Physician-Family Practice | 40.00 | $300,237 | $0 | $72,857 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,673,370 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $419,618 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 32 | 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/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| North Platte Physical Therapy | |||||
| PO Box 1790 | Douglas | WY | 82633 | Physical Therapy Services | $1,249,701 |
| HealthTech Management Services Inc | |||||
| 5110 Maryland Way | Brentwood | TN | 37027 | Management Services | $711,124 |
| Delta Locum | |||||
| PO Box 202940 | Dallas | TX | 753202940 | Locum Physician Services | $479,580 |
| Soliant Health Group | |||||
| PO Box 1024640 | Atlanta | GA | 303684640 | Temporary Contract Labor | $460,000 |
| Alliance Recruiting | |||||
| PO BOX 670416 | Dallas | TX | 752670416 | Locum Physician Services | $238,309 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 9 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $549,848 | RelatedOrganizationsAmt |
| Government Grants | $242,202 | GovernmentGrantsAmt |
| All Other Contributions | $782,757 | AllOtherContributionsAmt |
| Total Contributions | $1,574,807 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Service Revenue | 622110 | $44,563,892 | $44,563,892 |
| Other Income | 900099 | $678,443 | $678,443 |
| Pharmacy Contract Revenue | 446110 | $155,804 | $155,804 |
| Cafeteria | 722210 | $120,152 | $120,152 |
| Auxiliary Income | 900099 | $70,990 | $70,990 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $45,589,281 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $57,236 | TotalRevenueColumnAmt |
| Exclusion | $57,236 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $20,552 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $20,552 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,552 | TotalRevenueColumnAmt |
| Exclusion | $20,552 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,000,000 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,021,833 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$21,833 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$21,833 | TotalRevenueColumnAmt |
| Exclusion | -$21,833 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $47,220,043 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $45,589,281 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $55,955 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,769 | TotalAmt |
| Program Services | $25,769 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $947,356 | TotalAmt |
| Program Services | $722,797 | ProgramServicesAmt |
| Management And General | $224,559 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $235,255 | TotalAmt |
| Program Services | $235,255 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,982,238 | TotalAmt |
| Program Services | $19,678,925 | ProgramServicesAmt |
| Management And General | $2,243,527 | ManagementAndGeneralAmt |
| Fundraising | $59,786 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $328,789 | TotalAmt |
| Program Services | $284,368 | ProgramServicesAmt |
| Management And General | $42,767 | ManagementAndGeneralAmt |
| Fundraising | $1,654 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,093,450 | TotalAmt |
| Program Services | $2,754,531 | ProgramServicesAmt |
| Management And General | $338,413 | ManagementAndGeneralAmt |
| Fundraising | $506 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,465,943 | TotalAmt |
| Program Services | $1,368,676 | ProgramServicesAmt |
| Management And General | $92,828 | ManagementAndGeneralAmt |
| Fundraising | $4,439 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $247,284 | TotalAmt |
| Management And General | $247,284 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $715,726 | TotalAmt |
| Management And General | $715,726 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,280 | TotalAmt |
| Management And General | $98,280 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,468,718 | TotalAmt |
| Program Services | $4,395,360 | ProgramServicesAmt |
| Management And General | $1,073,358 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $135,960 | TotalAmt |
| Program Services | $3,281 | ProgramServicesAmt |
| Management And General | $132,679 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,387,957 | TotalAmt |
| Program Services | $1,202,521 | ProgramServicesAmt |
| Management And General | $182,898 | ManagementAndGeneralAmt |
| Fundraising | $2,538 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $686,907 | TotalAmt |
| Program Services | $121,580 | ProgramServicesAmt |
| Management And General | $564,502 | ManagementAndGeneralAmt |
| Fundraising | $825 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,540,024 | TotalAmt |
| Program Services | $1,459,327 | ProgramServicesAmt |
| Management And General | $80,697 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $444,807 | TotalAmt |
| Program Services | $311,536 | ProgramServicesAmt |
| Management And General | $130,011 | ManagementAndGeneralAmt |
| Fundraising | $3,260 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $101,152 | TotalAmt |
| Program Services | $101,152 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,072,089 | TotalAmt |
| Program Services | $474,189 | ProgramServicesAmt |
| Management And General | $597,900 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $662,089 | TotalAmt |
| Management And General | $662,089 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Provisions for bad debt | $4,092,925 | $4,092,925 | ||
| Medical Supplies | $3,069,980 | $3,069,980 | ||
| Food | $455,826 | $455,826 | ||
| Books, dues and subscri | $162,342 | $89,088 | $72,654 | $600 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $165,944 | TotalAmt |
| Program Services | $68,185 | ProgramServicesAmt |
| Management And General | $97,759 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,586,810 | TotalAmt |
| Program Services | $40,915,271 | ProgramServicesAmt |
| Management And General | $7,597,931 | ManagementAndGeneralAmt |
| Fundraising | $73,608 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,021,333 | BOYAmt |
| EOY | $3,669,425 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,882,247 | BOYAmt |
| EOY | $9,259,437 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,750 | BOYAmt |
| EOY | $10,833 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $156,496 | BOYAmt |
| EOY | $243,322 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $891,167 | BOYAmt |
| EOY | $868,026 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $175,279 | BOYAmt |
| EOY | $207,739 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $10,260,665 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $6,061,057 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,148,848 | BOYAmt |
| EOY | $4,199,608 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $661,876 | BOYAmt |
| EOY | $481,779 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $751,695 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,732,691 | BOYAmt |
| EOY | $18,940,169 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,635,266 | BOYAmt |
| EOY | $4,844,389 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,387 | BOYAmt |
| EOY | $17,106 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,729,692 | BOYAmt |
| EOY | $3,570,993 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $520,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,377,345 | BOYAmt |
| EOY | $8,952,488 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,936,190 | BOYAmt |
| EOY | $8,359,066 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,419,156 | BOYAmt |
| EOY | $1,628,615 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,355,346 | BOYAmt |
| EOY | $9,987,681 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,732,691 | BOYAmt |
| EOY | $18,940,169 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,366,767 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$898 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | Yes (1) | AgentTrusteeEtcInd |
| Beginning Balance | $27,339 | BeginningBalanceAmt |
| Additions During Year | $70,990 | AdditionsDuringYearAmt |
| Distributions During Year | $70,092 | DistributionsDuringYearAmt |
| Ending Balance | $28,237 | EndingBalanceAmt |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $677,372 | OtherCostOrOtherBasisAmt |
| Depreciation | $330,875 | DepreciationAmt |
| Book Value | $346,497 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,429,755 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,730,182 | DepreciationAmt |
| Book Value | $3,699,573 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $153,538 | OtherCostOrOtherBasisAmt |
| Book Value | $153,538 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,199,608 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Estimated Third Party Payor Settlements | Desc |
| Amt | $520,000 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $520,000 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $42,954,976 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$4,194,077 | OtherRevenueAmt |
| Revenue Not Reported | -$4,194,077 | RevenueNotReportedAmt |
| Revenue Subtotal | $47,149,053 | RevenueSubtotalAmt |
| Other Revenues Not Included | $70,990 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $70,990 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $47,220,043 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $44,322,641 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $44,322,641 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $4,264,169 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $4,264,169 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $48,586,810 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part IV, Line 1b: | The organization is acting as agent for the PVHC Auxiliary. |
| Part IV, Line 2b: | Organization holds funds in trust on behalf of nursing home residents. |
| Part X, Line 2: | The Hospital is organized and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Hospital is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Hospital is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Hospital files an Exempt Organization Business Income Tax Return (Form 990-T) with the IRS to report its unrelated business taxable income. The Organization believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. The Hospital is no longer subject to federal or state tax examinations by tax authorities for years before 2011. |
| Part XI, Line 2d - Other Adjustments: | Provision for bad debts reported in revenue on financial statements -4,092,925. Interest Expense reported in revenue on financial statements -101,152. |
| Part XI, Line 4b - Other Adjustments: | Auxiliary income not recorded for financial statements 70,990. |
| Part XII, Line 4b - Other Adjustments: | Auxiliary expenses not recorded for financial statements 70,092. Provision for bad debts reported in revenue on financial statements 4,092,925. Interest Expense reported in revenue for financial statements 101,152. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $612,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $612,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01380 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $612,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $612,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01380 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,510 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,218 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,292 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $240,324 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,200 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $226,124 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00510 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,232,862 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,281,077 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,951,785 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08880 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $15,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,499,696 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,300,495 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,199,201 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09430 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,111,696 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,300,495 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,811,201 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10810 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $4,092,925 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $564,824 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,026,414 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,130,916 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$104,502 | 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 | Powell Valley Hospital | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 777 Avenue H | AddressLine1 |
| City | Powell | City |
| State | WY | State |
| ZIP Code | 82435 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.pvhc.org | WebsiteAddressTxt |
| State License | 0713050 | 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 |
| Other | Physician provider based clinic | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Powell Valley Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| 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 | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | http://www.pvhc.org/about-us/community-he | OwnWebsiteURLTxt |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Develop Community Wide Plan | Yes (X) | DevelopCommunityWidePlanInd |
| Exec Community Wide Plan | Yes (X) | ExecCommunityWidePlanInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| All Needs Addressed | 0 | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (1) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (1) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Other Factors | Yes (X) | OtherFactorsInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| 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 |
| Lowest Negotiated Rates | Yes (X) | LowestNegotiatedRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Powell Valley Hospital | Part V, Section B, Line 3: Four focus groups with a total of 24 individuals including a former local public health nurse, a behavioral health professional, women, seniors, and general community members were utilized. Six key informants were identified and interviewed as well. |
| Powell Valley Hospital | Part V, Section B, Line 7: The needs identified in the most recently conducted CHNA have been addressed in the following ways:1. Access to primary care services: In 2014 PVHC recruited family practitioner, Adam Childers, D.O. PA, Jana Keeler, also began working in the clinic in primary care in 2014 and PA, Lisa Jarvis, was hired in Sept. 2013 to work in primary care in the clinic.2. Access to mental health services: The social worker at PVHC, coordinates a "mental health professionals" resource pamphlet and shares copies with health care providers in Powell, Cody, Lovell, Greybull and Basin. They also coordinate a mental health provider networking lunch every other month. The meeting alternates between Powell and Cody locations.3. Public transportation: Powell Economic Partnership and Forward Cody have secured a public transportation feasibility study grant to look intopublic transportation for Park County, which is scheduled to take place in 2015. The Powell Medical Foundation had previously started building funds in 2014 for exploring possible solutions in public transportation for Powell and PVHC, but held off after learning about the feasibility study coming into play. PVHC and the Foundation will wait to see what comes out of the study before making further decisions.4. Access to preventive services: PVHC continues to offer flu shot clinics during flu season. In 2014, PVHC ran an advertising campaign to inform the community of its four providers who offer endoscopy services for colonoscopy and gastroscopy care. For 2015, PVHC will be offering "health fair" blood screening at a discounted price during the month of March. On-line registration is available for this service to make it more convenient for people to register and get their blood drawn.No progress has been made at this point to address the need of Access to Dental Health Services. |
| Powell Valley Hospital | Part V, Section B, Line 12i: In addition to providing free or discounted care based on Federal Poverty Guidelines, we review income tax returns and pay stubs. This information helps us more accurately determine a patient's ability to pay. |
| Powell Valley Hospital | Part V, Section B, Line 14g: A summary of the Financial Assistance Policy is made available to the community on the hospital's website, attached to billing invoices, posted in the hospital emergency rooms or waiting rooms, posted in the hospital admissions offices, and provided, in writing, to patients on admission to the hospital. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 6 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | FacilityFacilityTxt |
|---|---|---|---|---|
| Powell Valley Clinic | ||||
| 777 Avenue H | Powell | WY | 82435 | Outpatient physician clinic |
| Powell Valley Care Center | ||||
| 777 Avenue H | Powell | WY | 82435 | Nursing home |
| Heartland Assisted Living | ||||
| 777 Avenue H | Powell | WY | 82435 | Assisted living facility |
| Powell Valley Home Health | ||||
| 777 Avenue H | Powell | WY | 82435 | Home health agency |
| Powell Valley Hospice | ||||
| 777 Avenue H | Powell | WY | 82435 | Hospice |
| Express Care Clinic | ||||
| 777 Avenue H | Powell | WY | 82435 | Immediate care clinic |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | In addition to providing free or discounted care based on Federal Poverty Guidelines, we review income tax returns and pay stubs. This information helps us more accurately determine a patient's ability to pay.Part I, line 6b: The community benefit report is posted on the Organization's website. |
| Part I, Line 7: | Charity care expense was converted to cost on line 7a based on an overall cost to charge ratio addressing all patient segments. The expenses associated with community health improvement services, line 7e, and health professions education, line 7f were determined using an average hourly rate for staff time, space use, and ambulances. Cash and in-kind contributions to community groups, line 7i, were reported based on actual expenses recorded in the organization's general ledger. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report. |
| Part I, Ln 7 Col(f): | The amount of bad debt expense removed from the denominator of the calculation on Part 1, Line 7, column f was $4,092,925. |
| Part III, Line 4: | The organization's bad debt is reported as charges incurred during the year.The estimated amount of bad debt expense attributable to patients eligible under the organization's financial assistance policy is 13.8% (based upon US Census Bureau Quickfacts for percent of citizens below the povertly level in the city of Powell). This represents a reasonable percentage of individuals who potentially qualify for charity care but may not have applied and and therefore were written off to bad debt.Footnote from organization's financial statements: The footnote that describes bad debt expense is found on page 10 of the attached audit report. |
| Part III, Line 8: | Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services.Powell Valley Health Care provides services to patients under the Medicare program knowing they will not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, the Medicare shortfall should be considered a community benefit. |
| Part III, Line 9b: | Powell Valley Health Care, Inc. tries to determine if a patient needs financial assistance before services are rendered, except in emergency situations. No patient is denied acute care in an emergency situation. The Health Center will pursue all possible forms of third-party payments such as insurance, state Medicaid programs, and county indigent care programs before granting financial assistance. Collection efforts are not pursued during this time. Collection efforts are not pursued while a completed charity care application is under review. Decisions on charity care applications are made within 30 days of the completed application. Once a decision is made, any personal portion due will follow the same collection procedures as other accounts. If a determination for financial assistance is made on an account or further insurance processing is needed after an account is sent to collections, all collection efforts will cease and any negative reporting will be reversed. |
| Part VI, Line 2: | Powell Valley Health Care is served by a publicly elected District Board. The Board members actively provide information relative to the health care needs of the community. Additionally, we survey patients, residents, and their families and in doing so, look for trends and/or suggestions for improvements/ expansion/or initiation of services. Our guest relations process also assists us in identifying any unmet community health needs. Administration, Providers, and the Board Trustees also review county-wide market/utilization data annually. |
| Part VI, Line 3: | Powell Valley Health Care is committed to providing financial assistance to persons who have health care needs and are unable to pay for medically necessary care. We strive to ensure that people who are uninsured, underinsured, ineligible for a government program, or otherwise unable to pay are still able to receive care. Notifications about charity care are included in patient bills, posted in emergency rooms, admitting and registration departments, the Business Office, and waiting rooms. Information is also included in patient information packets. Staff also discusses financial assistance upon admitting and discharge. |
| Part VI, Line 4: | Powell Valley Health Care is a 25 bed critical access hospital, 100 bed intermediate care nursing facility, a 24 apartment assisted living facility, and a doctor's clinic located in the northwest corner of Wyoming, 75 miles east of Yellowstone National Park, and 98 miles south of Billings, MT. Powell has a diverse commercial, industrial, educational, and agricultural/ranching based economy. In 2011, 10.7% of the residents lived in poverty. The median household income was $49,309 and the population was 6,393. The nearest city with a population of 50,000+ is Billings, MT. The nearest hospitals are North Big Horn Hospital District, a critical access hospital located approximately 22 miles Northeast and West Park Hospital, a critical access hospital located approximately 25 miles Southwest.Net revenue from Medicare and Medicaid account for approximately 32% and 16% respectively. |
| Part VI, Line 5: | At Powell Valley Health Care, we understand that healthcare is evolving. The advancement in medicine and strides in technology are providing local communities access to better healthcare. Our Board of Trustees is comprised primarily of local business leaders who reside in our primary service area. To meet the needs of our community, the hospital extends privileges to medical staff that are qualified through licensure. Our emergency room is available 7 days a week and is available to all regardless of a patient's ability to pay. Excess funds are reinvested and used for patient care and facility upgrades. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Cash GrantCashGrantAmt |
|---|---|---|
| Scholarships | 5 | $6,400 |
| Tuition Reimbursements | 11 | $19,369 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | The Organization provided scholarships to individuals and required the individual to provide information to support the purpose of the scholarship. Tuition reimbursements are paid out at 50% of tuition after employees show passing grades. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | Yes (1) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Mark Wurzel MD | ||||||||||||||
| President/Physician | $158,213 | $0 | $0 | $0 | $0 | $0 | $30,300 | $0 | $0 | $0 | $188,513 | $0 | $0 | $0 |
| Valerie Lengfelder MD | ||||||||||||||
| Director, Chief of Staff | $169,589 | $0 | $0 | $0 | $0 | $0 | $5,308 | $0 | $29,660 | $0 | $204,557 | $0 | $0 | $0 |
| Mike Tracy MD | ||||||||||||||
| Director | $156,243 | $0 | $146,398 | $0 | $0 | $0 | $28,108 | $0 | $35,810 | $0 | $366,559 | $0 | $0 | $0 |
| Jeffrey Hansen | ||||||||||||||
| Physician-Orthopedic Surge | $400,893 | $0 | $1,005,813 | $0 | $0 | $0 | $34,083 | $0 | $44,260 | $0 | $1,485,049 | $0 | $0 | $0 |
| Kelly Christensen | ||||||||||||||
| Physician-Family Practice: | $142,119 | $0 | $268,807 | $0 | $0 | $0 | $28,767 | $0 | $41,909 | $0 | $481,602 | $0 | $0 | $0 |
| Sarah Durney | ||||||||||||||
| Physician-Family Practice: | $167,178 | $0 | $169,969 | $0 | $0 | $0 | $10,359 | $0 | $29,660 | $0 | $377,166 | $0 | $0 | $0 |
| Paul Laveau | ||||||||||||||
| Physician-Cardiology | $440,033 | $0 | $0 | $0 | $0 | $0 | $28,537 | $0 | $0 | $0 | $468,570 | $0 | $0 | $0 |
| Michael Bohlman | ||||||||||||||
| Physician-Family Practice | $156,474 | $0 | $143,763 | $0 | $0 | $0 | $34,000 | $0 | $38,857 | $0 | $373,094 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3 | The Organization does not pay compensation to the CEO directly. The CEO is compensated by an unrelated management company, HealthTech Management Services, Inc. The Board of Directors approves the compensation paid by HealthTech Management Services, Inc. |
| Part I, Line 6 | Bonuses are calculated as a percentage of net revenue per quarter per contract for each individual based on billed charges for that quarter. |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp (2 entries)
| Relationship With OrgRelationshipWithOrgTxt | Loan PurposeLoanPurposeTxt | Loan From OrganizationLoanFromOrganizationInd | Original PrincipalOriginalPrincipalAmt | Balance DueBalanceDueAmt | DefaultDefaultInd | Board Or Committee ApprovalBoardOrCommitteeApprovalInd | Written AgreementWrittenAgreementInd |
|---|---|---|---|---|---|---|---|
| Sarah Durney | |||||||
| Employee | Relocation Expenses | Yes (X) | $45,000 | $8,333 | 0 | Yes (1) | Yes (1) |
| Mike Long | |||||||
| Employee | Relocation Expenses | Yes (X) | $2,500 | $2,500 | 0 | Yes (1) | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $10,833 | TotalBalanceDueAmt |
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Steve Katz | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | Husband of board member Boni Katz | RelationshipDescriptionTxt |
| Transaction | $235,255 | TransactionAmt |
| Transaction | Compensation | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 1 | The Executive Committee shall consist of the officers of the Board. The Executive Committee shall take action on behalf of the Board as may be necessary and prudent between regular Board meetings. The committee shall meet as often as needed. |
| Form 990, Part VI, Section A, line 3 | The CEO, Bill Patten, is an employee of HealthTech Management Services, Inc, a healthcare management company. As this position is held outside the organization, the control over management duties customarily performed by and under direct supervision of officers, directors or trustees, or key employees has effectively been delegated outside of the organization. Bill Patten is compensated by HealthTech Management Services, Inc. His compensation for services provided to the organzation for calendar year 2013 was $240,000. |
| Form 990, Part VI, Section A, line 7a | Seven Board members from the Hospital District Board of Trustees shall be appointed by virtue of their election to the Hospital District Board of Directors. |
| Form 990, Part VI, Section A, line 7b | A Board member who is from the Hospital District Board of Trustees may only be removed by action of the District Board of Directors. |
| Form 990, Part VI, Section A, line 8b | The Executive Committee did not meet during the year. Had they met during the year, their meeting would have been documented in the same manner as the governing body. |
| Form 990, Part VI, Section B, line 11 | A copy of Form 990 is provided to the CEO and CFO to review. The CEO or CFO will either make changes or approve the Form 990. After the Form 990 is finalized, but prior to being filed, a copy will be provided to the Board of Directors at a Board meeting. |
| Form 990, Part VI, Section B, line 12c | Individuals covered by the conflict of interest policy include members of the Board of Directors, officers and key employees (if applicable). The process used to determine if any conflicts of interest exist, consists of sending the Members a document for them to complete prior to the Board of Directors meeting. Each individual completes the document which entails disclosing any possible conflicts and returns for review to the President of the Board. If a member has a conflict they are not allowed to vote on the conflicted issues. In addition, employees have access to October Odyssey which is a program for employees to disclose conflicts. Administration tracks the employee conflicts and brings to the next Board meeting. |
| Form 990, Part VI, Section B, line 15 | Compensation for the CEO is determined by HealthTech Management Services, Inc. which is the management company that employs the CEO. Once HealthTech Management Services, Inc. has determined the compensation, they present the compensation to the Board of Directors for them to approve. This process occurs yearly and was last completed during fiscal year end 2014. The compensation of the CFO and Physicians is not within the Board of Directors administrative powers; therefore a Senior Management Team determines compensation for the physicians. The steps taken include comparing to other hospitals similar in size and experience, budget constraints, market, HealthTech Management Services, Inc. professional recruiting resources and salary surveys. The Management Team discusses and comes to an agreement for compensation and reports it to the Human Resources Department. |
| Form 990, Part VI, Section C, line 19 | The organization makes its governing documents, conflict of interest policy, and financials statements available to the public by request. The public may request a copy by calling, via mail, or walk-in. |
| Form 990, Part IX, line 11g | Contract Labor: Program service expenses 2,603,504. Management and general expenses 724,523. Fundraising expenses 0. Total expenses 3,328,027. Purchased Services: Program service expenses 6,270. Management and general expenses 11,400. Fundraising expenses 0. Total expenses 17,670. Repairs & Maintenance: Program service expenses 537,523. Management and general expenses 40,429. Fundraising expenses 0. Total expenses 577,952. Physicians Fees: Program service expenses 883,622. Management and general expenses 0. Fundraising expenses 0. Total expenses 883,622. Recruitment: Program service expenses 328,670. Management and general expenses 18,652. Fundraising expenses 0. Total expenses 347,322. Collection Fees: Program service expenses 35,771. Management and general expenses 278,354. Fundraising expenses 0. Total expenses 314,125. |
| Form 990, Part XI, line 9: | Changes in current year auxiliary activity not reported for audit purposes -898. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Powell Hospital District #1 | ||||||||||
| 777 Avenue H | Powell | WY | 82435 | 830200759 | Related - Provision of health care services | WY | Government | N/A | N/A | 0 |
| Powell Medical Foundation | ||||||||||
| PO Box 801 | Powell | WY | 82435 | 742275540 | Promote public health and improve facilities around the city of Powell, WY | WY | 501(c)(3) | Line 8 | N/A | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Powell Valley Integrated Health Services Inc | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 777 Avenue H | AddressLine1 |
| City | Powell | City |
| State | WY | State |
| ZIP Code | 82435 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 830319855 | EIN |
| Primary Activities | Public Benefit Corporation/Health Care Contract | PrimaryActivitiesTxt |
| Legal Domicile State | WY | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Powell Valley Health Care Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | $866,294 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $658,076 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
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