GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION (EIN 43-0715842)
- Tax period
- 2013-07-01 to 2014-06-30
- Filed
- 2015-05-12
- IRS object ID
- 201531329349303663
- 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 C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-05-12T14:49:59-05:00 | ReturnTs |
| Tax Period End | 2014-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 Walnut Suite 1700 | AddressLine1 |
| City | Kansas City | City |
| State | MO | State |
| ZIP Code | 641062246 | 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 | 430715842 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | General John J Pershing | BusinessNameLine1 |
| Business Name Line2 | Memorial Hospital Association | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % GARY TANDY CFO | InCareOfNm |
| Business Name Control | GENE | BusinessNameControlTxt |
| Phone | 6602582222 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 130 E Lockling | AddressLine1 |
| Address Line2 | PO Box 408 Suite | AddressLine2 |
| City | Brookfield | City |
| State | MO | State |
| ZIP Code | 64628 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PHIL HAMILTON | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6602582222 | PhoneNum |
| Signature | 2015-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kevin Ensminger CPA | PreparerPersonNm |
| PTIN | P01310558 | PTIN |
| Phone | 6602582222 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | PHIL HAMILTON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 130 E LOCKLING PO BOX 408 | AddressLine1 |
| City | BROOKFIELD | City |
| State | MO | State |
| ZIP Code | 64628 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $17,915,603 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | http://www.pershinghealthsystem.com/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1955 | FormationYr |
| Legal Domicile State | MO | LegalDomicileStateCd |
| Activity Or Mission | WE CONTINUED TO IMPLEMENT THE STAGES OF OUR ELECTRONIC MEDICAL RECORD SYSTEM. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 192 | TotalEmployeeCnt |
| Total Volunteers | 25 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,310 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,226 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $19,236,979 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $17,742,920 | CYProgramServiceRevenueAmt |
| PY Investment Income | $76,670 | PYInvestmentIncomeAmt |
| CY Investment Income | $75,017 | CYInvestmentIncomeAmt |
| PY Other Revenue | $121,069 | PYOtherRevenueAmt |
| CY Other Revenue | $93,825 | CYOtherRevenueAmt |
| PY Total Revenue | $19,438,028 | PYTotalRevenueAmt |
| CY Total Revenue | $17,912,988 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $8,609 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $9,109 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,621,000 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,470,983 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,076,174 | PYOtherExpensesAmt |
| CY Other Expenses | $10,153,657 | CYOtherExpensesAmt |
| PY Total Expenses | $18,705,783 | PYTotalExpensesAmt |
| CY Total Expenses | $18,633,749 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $732,245 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$720,761 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $21,152,431 | TotalAssetsBOYAmt |
| Total Assets EOY | $20,400,463 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $7,775,620 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,744,413 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $13,376,811 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $12,656,050 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | SERVING OTHERS THROUGH QUALITY, COMPASSIONATE CARE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $2,887,105 | ExpenseAmt |
| Grant | $1,822 | GrantAmt |
| Revenue | $3,548,585 | RevenueAmt |
| Desc | INPATIENT ACUTE CARE SERVICES WITH 610 INPATIENT ADMISSIONS | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $8,083,892 | ExpenseAmt |
| Grant | $5,101 | GrantAmt |
| Revenue | $9,936,035 | RevenueAmt |
| Desc | OUTPATIENT SERVICES WITH APPROXIMATELY 22,978 REGISTRATIONS. THIS INCLUDES 4,978 EMERGENCY ROOM VISITS. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,010,486 | ExpenseAmt |
| Grant | $637 | GrantAmt |
| Revenue | $1,242,004 | RevenueAmt |
| Desc | COMMUNITY MEDICAL ASSOCIATES, OUR PROVIDER BASED RURAL HEALTH CLINIC, WITH BOTH SCHEDULED AND WALK-IN SERVICES, IS OPEN 10 HOURS A DAY MONDAY THRU SATURDAY AND 5 HOURS ON SUNDAY. IT HAD 13,112 VISITS THIS PAST FISCAL YEAR. IT IS A LOWER COST ALTERNATIVE THAN USING THE EMERGENCY ROOM. APPLEGATE MEDICAL GROUP SAW 11,266 PATIENTS AND MEADVILLE MEDICAL CENTER IS OPEN 3 DAYS A WEEK AND SAW 955 PATIENTS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $2,454,039 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $1,549 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $3,016,296 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $14,435,522 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (true) | 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 | Yes (true) | 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 | 44 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 192 | 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 | 10 | 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 | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | 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 | MO | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GARY TANDY CFO | PersonNm |
| Phone | 6602582222 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 130 E LOCKLING PO BOX 408 | AddressLine1 |
| City | BROOKFIELD | City |
| State | MO | State |
| ZIP Code | 64628 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| ANGELA P LITTRELL | |||||||
| DIRECTOR/SECRETARY | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| WILLIAM THUDIUM | |||||||
| DIRECTOR/PRESIDENT | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| PAUL WILLIAMS | |||||||
| DIRECTOR/CONTRACTED PHYSICIAN | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| GAIL TURNER | |||||||
| DIRECTOR/TREASURER | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| GARY ROUTLEDGE | |||||||
| DIRECTOR | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| CARY SAYRE | |||||||
| DIRECTOR | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| MARK CLEVELAND | |||||||
| DIRECTOR | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| TOD SYLVARA | |||||||
| DIRECTOR/CONTRACTED PHYSICIAN | 14.0 | Yes (X) | $102,830 | $0 | $0 | ||
| JIM ELLIOTT | |||||||
| DIRECTOR | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| DAVID SHAW | |||||||
| DIRECTOR/SECRETARY | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| BRIAN WINN | |||||||
| DIRECTOR | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| PHIL HAMILTON | |||||||
| CEO | 40.0 | Yes (X) | $142,559 | $0 | $13,039 | ||
| GARY TANDY | |||||||
| CFO | 40.0 | Yes (X) | $105,241 | $0 | $13,834 | ||
| BRIAN CASEBOLT | |||||||
| EMPLOYEE/PHARMACIST | 40.0 | $116,738 | $0 | $36,872 | Yes (X) | ||
| GARY FITE | |||||||
| EMPLOYEE/PHYS. THERAPIST | 40.0 | $118,648 | $0 | $23,886 | Yes (X) | ||
| WACLAW DYMEK | |||||||
| EMPLOYED PHYSICIAN | 40.0 | $416,950 | $0 | $22,845 | Yes (X) | ||
| GRACE DYMEK | |||||||
| EMPLOYED PHYSICIAN | 40.0 | $179,235 | $0 | $2,120 | Yes (X) | ||
| DR SP GALVEZ | |||||||
| EMPLOYED PHYSICIAN | 24.0 | $192,959 | $0 | $1,010 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,375,160 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $113,606 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 13 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (true) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| ServicesServicesDesc | CompensationCompensationAmt |
|---|---|
| BOONE HOSPITAL CENTER | |
| MANAGEMENT | $207,910 |
| DR PEPITO RIVERA | |
| PHYSICIAN SERVICES | $580,233 |
| HAVE A NICE DAY ANESTHESIA | |
| ANETHESIOLOGIST | $199,405 |
| DR GARRETT ELAM | |
| PHYSICIAN SERVICES | $173,880 |
| DR JERRY WAIT | |
| PHYSICIAN SERVICES | $168,070 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 9 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $1,226 | AllOtherContributionsAmt |
| Total Contributions | $1,226 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net Patient Service Rev | 621400 | $17,321,255 | $17,321,255 |
| 340B Revenue | 900099 | $421,665 | $421,665 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $17,742,920 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $77,632 | TotalRevenueColumnAmt |
| Exclusion | $77,632 | 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 | $24,843 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $24,843 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $24,843 | TotalRevenueColumnAmt |
| Exclusion | $24,843 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $2,615 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$2,615 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$2,615 | TotalRevenueColumnAmt |
| Exclusion | -$2,615 | 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 |
|---|---|---|---|
| Cafeteria | 900099 | $31,588 | $31,588 |
| Miscellaneous income | 900099 | $13,441 | $13,441 |
| Vending Machines | 900099 | $23,953 | $23,953 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $68,982 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,912,988 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,742,920 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $168,842 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,109 | TotalAmt |
| Program Services | $9,109 | ProgramServicesAmt |
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 | $386,485 | TotalAmt |
| Program Services | $113,260 | ProgramServicesAmt |
| Management And General | $273,225 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $176,070 | TotalAmt |
| Program Services | $128,531 | ProgramServicesAmt |
| Management And General | $47,539 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,168,742 | TotalAmt |
| Program Services | $4,652,492 | ProgramServicesAmt |
| Management And General | $1,516,250 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $82,335 | TotalAmt |
| Program Services | $63,562 | ProgramServicesAmt |
| Management And General | $18,773 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,191,372 | TotalAmt |
| Program Services | $885,808 | ProgramServicesAmt |
| Management And General | $305,564 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $465,979 | TotalAmt |
| Program Services | $340,165 | ProgramServicesAmt |
| Management And General | $125,814 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,481 | TotalAmt |
| Management And General | $13,481 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,818 | TotalAmt |
| Management And General | $65,818 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,549 | TotalAmt |
| Management And General | $5,549 | ManagementAndGeneralAmt |
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 | $3,250,698 | TotalAmt |
| Program Services | $2,666,710 | ProgramServicesAmt |
| Management And General | $583,988 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,838 | TotalAmt |
| Program Services | $11,562 | ProgramServicesAmt |
| Management And General | $4,276 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $759,044 | TotalAmt |
| Program Services | $554,102 | ProgramServicesAmt |
| Management And General | $204,942 | 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 | $393,073 | TotalAmt |
| Program Services | $286,943 | ProgramServicesAmt |
| Management And General | $106,130 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,539 | TotalAmt |
| Management And General | $6,539 | 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 | $16,522 | TotalAmt |
| Management And General | $16,522 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $275,669 | TotalAmt |
| Program Services | $201,238 | ProgramServicesAmt |
| Management And General | $74,431 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,514,690 | TotalAmt |
| Program Services | $1,105,724 | ProgramServicesAmt |
| Management And General | $408,966 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $196,796 | TotalAmt |
| Program Services | $143,661 | ProgramServicesAmt |
| Management And General | $53,135 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Bad Debt Expense | $1,867,933 | $1,867,933 | |
| Medical Supplies | $1,169,484 | $853,723 | $315,761 |
| Taxes & Licenses | $46,988 | $46,988 | |
| Medicaid FRA Payments | $503,505 | $503,505 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,030 | TotalAmt |
| Program Services | $47,494 | ProgramServicesAmt |
| Management And General | $4,536 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,633,749 | TotalAmt |
| Program Services | $14,435,522 | ProgramServicesAmt |
| Management And General | $4,198,227 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,908,017 | BOYAmt |
| EOY | $6,723,106 | 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 | $3,179,548 | BOYAmt |
| EOY | $3,631,472 | 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 | $242,211 | BOYAmt |
| EOY | $241,240 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $234,688 | BOYAmt |
| EOY | $229,166 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $211,978 | BOYAmt |
| EOY | $247,853 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $19,708,637 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $10,779,323 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,121,852 | BOYAmt |
| EOY | $8,929,314 | 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 | $254,137 | BOYAmt |
| EOY | $398,312 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,152,431 | BOYAmt |
| EOY | $20,400,463 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,179,167 | BOYAmt |
| EOY | $1,392,611 | 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 | $6,596,453 | BOYAmt |
| EOY | $6,351,802 | 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 | $7,775,620 | BOYAmt |
| EOY | $7,744,413 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,366,686 | BOYAmt |
| EOY | $12,648,703 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,125 | BOYAmt |
| EOY | $7,347 | 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 | $13,376,811 | BOYAmt |
| EOY | $12,656,050 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,152,431 | BOYAmt |
| EOY | $20,400,463 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$720,761 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | false | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (true) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $5,549 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $5,549 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
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 | $107,129 | OtherCostOrOtherBasisAmt |
| Book Value | $107,129 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,568,409 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,616,613 | DepreciationAmt |
| Book Value | $6,951,796 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,975,343 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,162,710 | DepreciationAmt |
| Book Value | $1,812,633 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $57,756 | OtherCostOrOtherBasisAmt |
| Book Value | $57,756 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,929,314 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $16,268,751 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $5,540 | OtherRevenueAmt |
| Revenue Not Reported | $5,540 | RevenueNotReportedAmt |
| Revenue Subtotal | $16,263,211 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,649,777 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,649,777 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $17,912,988 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $16,986,734 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $16,986,734 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,647,015 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,647,015 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $18,633,749 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PART X, LINE 2 | MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. |
| SCHEDULE D, PART XI, LINE 2D | NET ASSETS RELEASED FROM RESTRICTIONS $ 5,540 |
| SCHEDULE D, PART XI, LINE 4B | RESTRICTED CONTRIBUTIONS RECEIVED $ 2,762 PROVISION FOR UNCOLLECTIBLE ACCOUNTS $ 1,647,015 ----------- TOTAL $ 1,649,777 |
| SCHEDULE D, PART XII, LINE 4B | PROVISION FOR UNCOLLECTIBLE ACCOUNTS $ 1,647,015 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| 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 | 133. | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 213. | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $140,800 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $140,800 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00830 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,792,909 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,201,815 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $591,094 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03480 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,933,709 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,201,815 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $731,894 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04310 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,714 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $19,264 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$3,550 | NetCommunityBenefitExpnsAmt |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,999 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,999 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,713 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $19,264 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,449 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,954,422 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,221,079 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $733,343 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04340 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,867,933 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $247,000 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $7,938,076 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,894,993 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $43,083 | 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 | GENERAL JOHN J PERSHING MEM HOSPITAL | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 130 E LOCKLING AVE PO BOX 408 | AddressLine1 |
| City | BROOKFIELD | City |
| State | MO | State |
| ZIP Code | 64628 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | COMMUNITY MED ASSOC APPLEGATE MED GROUP MEADVILLE MED CLINIC | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GENERAL JOHN J PERSHING MEM HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| 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 | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | http://www.pershinghealthsystem.com/ | OwnWebsiteURLTxt |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Develop Community Wide Plan | Yes (X) | DevelopCommunityWidePlanInd |
| Include Operational Plan | Yes (X) | IncludeOperationalPlanInd |
| Adopt Budget | Yes (X) | AdoptBudgetInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | Yes (true) | AllNeedsAddressedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (true) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 133. | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (true) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 213. | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| Medicaid Medicare | Yes (X) | MedicaidMedicareInd |
| State Regulation | Yes (X) | StateRegulationInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| Posted On Website | Yes (X) | PostedOnWebsiteInd |
| Attached To Invoice | Yes (X) | AttachedToInvoiceInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Provided On Admission | Yes (X) | ProvidedOnAdmissionInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, SECTION B, LINE 3 | THE HOSPITAL RECEIVED INPUT FROM SEVERAL REPRESENTATIVES FROM THE COMMUNITY INCLUDING INDEPENDENT HEALTHCARE PROFESSIONALS, COUNTY HEALTH DEPARTMENT OFFICIALS, PERSHING MEMORIAL HOSPITAL EMPLOYEES, AND OTHER MEMBERS OF THE COMMUNITY. |
| PART V, SECTION B, LINE 20D | THE HOSPITAL FACILITY DETERMINED THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE BY TAKING MANAGED CARE CONTRACTUAL WRITE OFFS DIVIDED BY MANAGE CARE REVENUES. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | FacilityFacilityTxt |
|---|---|---|---|---|
| COMMUNITY MEDICAL ASSOCIATES | ||||
| 130 E LOCKLING AVE | BROOKFIELD | MO | 64628 | PROVIDER BASED RURAL HEALTH CLINIC |
| APPLEGATE MEDICAL GROUP | ||||
| 125 E LOCKLING AVE | BROOKFIELD | MO | 64628 | PROVIDER BASED RURAL HEALTH CLINIC |
| MEADVILLE MEDICAL CLINIC | ||||
| 101 E HAYWARD | MEADVILLE | MO | 64659 | PROVIDER BASED RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7, COLUMN F | THE BAD DEBT EXPENSE INCLUDED IN FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS 1,867,933. |
| PART I, LINE 7 | THE COST-TO-CHARGE RATIO USED WAS DERIVED FROM WORKSHEET 2. |
| PART III, SECTION A, LINE 2 | BAD DEBT EXPENSE IS THAT PORTION OF ANY SELF SERVICE BALANCE REFERRED ON FOR OUTSIDE COLLECTION SERVICES, AND THAT EITHER DID NOT APPLY OR DID NOT QUALIFY UNDER OUR CHARITY CARE POLICY. THE HOSPITAL PROVIDES SERVICES WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATE (TO PATIENTS WHO MEET THE CRITERIA OF ITS CHARITY CARE POLICY). THE HOSPITAL'S CHARITY CARE POLICY IS FOUNDED ON THE FEDERAL POVERTY INCOME GUIDELINES. ACCOUNTS AND AMOUNTS DETERMINED TO MEET THIS CRITERIA ARE NOT REPORTED AS NET REVENUE AND ARE NOT PURSUED FOR COLLECTION. |
| PART III, SECTION A, LINE 3 | USED THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 AND APPLIED THAT PERCENTAGE TO NET BAD DEBTS TO ARRIVE AT AN ESTIMATED COST OF BAD DEBT. THEN, PER COLLECTIOIN SUPERVISOR'S ESTIMATE, APPLIED 15% TO THE NET BAD DEBTS TO ARRIVE AT ESIMATED COST THAT COULD BE CHARITY. |
| PART III, SECTION A, LINE 4 | PLEASE SEE NOTE 1 BEGINNING ON PAGE 7 OF THE ATTACHED FINANCIAL STATEMENTS FOR THE FOOTNOTE DESCRIBING THE ORGANIZATION'S BAD DEBT EXPENSE. |
| PART III, LINE 9B | WE HAVE A FINANCIAL ASSISTANCE POLICY AND COLLECTION POLICY THAT COVERS CRITERIA FOR PAYMENT ARRANGEMENTS AND FOR PARTIAL OR FULL CHARITY CARE WRITE-OFF. |
| NEEDS ASSESSMENT | PERSHING IS A SMALL RURAL CRITICAL ACCESS HOSPITAL AND AS SUCH RECEIVES CONTINUOUS FEEDBACK FROM THE PATIENTS WE SERVE, OUR PHYSICIANS, OTHER MEDICAL PROVIDERS, BOARD MEMBERS (WHO REPRESENT A WIDE REPRESENTATION OF OUR COMMUNITY), AND FROM VARIOUS ONGOING PATIENT SATISFACTION SURVEYS. SUCH SURVEYS ARE REPORTED AT BOARD MEETINGS AND DISTRIBUTED TO ALL HOSPITAL DEPARTMENTS. YOU CAN FIND THE HOSPITAL'S STRATEGIC PLAN AT http://www.pershinghealthsystem.com/. |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | INFORMATION ON OUR FINANCIAL ASSISTANCE POLICY (FAP) IS ON OUR WEBSITE. THE FAP, CHARITY CARE AND COLLECTION (PAYMENT ARRANGEMENTS) INFORMATION IS AVAILABLE THROUGH OUR COLLECTION PERSONNEL AND OTHERS AT PERSHING HOSPITAL AND THROUGH OUR WALK-IN CLINIC, COMMUNITY MEDICAL ASSOCIATES, AT APPLEGATE MEDICAL GROUP, AND MEADVILLE MEDICAL CLINIC. FURTHER, WE PRINT A REFERENCE TO OUR FAP POLICY ON THE FRONT OF EACH PATIENT BILLING STATEMENT SENT OUT. SOCIAL SERVICES - THROUGH THE ASSESSMENT/CONSULTATION PROCESS, IDENTIFIES AND ASSISTS IN THE APPLICATION PROCESS FOR INDIVIDUALS. |
| COMMUNITY INFORMATION | PERSHING HEALTH SYSTEM SERVES LINN COUNTY (POPULATION OF AROUND 13,000) AND SURROUNDING AREA. IT IS MADE UP OF RURAL COMMUNITIES WITH A MIXTURE OF BUSINESSES AND AGRICULTURE. |
| PROMOTION OF COMMUNITY HEALTH | "PROMOTING THE HEALTH OF THE COMMUNITY" WE OPERATE THREE (3) PROVIDER BASED RHCS: 1) APPLEGATE MEDICAL GROUP, WHICH INCLUDES THE ONLY LOCALLY AVAILABLE PEDIATRICIAN. IT ALSO INCLUDES AN INTERNAL MEDICINE PHYSICIAN. 2) COMMUNITY MEDICAL ASSOCIATES, LOCATED WITHIN THE HOSPITAL BUILDING, AND OPEN 7 DAYS A WEEK. PROVIDED CLINICAL ROTATION SITE FOR MEDICAL STUDENTS, NURSE PRACTITIONERS, NURSING, AND PHYSICAL THERAPY STUDENTS. PROVIDED JOB SHADOWING AND CLINICAL ROTATIONS TO THE AREA CAREER CENTERS. PROVIDE FREE SPORTS PHYSICALS AT THE BEGINNING OF EACH SCHOOL YEAR. NURSE PRACTITIONERS PROVIDE WELL CHILD EXAMS YEARLY AT THE LINN CO. HEALTH DEPT. 3) MEADVILLE MEDICAL CLINIC, 12 MILES FROM THE HOSPITAL, SERVES ONE OF THE SMALL COMMUNITIES WITHIN OUR SERVICE AREA WITH A 3 DAY A WEEK NURSE PRACTITIONER. HOSPITAL WEEK, ANNUAL PUBLIC EVENT DONE AT THE LOCAL (BROOKFIELD) YMCA AND AT MARCELINE BETHANY BAPTIST CHURCH: -PROCESSED 585 BLOOD DRAWS; OCCUPATIONAL THERAPY HEALTH BOOTH; BLOOD PRESSURES AND PULSE OXIMETRY TESTS WERE PERFORMED. PROMOTED ADVANCED DIRECTIVES INFORMATIONAL PACKETS. SPONSOR OF A YMCA YOUTH ATHLETIC TEAM. OTHER HEALTH FAIRS AND EVENTS: -CONDUCTED FAIRS AT OTHER BUSINESSES IN OUR SERVICE AREA. TOURS: -TOURS OF THE HOSPITAL WERE CONDUCTED THIS YEAR WITH AREA SCHOOLS - A ONCE A YEAR PUBLIC EVENT WHICH LETS US PROMOTE THE POSITIVE ASPECTS OF PERSHING HEALTH SYSTEM. NEWSPAPER ARTICLES: -RADIOLOGY-PERIPHERAL ARTERY DISEASE SCREENING; RHC-EFFECTS OF THE AFFORDABLE CARE ACT; SOCIAL SERVICES -COMMUNITY HEALTH NEEDS; OCCUPATIONAL THERAPY-O.T. AND THE PAINFUL SHOULDER; SPEECH AND LANGUAGE THERAPY SERVICES; CARDIAC AND PULMONARY REHAB PATIENTS; GERD; LAB- COMMUNITY BASED HEALTH SCREENINGS. -NUMEROUS OTHER MINOR CONTRIBUTIONS TO THE GENERAL WELFARE AND SAFETY OF OUR COMMUNITY. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | false | GrantRecordsMaintainedInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE I, PART I, LINE 2 | THE ORGANIZATION DOES NOT MONITOR THE USE OF THE CONTRIBUTION AS THE REQUESTED FUNDS ARE FOR STATED OPERATING COSTS, SUCH AS USAGE OF THE ORGANIZATION, STAFF PAYROLL, ETC. |
| SCHEDULE I, PART II | THE ORGANIZATION MADE NO GRANTS OVER $5,000 TO ANY GOVERNMENT OR ORGANIZATION IN THE UNITED STATES. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| 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 (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PHIL HAMILTON | ||||||||||||||
| CEO | $121,073 | $0 | $19,858 | $0 | $1,628 | $0 | $2,664 | $0 | $10,375 | $0 | $155,598 | $0 | $0 | $0 |
| BRIAN CASEBOLT | ||||||||||||||
| EMPLOYEE/PHARMACIST | $110,095 | $0 | $0 | $0 | $6,643 | $0 | $2,169 | $0 | $34,703 | $0 | $153,610 | $0 | $0 | $0 |
| WACLAW DYMEK | ||||||||||||||
| EMPLOYED PHYSICIAN | $346,393 | $0 | $70,557 | $0 | $0 | $0 | $1,452 | $0 | $21,394 | $0 | $439,796 | $0 | $0 | $0 |
| GRACE DYMEK | ||||||||||||||
| EMPLOYED PHYSICIAN | $179,235 | $0 | $0 | $0 | $0 | $0 | $1,085 | $0 | $1,035 | $0 | $181,355 | $0 | $0 | $0 |
| DR SP GALVEZ | ||||||||||||||
| EMPLOYED PHYSICIAN | $192,959 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $1,010 | $0 | $193,969 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990, PART VII, LINE 5 | FormAndLineReferenceDesc |
| Explanation | PHIL HAMILTON RECEIVED $155,598 FROM BOONE HOSPITAL CENTER, AN UNRELATED ORGANIZATION, FOR HIS SERVICES AS CEO. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| DR KAREN SYLVARA | |||
| SPOUSE OF DIRECTOR | $140,455 | INDEPENDENT CONTRACTOR | false |
| JENNIFER THUDIUM | |||
| DAUGHTER-IN-LAW OF DIR | $35,615 | EMPLOYEE | false |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 4D | THE HOSPITAL ALSO ADVANCES THE QUALITY OF LIFE IN THE RURAL AREA THROUGH PUBLIC EDUCATION REGARDING HEALTH CARE ISSUES, PROMOTING HEALTHY LIFESTYLES AND PROVISION OF HEALTH SCREENING. |
| FORM 990, PART VI, SECTION A, LINE 3 | THE ORGANIZATION ENTERED INTO A MANAGEMENT AGREEMENT FOR THE OPERATION AND MANAGEMENT OF THE HOSPITAL. THE MANAGEMENT AGREEMENT PROVIDES DAILY OPERATING AUTHORITY TO THE MANAGEMENT COMPANY AND CEO SERVICES. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS ONE CLASS OF ASSOCIATION MEMBERSHIP. ALL MEMBERS OF THE CORPORATION ARE ENTITLED TO VOTE IN PERSON AT ALL MEETINGS OF MEMBERSHIP. THE MEETING OF MEMBERSHIP IS AN ANNUAL MEETING HELD ON THE FOURTH MONDAY IN JUNE. MEMBERS OF THIS CORPORATION HAVE THE RIGHT TO ELECT THE MEMBERS OF THE BOARD OF DIRECTORS AT THIS MEETING. MEMBERS ARE NOT ENTITLED TO RECEIVE A SHARE OF THE CORPORATIONS PROFITS, EXCESS DUES OR A SHARE OF THE CORPORATIONS NET ASSETS UPON DISSOLUTION. |
| FORM 990, PART VI, SECTION A, LINE 7A & 7B | MEMBERS OF THE CORPORATION HAVE THE RIGHT TO ELECT ALL MEMBERS OF THE BOARD OF DIRECTORS AT THE ANNUAL MEETING OF MEMBERSHIP. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PREPARED AND REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. THE FORM 990 IS THEN REVIEWED BY OFFICERS AND ACCOUNTING PERSONNEL. ANY QUESTIONS THEY HAVE ARE ADDRESSED. THE FORM 990 IS THEN FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY AND THE CONFLICT OF INTEREST DISCLOSURE FORM AND QUESTIONNAIRE IS DISTRIBUTED ANNUALLY TO THE BOARD OF DIRECTORS AND OFFICERS. THE QUESTIONNAIRE IS COMPLETED TO IDENTIFY ANY RELATIONSHIPS, POSITIONS, OR CIRCUMSTANCES WITH RESPECT TO WHICH IT IS BELIEVED A CONFLICT MAY ARISE. IN SUCH A CASE THAT A CONFLICT OF INTEREST DOES OCCUR, THE DISCLOSING INDIVIDUAL WITH THE CONFLICT OF INTEREST DOES NOT ATTEND ANY MEETINGS OR DISCUSSIONS REGARDING THE MATTER. THE DISCLOSING INDIVIDUAL DOES NOT VOTE OR ENDEAVOR TO INFLUENCE CORPORATE ACTION IN ANY SUCH MATTER. |
| FORM 990, PART VI, SECTION B, LINE 15A & 15B | THE CEO'S COMPENSATION IS INCLUDED IN THE INDEPENDENT CONTRACT FEE TO BOONE HOSPITAL. BOONE HOSPITAL DETERMINES AND PAYS HIS COMPENSATION. THE INDEPENDENT CONTRACTOR FEE IS APPROVED BY THE FILING ORGANIZATION'S BOARD OF DIRECTORS. THE CEO DETERMINES THE CFO'S COMPENSATION ANNUALLY. COMPENSATION SURVEYS ARE USED TO EVALUATE COMPENSATION LEVELS. THE CEO CONDUCTS AN ANNUAL EVALUATION OF KEY MANAGEMENT STAFF. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:1653034 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:COLLECTION FEES TOTAL FEES:23854 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONTRACT SERVICES TOTAL FEES:1573810 |
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