MEMORIAL HOSPITAL: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- MEMORIAL HOSPITAL (EIN 23-1265004)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-21
- IRS object ID
- 201421419349300722
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-21T15:10:25-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 232932984 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PARENTEBEARD LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | SUITE 200 221 W PHILADELPHIA ST | AddressLine1 |
| City | YORK | City |
| State | PA | State |
| ZIP Code | 174012993 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 231265004 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MEMO | NameControl |
| Phone | 7178438623 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 325 SOUTH BELMONT STREET | AddressLine1 |
| City | YORK | City |
| State | PA | State |
| ZIP Code | 17403 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SALLY J DIXON | Name |
| Title | PRESIDENT/CEO | Title |
| Phone | 7178438623 | Phone |
| Date Signed | 2014-05-21 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JULIUS C GREEN CPA JD | Name |
| PTIN | P00350393 | PTIN |
| Phone | 7178467000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | SALLY J DIXON | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 325 SOUTH BELMONT STREET | AddressLine1 |
| City | YORK | City |
| State | PA | State |
| ZIP Code | 17403 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 26741796 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.MHYORK.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1945 | YearFormation |
| State Legal Domicile | PA | StateLegalDomicile |
| Activity Or Mission Description | MEDICAL SERVICES: INPATIENT, OUTPATIENT (EMERGENCY, CLINIC, AND OCCUPATIONAL MED), HOME HEALTH. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1121 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 358044 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 99602117 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 106156 | InvestmentIncomePriorYear |
| Investment Income Current Year | 926145 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1919851 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 101986168 | TotalRevenuePriorYear |
| Total Revenue Current Year | 926145 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 55982082 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 51889295 | OtherExpensePriorYear |
| Other Expenses Current Year | 72561 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 107871377 | TotalExpensesPriorYear |
| Total Expenses Current Year | 72561 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -5885209 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 853584 | RevenuesLessExpensesCY |
| Total Assets BOY | 50094459 | TotalAssetsBOY |
| Total Assets EOY | 19046416 | TotalAssetsEOY |
| Total Liabilities BOY | 31903800 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 225205 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 18190659 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 18821211 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | MEMORIAL HOSPITAL IS COMMITTED TO PROMOTING, IMPROVING, AND ENHANCING THE HEALTH AND WELL-BEING OF THE COMMUNITY WE SERVE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 1 | SignificantChange |
| Description | MEMORIAL HEALTH SYSTEMS CORPORATION, PARENT COMPANY OF MEMORIAL HOSPITAL, ENTERED INTO AN ASSET PURCHASE AGREEMENT DATED JANUARY 24, 2012 WITH COMMUNITY HEALTH SYSTEMS, INC. TO SELL SUBSTANTIALLY ALL OF THE ASSETS OF THE SYSTEM. THE SALE CLOSED ON JULY 1, 2012. THE HOSPITAL TERMINATED ITS BUSINESS ACTIVITIES ON THAT DATE AND IS IN THE PROCESS OF DISSOLVING THE ENTITY. UPON DISSOLUTION, ANY ASSETS REMAINING WILL BE TRANSFERRED TO THE MEMORIAL HEALTH SYSTEMS CORPORATION ("MHSC"). MHSC WILL REMAIN ACTIVE IN THE YORK COMMUNITY PROVIDING FUNDS TO SUPPORT THE HEALTHCARE NEEDS OF THE COMMUNITY. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | HOSPICE SERVICES | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Info In Schedule O Part V | X | InfoInScheduleOPartV |
| Number Forms Transmitted With1096 | 26 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1121 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | PA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SALLY J DIXON | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7178438623 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 325 SOUTH BELMONT STREET | AddressLine1 |
| City | YORK | City |
| State | PA | State |
| ZIP Code | 17403 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (18 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| CHLOE R EICHELBERGER | ||||||||
| CHAIRMAN | 3.00 | 2.00 | X | X | 0 | 0 | 0 | |
| RANDALL A GROSS | ||||||||
| VICE CHAIRMAN | 3.00 | 1.00 | X | X | 0 | 0 | 0 | |
| JACK KAY | ||||||||
| IMMEDIATE PAST CHAIRMAN | 3.00 | 5.00 | X | 0 | 0 | 0 | ||
| RICHARD D POOLE | ||||||||
| DIRECTOR | 1.00 | 2.00 | X | 0 | 0 | 0 | ||
| TERRY N YORK DO | ||||||||
| DIRECTOR | 1.00 | 1.00 | X | 0 | 0 | 0 | ||
| LUTHER B SOWERS PHD | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| DELAINE TOERPER | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| MICHAEL NEWSOME | ||||||||
| TREASURER | 3.00 | X | X | 0 | 0 | 0 | ||
| MICHAEL W KING | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| CAROL ST GEORGE DO | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| JAMES A LEASE DO | ||||||||
| DIRECTOR | 40.00 | X | 183077 | 0 | 0 | |||
| PATRICK BRUBAKER | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| SALLY J DIXON | ||||||||
| PRESIDENT/CEO | 31.00 | 9.00 | X | X | 710616 | 0 | 1783 | |
| MANU S RAJACHANDRAN | ||||||||
| PHYSICIAN | 40.00 | 376923 | 0 | 0 | X | |||
| VAN D ADAMS | ||||||||
| PHYSICIAN | 40.00 | 258028 | 0 | 0 | X | |||
| RAYMOND S CUZZANITI | ||||||||
| PHYSICIAN | 40.00 | 250619 | 0 | 0 | X | |||
| HAOEH M JUNG | ||||||||
| PHYSICIAN | 40.00 | 227845 | 0 | 0 | X | |||
| RAVICHANDRAN SUPPIAH | ||||||||
| PHYSICIAN | 40.00 | 230105 | 0 | 0 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2237213 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 1783 | TotalOtherCompensation |
| Number Individuals GT100 K | 18 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 309966 | TotalRevenueColumn |
| Exclusion | $309,966 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 66092 | Securities |
| Other | 26365738 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 59596 | Securities |
| Other | 25756055 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 6496 | Securities |
| Other | 609683 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 616179 | TotalRevenueColumn |
| Exclusion | $616,179 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 926145 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $926,145 | ExclusionAmount |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14737 | Total |
| Management And General | 14737 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 57824 | Total |
| Management And General | 57824 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 72561 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 72561 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31 | BOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11279466 | BOY |
| EOY | 16696820 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2315747 | BOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1202540 | BOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 0 | LandBuildingsEquipmentBasis |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20566788 | BOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3443128 | BOY |
| EOY | 2318596 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31000 | BOY |
| EOY | 31000 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11255759 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50094459 | BOY |
| EOY | 19046416 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9775370 | BOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17502769 | BOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4625661 | BOY |
| EOY | 225205 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31903800 | BOY |
| EOY | 225205 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17567172 | BOY |
| EOY | 18231858 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 195956 | BOY |
| EOY | 161822 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 427531 | BOY |
| EOY | 427531 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18190659 | BOY |
| EOY | 18821211 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50094459 | BOY |
| EOY | 19046416 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 853584 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | -93523 | ReconciliationUnrealizedInvest |
| Reconcilation Prior Adjustment | -129509 | ReconcilationPriorAdjustment |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 0 | FSAudited |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 427531 | BeginningOfYearBalance |
| End Of Year Balance | 427531 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 427480 | BeginningOfYearBalance |
| Contributions | 51 | Contributions |
| End Of Year Balance | 427531 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 426890 | BeginningOfYearBalance |
| Contributions | 590 | Contributions |
| End Of Year Balance | 427480 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 426127 | BeginningOfYearBalance |
| Contributions | 500 | Contributions |
| Administrative Expenses | -263 | AdministrativeExpenses |
| End Of Year Balance | 426890 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 351269 | BeginningOfYearBalance |
| Contributions | 75000 | Contributions |
| Investment Earnings Or Losses | 2 | InvestmentEarningsOrLosses |
| Administrative Expenses | 144 | AdministrativeExpenses |
| End Of Year Balance | 426127 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 1 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DEFERRED COMPENSATION | $20,197 |
| ESTIMATED THIRD PARTY PAYOR SETTLEMENTS | $205,008 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 225205 | TotalOfAmounts |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | Identifier |
| Return Reference | PART V, LINE 4: | ReturnReference |
| Explanation | INCOME EARNED FROM ENDOWMENTS IS AVAILABLE FOR THE GENERAL OPERATIONS OF THE HOSPITAL. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAMES A LEASE DO | ||||||||||||||
| DIRECTOR | 183077 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 183077 | 0 | 0 | 0 |
| SALLY J DIXON | ||||||||||||||
| PRESIDENT/CEO | 225550 | 0 | 0 | 0 | 485066 | 0 | 1000 | 0 | 783 | 0 | 712399 | 0 | 485066 | 0 |
| MANU S RAJACHANDRAN | ||||||||||||||
| PHYSICIAN | 376923 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 376923 | 0 | 0 | 0 |
| VAN D ADAMS | ||||||||||||||
| PHYSICIAN | 258028 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 258028 | 0 | 0 | 0 |
| RAYMOND S CUZZANITI | ||||||||||||||
| PHYSICIAN | 250619 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 250619 | 0 | 0 | 0 |
| HAOEH M JUNG | ||||||||||||||
| PHYSICIAN | 227845 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 227845 | 0 | 0 | 0 |
| RAVICHANDRAN SUPPIAH | ||||||||||||||
| PHYSICIAN | 230105 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 230105 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 4B | ReturnReference |
| Explanation | SALLY J DIXON, PRESIDENT/CEO: SUPPLEMENTAL NON QUALIFIED RETIREMENT PLAN - RECEIVED $485,066 IN CALENDAR YEAR 2012. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MILLER & DIPIETRO ASSOCIATES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | TERRY N. YORK D.O., DIRECTOR, IS PARTNER IN MILLER & DIPIETRO PARTNERSHIP | Relationship |
| Amount Of Transaction | 211296 | AmountOfTransaction |
| Description Of Transaction | MILLER & DIPIETRO ASSOCIATES, MILLER & DIPIETRO PARTNERSHIP, AND MEDICAL IMAGING SYSTEMS OF YORK PROVIDED MEDICAL SERVICES. TERRY N. YORK IS A PARTNER WITH MILLER & DIPIETRO ASSOCIATES WHICH IS AFFILIATED WITH MILLER & DIPIETRO PARTNERSHIP AND MEDICAL IMAGING SYSTEMS OF YORK. | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| CHANGES IN PROGRAM SERVICES | FORM 990, PART III, LINE 3 | MEMORIAL HEALTH SYSTEMS CORPORATION, PARENT COMPANY OF MEMORIAL HOSPITAL, ENTERED INTO AN ASSET PURCHASE AGREEMENT DATED JANUARY 24, 2012 WITH COMMUNITY HEALTH SYSTEMS, INC. TO SELL SUBSTANTIALLY ALL OF THE ASSETS OF THE SYSTEM. THE SALE CLOSED ON JULY 1, 2012. THE HOSPITAL TERMINATED ITS BUSINESS ACTIVITIES ON THAT DATE AND IS IN THE PROCESS OF DISSOLVING THE ENTITY. UPON DISSOLUTION, ANY ASSETS REMAINING WILL BE TRANSFERRED TO THE MEMORIAL HEALTH SYSTEMS CORPORATION ("MHSC"). MHSC WILL REMAIN ACTIVE IN THE YORK COMMUNITY PROVIDING FUNDS TO SUPPORT THE HEALTHCARE NEEDS OF THE COMMUNITY. |
| FORM 990, PART V, LINE 2B: | MEMORIAL HOSPITAL IS THE COMMON REPORTING AGENT FOR THE GROUP OF RELATED TAX-EXEMPT ORGANIZATIONS AND FILES ALL 1099 FORMS FOR THE FOLLOWING: MHS TITLE COPORATION, SURGICAL CENTER OF YORK INC., AND MEMORIAL HEALTH SYSTEMS CORPORATION. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE ACCOUNTING DEPARTMENT PROVIDES INFORMATION TO THE INDEPENDENT ACCOUNTANT FOR PREPARATION OF THE FORM 990. THE DRAFT IS REVIEWED BY THE CEO. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION USES AN ANNUAL QUESTIONNAIRE TO DETERMINE IF ALL EMPLOYEES AND MEMBERS OF THE BOARD ARE INDEPENDENT. THE EMPLOYEE QUESTIONNAIRES ARE INITIALLY COMPLETED AS PART OF THE ORIENTATION PROGRAM UPON EMPLOYMENT, AND THEN AS PART OF THE ANNUAL REVIEW PROCESS. THESE FORMS ARE REVIEWED BY THE DIRECTOR OF HUMAN RESOURCES AND ANY POTENTIAL CONFLICT OF INTEREST IS REVIEWED WITH THE RELATED PARTY. ANNUAL QUESTIONNAIRES FOR THE BOARD/SENIOR MANAGEMENT ARE COLLECTED BY THE CEO AND ARE REVIEWED BY THE CEO AND THE BOARD CHAIRPERSON. AT THE BOARD LEVEL, ANY POTENTIAL CONFLICT IS MONITORED BY THE CEO AND CHAIR, AND BOARD MEMBERS WILL REFRAIN FROM VOTING ON CONFLICT/RELATED ISSUES. IN ADDITION TO THE REPORTING REQUIRED, KEY EMPLOYEES AND SENIOR MANAGEMENT ARE MONITORED BY THE CEO THROUGH THE PURCHASING AND CASH DISTRIBUTIONS CONTROLS IN PLACE. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE DETERMINATION OF THE COMPENSATION OF THE TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS OF THE ORGANIZATION INCLUDES A REVIEW AND APPROVAL BY THE COMPENSATION COMMITTEE OF MEMORIAL HOSPITAL. AN OUTSIDE CONSULTANT IS RETAINED BY THE COMPENSATION COMMITTEE. ON AN ANNUAL BASIS, THE CONSULTANT CONDUCTS A COMPENSATION SURVEY OF COMPARABLE EXECUTIVE POSITIONS AT COMPARABLE HOSPITALS WITHIN OUR GENERAL GEOGRAPHIC MARKETPLACE. THE CONSULTANT WILL ALSO ADVISE THE BOARD ON CURRENT TRENDS REGARDING COMPENSATION IN HEALTHCARE AND THE MARKETPLACE, INCLUDING THE REVIEW AND ESTABLISHMENT OF A VARIABLE PAY ("INCENTIVE") PROGRAM. THE COMMITTEE'S GENERAL GUIDELINES ARE TO MAINTAIN A BASE SALARY WITHIN THE 50TH-60TH PERCENTILE OF SIMILAR POSITIONS IN PEER INSTITUTIONS. ALONG WITH THE VARIABLE PAY OPPORTUNITY, TOTAL COMPENSATION IS GEARED TO THE 75TH PERCENTILE AND SHOULD NOT EXCEED THE 90TH PERCENTILE. IN UNIQUE AND SUPPORTABLE CIRCUMSTANCES, THE COMMITTEE MAY DEVIATE FROM THESE GUIDELINES. THE COMPENSATION IS REVIEWED BY THE EXECUTIVE COMMITTEE. THE DELIBERATION AND DECISION PROCESS IS CONTEMPORANEOUSLY DOCUMENTED. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. | |
| FORM 990, PART XII, LINE 2C: | THE FINANCE COMMITTEE IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED IN THE LAST YEAR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| SURGICAL CENTER OF YORK | |||||||||||
| 1750 FIFTH AVENUE | YORK | PA | 17403 | 232507740 | OUT PATIENT SURGERY CENTER | PA | 501(C)3 | 3 | MEMORIAL HEALTH SYSTEMS CORPORATION | 0 | |
| MEMORIAL HEALTH SYSTEMS CORPORATION | |||||||||||
| 1708 FIFTH AVENUE | YORK | PA | 17403 | 222546051 | SUPPORT AND DEVELOPMENT OF PROGRAMS FOR THE BENEFIT OF RELATED PARTIES | PA | 501(C)3 | 11 TYPE I | 0 | N/A | |
| MHS TITLE HOLDING CORP | |||||||||||
| 325 SOUTH BELMONT STREET | YORK | PA | 17403 | 222546052 | REAL PROPERTY MANAGEMENT FOR RELATED ENTITIES | PA | 501(C)3 | 11 TYPE I | MEMORIAL HEALTH SYSTEMS CORPORATION | 0 | |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL ENTERPRISES INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 325 SOUTH BELMONT STREET | AddressLine1 |
| City | YORK | City |
| State | PA | State |
| ZIP Code | 17403 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 232353226 | EIN |
| Primary Activity | MEDICAL CLINICS | PrimaryActivity |
| Legal Domicile State | PA | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Type Of Entity | C | TypeOfEntity |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 1 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
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