Johnson Evergreen Corporation: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- Johnson Evergreen Corporation (EIN 22-3012385)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-05-07
- IRS object ID
- 201331279349300323
- Schema version
- 2011v1.2
- 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 | 2013-05-07T08:56:34-07:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 223012385 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOHNSON EVERGREEN CORPORATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | JOHN | NameControl |
| Phone | 8606846341 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 205 Chestnut Hill Road | AddressLine1 |
| City | Stafford Springs | City |
| State | CT | State |
| ZIP Code | 060760549 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | John Grish | Name |
| Title | Chief Financial Officer | Title |
| Phone | 8606848152 | Phone |
| Date Signed | 2013-05-07 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Evergreen Health Care Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | David Morgan | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 50 Pleasantview Drive | AddressLine1 |
| City | Somers | City |
| State | CT | State |
| ZIP Code | 060760549 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 16851525 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.jmmc.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1989 | YearFormation |
| State Legal Domicile | CT | StateLegalDomicile |
| Activity Or Mission Description | To develop, operate ,and maintain programs directed toward improving the efficiency of utiliztion of Health Care Facilities and Services in the State of CT, and in Hartford and Tolland Counties and surrouding areas in particular, and reducing the cost of health care to the public while maintaining a high quality of care. Evergreen is skilled nursing facility with 120 long-term-care beds, a 30-bed Subacute unit for patients in need of extensive therapy and care before returning home, and a 30-bed Memory Support unit for residents with Alzheimers's disease and similiar forms of dimentia. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 14 | NbrIndependentVotingMembers |
| Total Nbr Employees | 326 | TotalNbrEmployees |
| Total Nbr Volunteers | 76 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 24258 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 8629 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 17547583 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 16798928 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 0 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 108544 | OtherRevenuePriorYear |
| Other Revenue Current Year | 43968 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 17680385 | TotalRevenuePriorYear |
| Total Revenue Current Year | 16851525 | 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 | 11749582 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 11716653 | 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 | 6019816 | OtherExpensePriorYear |
| Other Expenses Current Year | 6201793 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 17769398 | TotalExpensesPriorYear |
| Total Expenses Current Year | 17918446 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -89013 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1066921 | RevenuesLessExpensesCY |
| Total Assets BOY | 12616260 | TotalAssetsBOY |
| Total Assets EOY | 11723027 | TotalAssetsEOY |
| Total Liabilities BOY | 16939364 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 17113052 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -4323104 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -5390025 | NetAssetsOrFundBalancesEOY |
| Mission Description | To develop, operate ,and maintain programs directed toward improving the efficiency of utiliztion of Health Care Facilities and Services in the State of CT, and in Hartford and Tolland Counties and surrouding areas in particular, and reducing the cost of health care to the public while maintaining a high quality of care. Evergreen is a Skilled Nursing Facility with 120 long term beds, a 30 bed Subacute Rehabilitation unit, and a 30 bed Memory Support unity. Services include: 24 hour nursing care, long term care, cardiac recovery, subacute rehabilitation, dental care, hospice care, respite care, iv therapies, medically complex care, mental health services, oncology/cancer care, optometry and opthalmology, orthopedic care, pain management, wound care, podiatry and other special services, postoperative care, pulmonary/respiratory care, social services and therapeutic recreation. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 16860914 | Expense |
| Grants | 0 | Grants |
| Revenue | 16842896 | Revenue |
| Description | Nursing Home Care: Johnson Evergreen Corporation, DBA Evergreen Health Care Center maintains a 180 bed SNF with 24 hour skilled nursing care for residnets. During Fy 12 the facility maintained a high occupancy and high quality care in the facility. The cost shown represents the necessary salary, supplies, and overhead essential for caring for residents at Evergreen. (55156 resident days) | Description |
| Total Of Other Program Service Exp | 0 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 0 | TotalOfOtherProgramServiceGrnt |
| Total Of Other Program Service Rev | 0 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 16860914 | TotalProgramServiceExpense |
| 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 | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | 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 | 0 | 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 | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 37 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 326 | 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 | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 14 | 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 | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | 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 | 1 | 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 |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Tia Riedel | NamePerson |
| Telephone Number | 8606848742 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 201 Chestnut Hill Road | AddressLine1 |
| City | Stafford Springs | City |
| State | CT | State |
| ZIP Code | 06076 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| Gary J Roman | ||||||||
| Chairman | 2 | X | 0 | 0 | 0 | |||
| Patrick Mahon | ||||||||
| Vice Chairman | 2 | X | 0 | 0 | 0 | |||
| James M Makuch | ||||||||
| Treasurer | 2 | X | 0 | 0 | 0 | |||
| Evelyne A Parizek | ||||||||
| Secretary | 2 | X | 0 | 0 | 0 | |||
| James Baum | ||||||||
| Director | 2 | X | 0 | 0 | 0 | |||
| Joseph Ianello MD | ||||||||
| Director | 2 | X | 0 | 0 | 0 | |||
| John T Larabee | ||||||||
| Director | 2 | X | 0 | 0 | 0 | |||
| Younus F Masih MD | ||||||||
| Director | 2 | X | 0 | 0 | 0 | |||
| John W Patton | ||||||||
| Director | 2 | X | 0 | 0 | 0 | |||
| John Giamalis | ||||||||
| Director | 2 | X | 0 | 0 | 0 | |||
| Christopher Dadlez | ||||||||
| Director | 2 | X | 0 | 0 | 0 | |||
| Arthur DeTore MD | ||||||||
| Director | 2 | X | 0 | 0 | 0 | |||
| David O'connor | ||||||||
| Director | 2 | X | 0 | 0 | 0 | |||
| Michael P Krol | ||||||||
| Director | 2 | X | 0 | 0 | 0 | |||
| David Morgan | ||||||||
| Interim President/CEO | 50 | 0 | 433996 | 23035 | X | |||
| John Grish | ||||||||
| Chief Financial Officer | 50 | 0 | 271336 | 19175 | X | |||
| James Fidanza | ||||||||
| Administrator /Vice President | 50 | 165246 | 0 | 25029 | X | |||
| Damien R Eilerman | ||||||||
| Nursing Supervisor | 40 | 141739 | 0 | 21469 | X | |||
| Diana Rose | ||||||||
| VP Human Resources | 40 | 105345 | 0 | 15956 | X | |||
| Lynda Schold | ||||||||
| Nursing Supervisor | 40 | 104242 | 0 | 15789 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 516572 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 705332 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 120453 | TotalOtherCompensation |
| Number Individuals GT100 K | 4 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Federated Campaigns | 0 | FederatedCampaigns |
| Membership Dues | 0 | MembershipDues |
| Fundraising Events | 0 | FundraisingEvents |
| Related Organizations | 0 | RelatedOrganizations |
| Government Grants | 0 | GovernmentGrants |
| All Other Contributions | 8629 | AllOtherContributions |
| Noncash Contributions | 0 | NoncashContributions |
| Total Contributions | 8629 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Resident Revenues | Description |
| Business Code | 623000 | BusinessCode |
| Total Revenue Column | 16798928 | TotalRevenueColumn |
| Related Or Exempt Function Income | 16798928 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 16798928 | TotalProgramServiceRevenue |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
| Personal | 0 | Personal |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 0 | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrbtns Rprtd Fundraising Events | 0 | CntrbtnsRprtdFundraisingEvents |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|---|
| Title 19 Application Fees | 561000 | 14750 | 14750 | 0 | $0 |
| Miscellaneous Revenues | 900099 | 29218 | 29218 | 0 | $0 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 43968 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 16851525 | TotalRevenueColumn |
| Related Or Exempt Function Income | 16842896 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 197295 | Total |
| Management And General | 197295 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9364670 | Total |
| Program Services | 9013344 | ProgramServices |
| Management And General | 351326 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1463171 | Total |
| Program Services | 1409956 | ProgramServices |
| Management And General | 53215 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 691517 | Total |
| Program Services | 672996 | ProgramServices |
| Management And General | 18521 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12372 | Total |
| Management And General | 12372 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26910 | Total |
| Management And General | 26910 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 584485 | Total |
| Program Services | 564484 | ProgramServices |
| Management And General | 20001 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 716690 | Total |
| Program Services | 716690 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20490 | Total |
| Program Services | 19801 | ProgramServices |
| Management And General | 689 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 517972 | Total |
| Program Services | 517972 | ProgramServices |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 224472 | Total |
| Management And General | 224472 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 803210 | Total |
| Program Services | 803210 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 632347 | Total |
| Program Services | 492069 | ProgramServices |
| Management And General | 140278 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| Food | 433649 | 433649 | 0 | 0 |
| Patient Care and General Supplies | 1185690 | 1185690 | 0 | 0 |
| Provision for Uncollectible Accounts | 80739 | 80739 | 0 | 0 |
| Provider Taxes | 950314 | 950314 | 0 | 0 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12453 | Total |
| Management And General | 12453 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17918446 | Total |
| Program Services | 16860914 | ProgramServices |
| Management And General | 1057532 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 300 | BOY |
| EOY | 300 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1882964 | BOY |
| EOY | 1772253 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 404445 | BOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34502 | BOY |
| EOY | 42908 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 160645 | BOY |
| EOY | 109498 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 19780337 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 10640121 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9939551 | BOY |
| EOY | 9140216 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 193853 | BOY |
| EOY | 657852 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12616260 | BOY |
| EOY | 11723027 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1662256 | BOY |
| EOY | 1540139 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14829913 | BOY |
| EOY | 14431156 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 447195 | BOY |
| EOY | 1141757 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16939364 | BOY |
| EOY | 17113052 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -4323104 | BOY |
| EOY | -5390025 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -4323104 | BOY |
| EOY | -5390025 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12616260 | BOY |
| EOY | 11723027 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -1066921 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 17413 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 24292 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 24258 | CurrentTaxYearMinus1Year |
| Current Tax Year | 8629 | CurrentTaxYear |
| Total | 74592 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 15665476 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 15862663 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 16970737 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 17547583 | CurrentTaxYearMinus1Year |
| Current Tax Year | 16798928 | CurrentTaxYear |
| Total | 82845387 | Total |
Gross Receipts From Non UBI GrossReceiptsFromNonUBI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 0 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 0 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 0 | CurrentTaxYearMinus1Year |
| Current Tax Year | 0 | CurrentTaxYear |
| Total | 0 | Total |
Tax Rev Levied For Org Benefit509 TaxRevLeviedForOrgBenefit509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 0 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 0 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 0 | CurrentTaxYearMinus1Year |
| Current Tax Year | 0 | CurrentTaxYear |
| Total | 0 | Total |
Value Of Svcs Fclts Furnishd By Govt ValueOfSvcsFcltsFurnishdByGovt
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 0 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 0 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 0 | CurrentTaxYearMinus1Year |
| Current Tax Year | 0 | CurrentTaxYear |
| Total | 0 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 15665476 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 15880076 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 16995029 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 17571841 | CurrentTaxYearMinus1Year |
| Current Tax Year | 16807557 | CurrentTaxYear |
| Total | 82919979 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 0 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 0 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 0 | CurrentTaxYearMinus1Year |
| Current Tax Year | 0 | CurrentTaxYear |
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 0 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 0 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 0 | CurrentTaxYearMinus1Year |
| Current Tax Year | 0 | CurrentTaxYear |
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 0 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 0 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 0 | CurrentTaxYearMinus1Year |
| Current Tax Year | 0 | CurrentTaxYear |
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 82919979 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 0 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 0 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 0 | CurrentTaxYearMinus1Year |
| Current Tax Year | 0 | CurrentTaxYear |
| Total | 0 | Total |
Post1975 UBTI Post1975UBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 0 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 0 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 0 | CurrentTaxYearMinus1Year |
| Current Tax Year | 0 | CurrentTaxYear |
| Total | 0 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 0 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 0 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 0 | CurrentTaxYearMinus1Year |
| Current Tax Year | 0 | CurrentTaxYear |
| Total | 0 | Total |
Net Income From Other UBI NetIncomeFromOtherUBI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 0 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 0 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 0 | CurrentTaxYearMinus1Year |
| Current Tax Year | 0 | CurrentTaxYear |
| Total | 0 | Total |
Other Income509 OtherIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 72127 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 529585 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 551751 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 108544 | CurrentTaxYearMinus1Year |
| Current Tax Year | 43968 | CurrentTaxYear |
| Total | 1305975 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 15737603 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 16409661 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 17546780 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 17680385 | CurrentTaxYearMinus1Year |
| Current Tax Year | 16851525 | CurrentTaxYear |
| Total | 84225954 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.98449 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.98483 | PriorYearSupportPercentage |
| Investment Income Percentage | 0 | InvestmentIncomePercentage |
| Prior Yr Invest Income Percentage | 0.00001 | PriorYrInvestIncomePercentage |
| Thirty Three Percnt Tests PY509 | X | ThirtyThreePercntTestsPY509 |
| General Explanation | Other income of $43,698 is comprised of Revenue from Title 19 Applications of 14750 and Various Misc. Revenues of $29,218 | GeneralExplanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Book Value | 0 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 15733693 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Depreciation | 7872884 | Depreciation |
| Book Value | 7860809 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Depreciation | 0 | Depreciation |
| Book Value | 0 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 2520277 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Depreciation | 2169098 | Depreciation |
| Book Value | 351179 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 1526367 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Depreciation | 598139 | Depreciation |
| Book Value | 928228 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 9140216 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Other Receivable | 472272 |
| Deferred Costs | 130800 |
| Patient Trust Fund | 54780 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 657852 | TotalBookValueOtherAssets |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (5 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Other Liabilities | $472,272 |
| Patient Trust Funds | $54,780 |
| Payments due under Plan of Reorganization | $223,000 |
| Due to Affilated Corporations | $243,340 |
| Estimated Amounts due to Third-Party Payers | $148,365 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1141757 | TotalOfAmounts |
| Total Revenue | 16851525 | TotalRevenue |
| Total Expenses | 17918446 | TotalExpenses |
| Excess Or Deficit For Year | -1066921 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 0 | NetUnrealizedGLOnInvestments |
| Donated Services And Facilities | 0 | DonatedServicesAndFacilities |
| Investment Expenses | 0 | InvestmentExpenses |
| Prior Period Adjustments | 0 | PriorPeriodAdjustments |
| Other | $0 | OtherAmount |
| Total Adjustments | 0 | TotalAdjustments |
| Excess Or Deficit Per FS | -1066921 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 16851525 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 0 | NetUnrealizedGainsInvestments |
| Donated Srvc And Use Of Facilities | 0 | DonatedSrvcAndUseOfFacilities |
| Recoveries Of Prior Year Grants | 0 | RecoveriesOfPriorYearGrants |
| Other Revenues | 0 | OtherRevenues |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 16851525 | RevenueSubtotal |
| Investment Expenses Not Included | 0 | InvestmentExpensesNotIncluded |
| Other Revenues Not Included | 0 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 16851525 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 17918446 | TotExpensesEtcAuditedFinclStmt |
| Donated Services Use Of Facilities | 0 | DonatedServicesUseOfFacilities |
| Prior Year Adjustments | 0 | PriorYearAdjustments |
| Losses Reported | 0 | LossesReported |
| Other Expenses Included | 0 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 17918446 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 0 | InvestmentExpensesNotIncluded2 |
| Other Expenses Not Included | 0 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 17918446 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SchD_P10_S00_L02 | Identifier |
| Return Reference | Schedule D, Part X, Line 2 | ReturnReference |
| Explanation | Management has analyzed the tax positions taken and has concluded that as of September 30, 2012, there are no uncertain tax postions taken or expected to be taken that would require recognition of a liability (or asset) or disclosure in the financial statements. The Company is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. Management believes the Company is no longer subject to income tax examinations prior to 2009. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | 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 (4 entries)
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| David Morgan | |||||||||||||
| 0 | 433996 | 0 | 0 | 0 | 23035 | 0 | 0 | 0 | 0 | 0 | 457031 | 0 | 0 |
| John Grish | |||||||||||||
| 0 | 271336 | 0 | 0 | 0 | 19175 | 0 | 0 | 0 | 0 | 0 | 290511 | 0 | 0 |
| James Fidanza | |||||||||||||
| 165246 | 0 | 0 | 0 | 32049 | 0 | 0 | 0 | 0 | 0 | 197295 | 0 | 0 | 0 |
| Damien R Eilerman | |||||||||||||
| 141739 | 0 | 0 | 0 | 28148 | 0 | 0 | 0 | 0 | 0 | 169887 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| F990_P06_S0A_L06 | Form 990, Part VI, Section A, Line 6 | Article 3 of the Johnson Memorial Medical Center Bylaws stipulates there will be not less than 30 nor more than 60 Members. |
| F990_P06_S0A_L07a | Form 990, Part VI, Section A, Line 7a | Members are elected by the Board as recommended by the Governance and Nominating Committee |
| F990_P06_S0B_L11b | Form 990, Part VI, Section B, Line 11b | Board Policy provides that Members of the Finance Committee are provided opportunity to review and comment to Executive leadership before the 990 is filed. All members of the Board have access to any copy of the Form 990 and the Chief Financial Officer provides a summary of the 990 at the Board meeting following the filing of Form 990. |
| F990_P06_S0B_L12c | Form 990, Part VI, Section B, Line 12c | An annual disclosure statement is required. Executives, Managers, and Board Members are required on an annual basis to disclose interests that may give rise to a conflict of interest. |
| F990_P06_S0B_L15 | Form 990, Part VI, Section B, Line 15 | A Board committee reviews compensation for the executive team and recommends compensation for Board approval. Comparability data is reviewed and may include surveys, documentated comparisons of persons holding similiar positions in similiar organizations, and expert compensation schedules. |
| F990_P06_S0C_L19 | Form 990, Part VI, Section C, Line 19 | The Johnson Memorial Medical Center maintains these documents in Administration and are available for viewing upon request during normal business hours. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|
| Johnson Memorial Medical Center | |||||||||
| 201 Chestnut Hill Road | Stafford Springs | CT | 06076 | 222541974 | Parent Corporation | CT | 501 c 3 | 11 | N/A |
| Johnson Memorial Hospital | |||||||||
| 201 Chestnut Hill Road | Stafford Springs | CT | 06076 | 060646696 | Acute Care Hospital | CT | 501 c 3 | 3 | N/A |
| Johnson Development Fund Inc | |||||||||
| 201 Chestnut Hill Road | Stafford Springs | CT | 06076 | 222541977 | Fund Raising | CT | 501 c 3 | 11 | N/A |
| Johnson Health Care Inc | |||||||||
| 201 Chestnut Hill Road | Stafford Springs | CT | 06076 | 222541981 | Occupational Medicine | CT | 501 c 3 | 9 | N/A |
| Home and Community Health Services | |||||||||
| 101 Phoenix Avenue | Enfield | CT | 06083 | 060646620 | Visiting Nurse Association | CT | 501 c 3 | 9 | N/A |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wellcare Inc | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 201 Chestnut Hill Road | AddressLine1 |
| City | stafford Springs | City |
| State | CT | State |
| ZIP Code | 06076 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 222541983 | EIN |
| Primary Activity | Inactive For Profit Corporation | PrimaryActivity |
| Legal Domicile State | CT | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Type Of Entity | C | TypeOfEntity |
| Percentage Ownership | 0 | PercentageOwnership |
| 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 | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| 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 | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| Johnson Memorial Hospital | ||
| j | 180000 | Reasonable Cost |
| Johnson Memorial Hospital | ||
| o | 224472 | Reasonable Allocation |
Reasonable Cause Explanation ReasonableCauseExplanation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | N/A | Explanation |
Comments