MINNIE HAMILTON HEALTH CARE CENTER: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- MINNIE HAMILTON HEALTH CARE CENTER (EIN 55-0629032)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-14
- IRS object ID
- 201333189349300938
- 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 | 2013-11-14T07:48:03-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550486667 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Arnett Foster Toothman PLLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O Box 2629 | AddressLine1 |
| City | Charleston | City |
| State | WV | State |
| ZIP Code | 25329 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550629032 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Minnie Hamilton Health Care Center Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MINN | NameControl |
| Phone | 3043549244 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 186 Hospital Drive | AddressLine1 |
| City | Grantsville | City |
| State | WV | State |
| ZIP Code | 26147 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Kyle Pierson | Name |
| Title | CFO | Title |
| Phone | 3043549244 | Phone |
| Date Signed | 2013-11-07 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Harry C Harless | Name |
| PTIN | P01042847 | PTIN |
| Phone | 3043460441 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | 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 | Minnie Hamilton Health System | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Stephen S Whited | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 186 Hospital Drive | AddressLine1 |
| City | Grantsville | City |
| State | WV | State |
| ZIP Code | 26147 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 18537469 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.mhhcc.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1983 | YearFormation |
| State Legal Domicile | WV | StateLegalDomicile |
| Activity Or Mission Description | The organization operates a critical access hospital, community health center, federal qualified health center, and long-term care unit. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 291 | TotalNbrEmployees |
| Total Nbr Volunteers | 22 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1723695 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1622700 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 15246541 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 16633968 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 5466 | InvestmentIncomePriorYear |
| Investment Income Current Year | 7255 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 155930 | OtherRevenuePriorYear |
| Other Revenue Current Year | 273546 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 17131632 | TotalRevenuePriorYear |
| Total Revenue Current Year | 18537469 | 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 | 11290134 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 11646451 | 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 | 5792391 | OtherExpensePriorYear |
| Other Expenses Current Year | 6641201 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 17082525 | TotalExpensesPriorYear |
| Total Expenses Current Year | 18287652 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 49107 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 249817 | RevenuesLessExpensesCY |
| Total Assets BOY | 6475988 | TotalAssetsBOY |
| Total Assets EOY | 6328766 | TotalAssetsEOY |
| Total Liabilities BOY | 3173386 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 2776347 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 3302602 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 3552419 | NetAssetsOrFundBalancesEOY |
| Mission Description | Minnie Hamilton Health System is dedicated to maintaining the health and improving the quality of life of all people in our service area through an innovative delivery system of services and education. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 15700842 | Expense |
| Revenue | 16633968 | Revenue |
| Description | Inpatient services provided included 1,075 acute care days, 8,124 long-term care days and 702 swing bed days. Outpatient services included 21,353 outpatient visits and 1,877 emergency room visits. Primary care services included 41,683 clinic and dental visits. | Description |
| Total Program Service Expense | 15700842 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | 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 | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | 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 | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| 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 | 0 | 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 |
| Number Forms Transmitted With1096 | 10 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 291 | 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 |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | 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 | 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
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Stephen S Whited | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3043549244 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 186 Hospital Drive | AddressLine1 |
| City | Grantsville | City |
| State | WV | State |
| ZIP Code | 26147 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (18 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| Jean Simers | |||||||
| President | 4.00 | X | 0 | 0 | 0 | ||
| Randy Ball | |||||||
| Vice President | 2.00 | X | 0 | 0 | 0 | ||
| Reta Kight | |||||||
| Treasurer | 1.00 | X | 0 | 0 | 0 | ||
| Kathy Frederick | |||||||
| Secretary | 1.00 | X | 0 | 0 | 0 | ||
| Neal Benson | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Ronald Blankenship | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Harold Carpenter | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| John Lowther | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Helen Johnson | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Larry Baker | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Randy Lindauer | |||||||
| CEO | 40.00 | 74407 | 0 | 435 | X | ||
| Stephen S Whited | |||||||
| CEO/CFO | 40.00 | 137248 | 0 | 5715 | X | ||
| Kyle Pierson | |||||||
| CFO | 40.00 | 5762 | 0 | 0 | X | ||
| Suresh Balasubramony | |||||||
| Physician | 52.00 | 615207 | 0 | 18480 | X | ||
| Alfonso Cinco | |||||||
| Physician | 52.00 | 418269 | 0 | 9223 | X | ||
| John D'Angelo | |||||||
| Physician | 38.00 | 218877 | 0 | 0 | X | ||
| Chadwick Smith | |||||||
| Physician | 32.00 | 464641 | 0 | 8745 | X | ||
| Matthew Siwicki | |||||||
| Pharmacist | 40.00 | 168683 | 0 | 15562 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2103094 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 58160 | TotalOtherCompensation |
| Number Individuals GT100 K | 13 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (4 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| CPSI | |||||
| 600 Wall Street | Mobile | AL | 36695 | Computer Operating Systems | 339304 |
| Radiological Physician Associates | |||||
| 700 Village Drive | Fairmont | WV | 26554 | Radiological Professional Services | 254553 |
| Labcorp of America | |||||
| 231 Maple Ave | Burlington | NC | 27216 | Reference Lab | 132580 |
| NextGen | |||||
| PO Box 809390 | Chicago | IL | 60680 | Computer software | 130546 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 4 | NumberOfContractorsGT100K |
| Government Grants | 1620689 | GovernmentGrants |
| All Other Contributions | 2011 | AllOtherContributions |
| Total Contributions | 1622700 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Patient services | 622110 | 16378796 | 16378796 |
| Other health care | 622110 | 255172 | 255172 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 16633968 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 7255 | TotalRevenueColumn |
| Exclusion | $7,255 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 6672 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 6672 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6672 | TotalRevenueColumn |
| Exclusion | $6,672 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| Rebates/refunds | 900099 | 115185 | $115,185 |
| Cafeteria | 722210 | 80107 | $80,107 |
| Day care | 624410 | 65147 | $65,147 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6435 | TotalRevenueColumn |
| Exclusion | $6,435 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 266874 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 18537469 | TotalRevenueColumn |
| Related Or Exempt Function Income | 16633968 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $280,801 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 223617 | Total |
| Program Services | 191014 | ProgramServices |
| Management And General | 32603 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9927667 | Total |
| Program Services | 8480213 | ProgramServices |
| Management And General | 1447454 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 156870 | Total |
| Program Services | 133998 | ProgramServices |
| Management And General | 22872 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 632122 | Total |
| Program Services | 539959 | ProgramServices |
| Management And General | 92163 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 706175 | Total |
| Program Services | 603215 | ProgramServices |
| Management And General | 102960 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33127 | Total |
| Management And General | 33127 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 98813 | Total |
| Management And General | 98813 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 647808 | Total |
| Program Services | 553358 | ProgramServices |
| Management And General | 94450 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 56563 | Total |
| Program Services | 48316 | ProgramServices |
| Management And General | 8247 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 837755 | Total |
| Program Services | 715610 | ProgramServices |
| Management And General | 122145 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 278963 | Total |
| Program Services | 238290 | ProgramServices |
| Management And General | 40673 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 247372 | Total |
| Program Services | 211305 | ProgramServices |
| Management And General | 36067 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 102868 | Total |
| Program Services | 87870 | ProgramServices |
| Management And General | 14998 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 111425 | Total |
| Management And General | 111425 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 751088 | Total |
| Program Services | 641579 | ProgramServices |
| Management And General | 109509 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 139978 | Total |
| Management And General | 139978 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Bad debts | 1564132 | 1564132 | |
| Medical supplies | 964770 | 964770 | |
| Healthcare provider tax | 218647 | 218647 | |
| Repairs & maintenance | 139243 | 118941 | 20302 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 448649 | Total |
| Program Services | 389625 | ProgramServices |
| Management And General | 59024 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18287652 | Total |
| Program Services | 15700842 | ProgramServices |
| Management And General | 2586810 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4349 | BOY |
| EOY | 8174 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 581857 | BOY |
| EOY | 755485 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 55860 | BOY |
| EOY | 21663 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2258766 | BOY |
| EOY | 2407588 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 116548 | BOY |
| EOY | 120449 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 40058 | BOY |
| EOY | 84022 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 8979294 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 6049909 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3354978 | BOY |
| EOY | 2929385 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 2000 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 63572 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6475988 | BOY |
| EOY | 6328766 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1165218 | BOY |
| EOY | 1139219 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2106 | BOY |
| EOY | 50341 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1315680 | BOY |
| EOY | 1063383 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 388329 | BOY |
| EOY | 314862 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 302053 | BOY |
| EOY | 208542 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3173386 | BOY |
| EOY | 2776347 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3302602 | BOY |
| EOY | 3552419 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3302602 | BOY |
| EOY | 3552419 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6475988 | BOY |
| EOY | 6328766 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 249817 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 72395 | OtherCostOrOtherBasis |
| Book Value | 72395 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2135216 | OtherCostOrOtherBasis |
| Depreciation | 1262487 | Depreciation |
| Book Value | 872729 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 462218 | OtherCostOrOtherBasis |
| Depreciation | 108146 | Depreciation |
| Book Value | 354072 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6309465 | OtherCostOrOtherBasis |
| Depreciation | 4679276 | Depreciation |
| Book Value | 1630189 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 2929385 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Capital leases | $195,687 |
| Estimated third-party payor settlements | $12,855 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 208542 | TotalOfAmounts |
| Tot Revenue Etc Audited Fincl Stmt | 16973337 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 16973337 | RevenueSubtotal |
| Other Revenues Not Included | 1564132 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 1564132 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 18537469 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 16723520 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 16723520 | ExpensesSubtotal |
| Other Expenses Not Included | 1564132 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 1564132 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 18287652 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Part XI, Line 4b - Other Adjustments: | Bad debts netted against revenue in the financial statements 1,564,132. |
| Part XII, Line 4b - Other Adjustments: | Bad debts 1,564,132. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 794917 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 794917 | DirectOffsettingRevenue |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1469207 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1503209 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -34002 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2264124 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2298126 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -34002 | NetCommunityBenefitExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 15 | NumberOfActivitiesOrPrograms |
| Persons Served | 715 | PersonsServed |
| Total Community Benefit Expense | 83250 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 78250 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 12 | NumberOfActivitiesOrPrograms |
| Persons Served | 100 | PersonsServed |
| Total Community Benefit Expense | 2500 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2500 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 27 | NumberOfActivitiesOrPrograms |
| Persons Served | 815 | PersonsServed |
| Total Community Benefit Expense | 85750 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 78250 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 7500 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 27 | NumberOfActivitiesOrPrograms |
| Persons Served | 815 | PersonsServed |
| Total Community Benefit Expense | 2349874 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2376376 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -26502 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $1,239,887 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 3589531 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 3589531 | CostOfCareReimbursedByMedicare |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Minnie Hamilton Health Care Center | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 186 Hospital Drive | AddressLine1 |
| City | Grantsville | City |
| State | WV | State |
| ZIP Code | 26147 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
| Other | Long Term Care | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Minnie Hamilton Health Care Center Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lawsuit | X | PermitLawsuit |
| Permit Other Actions | X | PermitOtherActions |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Medicare Rate | X | MedicareRate |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 1 | NumberOfOtherFacilities |
Other Facilities OtherFacilities
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Gilmer Primary Care | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 809 Medical Drive Suite 1 | AddressLine1 |
| City | Glenville | City |
| State | WV | State |
| ZIP Code | 26351 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Type | Federally Qualified Health Center | FacilityType |
Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| Part I, Line 3c: 1. The qualifications for the Sliding Fee Program are based on both the number of people in the household and the total gross income received in the household. 2. The applicants are required to complete the Sliding Fee Program application and to provide a proof of income within 30 days after filing their application. Acceptable proof of income includes: wage statement, W-2 forms, check stub, retirement statement, unemployment statement, social security check or benefit letter, alimony check, child support check, food stamp voucher, or other documents approved by financial management.3. If the patient has no income, they are asked to declare so by signing a Lack of Income Verification form. 4. The Financial Assistance Application, along with the above mentioned documents verifying income or lack of it, will be processed promptly by the cashier/clerk.5. After the patient has been approved for the Sliding Fee Program, they will receive a Sliding Fee identification card describing the benefits such as: A. Fee of $5 or $10 for an office visit, collected at the time of the visit B. 40% or 50% discount for lab tests C. 40% to 50% discount for the technical component of diagnostic, non-invasive radiology services D. 40 to 50% discount on respiratory procedures E. 40 to 50% discount on spreech pathology procedures6. Qualification for Sliding Fee remains in effect for one year from the date of approval, unless the patient or the household income should change within that year.7. The Sliding Fee Program benefits may apply to the outstanding patient accounts which do not exceed 365 days from the day of service. Accounts which have already been sent to a collection agency may not qualify for this program. 8. It is the patient's responsibility to reapply annually for continued participation in the Sliding Fee Program. | |
| Part I, Line 7: Cost of community health improvement and commumity benefit services includes cost of supplies and employee costs. Cash and in-kind contributions to community groups includes cost of employee time and donated space. | |
| Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 1564132. | |
| Part III, Line 4: The cost of bad debts was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions.Financial statement footnote that describes bad debt expense: Patient accounts receivable are carried at the original charge less an estimate made for doubtful or uncollectible accounts. In evaluating the collectability of accounts receivable, the System analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. The allowance is based upon a review of the outstanding balances aged by financial class. Management uses collection percentages based upon historical collection experience to determine collectability. Management also reviews troubled, aged accounts to determine collection potential. For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Systemn records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. Recoveries of accounts previously written off are recorded as a reduction to the provision for bad debt expense when received. Interest is not charged on patient accounts receivable. | |
| Part III, Line 8: Medicare allowable costs were estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions. | |
| Part III, Line 9b: All uncollectible accounts will be reviewed by the Collector before being sent to a collection agency or magistrate cours. Any account over $500 will be reviewed by the Collector to determine whether it could be taken to magistate court. The CFO will sign off on any account sent to magistrate court. Once a month a list of all accounts to be written off is prepared for approval by the Finance Committee and Board of Directors. | |
| Part V, Section B, Line 16e: Utilize collection agencies as well as magistrate court. | Minnie Hamilton Health Care Center, Inc. |
| Part VI, Line 2: Records of types of visits and diagnosis are kept and analyzed for adjustment of appropriate services. Official community needs assessments are periodically performed by an outside agency. | |
| Part VI, Line 3: The organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state or local government programs or under the organization's financial assistance policy by making information available as follows:1) Posting on the facility's website2) Attaching information to billing invoices3) Posting information in emergency rooms, waiting rooms and admission offices4) Providing in writing to patients on admission to the facility5) Making information available on request | |
| Part VI, Line 4: The organization services a rural area of 16,000 people in Calhoun, Gilmer and surrounding counties. The county has one of the highest unemployment rates in the State of WV. Patient principal payers percentages are: 40% medicare, 21% medicaid, 19% commercial, and 20% private pay. The nearest Hospital is over 30 miles away. The Health Care Center is designated as an HPSA site. | |
| Part VI, Line 5: All board members reside in the service area and none are employed by, or have contractual arrangements with Minnie Hamilton Health Care Center. The medical staff privileges are available to all qualified providers in the area. All profit and available funding is utilized for continuation and improvement of the provision of appropriate health services through staffing and acquisition of equipment and supplies. A 24-hour emergency room doctor is provided regardless of a patient's ability to pay. The nearest hospital is 40 minutes away, by car. An active auxiliary is made up of local volunteers and has been present during all years of the facilities hospital services. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Suresh Balasubramony | ||||||||||||||
| Physician | 615207 | 0 | 0 | 0 | 0 | 0 | 9350 | 0 | 9159 | 0 | 633716 | 0 | 0 | 0 |
| Alfonso Cinco | ||||||||||||||
| Physician | 416288 | 0 | 0 | 0 | 1981 | 0 | 0 | 0 | 9223 | 0 | 427492 | 0 | 0 | 0 |
| John D'Angelo | ||||||||||||||
| Physician | 218877 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 218877 | 0 | 0 | 0 |
| Chadwick Smith | ||||||||||||||
| Physician | 464641 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 8745 | 0 | 473386 | 0 | 0 | 0 |
| Matthew Siwicki | ||||||||||||||
| Pharmacist | 168683 | 0 | 0 | 0 | 0 | 0 | 6620 | 0 | 8942 | 0 | 184245 | 0 | 0 | 0 |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Calhoun County Building Commission | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 556000308 | IssuerEIN |
| Date Issued | 2006-12-13 | DateIssued |
| Issue Price | 2455000 | IssuePrice |
| Description Of Purpose | Refinance existing debt and new capital expenditures | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Amount Retired | 1391617 | AmountRetired |
| Total Proceeds | 2455000 | TotalProceeds |
| Issuance Costs From Proceeds | 53570 | IssuanceCostsFromProceeds |
| Working Capital Expenditures | 902044 | WorkingCapitalExpenditures |
| Capital Expenditures | 1499386 | CapitalExpenditures |
| Year Of Subst Completion | 2007 | YearOfSubstCompletion |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Bond Iss Meet Prvt Security Pay Test | 0 | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedProp |
| Non Qualified Bond Remed Procdrs | 0 | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiled |
| Rebate Not Due Yet | 0 | RebateNotDueYet |
| Exception To Rebate | 0 | ExceptionToRebate |
| No Rebate Due | 0 | NoRebateDue |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqs |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section B, line 11 | Form 990 is reviewed by Senior Management, the Finance Committee and the Board of Directors. | |
| Form 990, Part VI, Section B, line 12c | The Board of Directors sign the statement annually. Individual members are excused from decision making on issues where conflicts may arise. Board of Directors members recuses themselves from voting on issues where a conflict may exist. | |
| Form 990, Part VI, Section B, line 15 | A survey of like facilities in the state, utilizing the Health Care Authority information that is available, to compare salaries of top executives, as well as looking at job responsibilities and years of experience. The CEO is a contracted position and approved by the Board of Directors. Senior management is approved by the CEO. | |
| Form 990, Part VI, Section C, line 19 | Audited Financial Statements are available upon request to the public. Annually the audited balance sheet and income statement are published in the local newspaper as per the Health Care Authority financial disclosure requirements. | |
| Form 990, Page 1, Line 6 | Volunteers of the organization include members of the hospital auxiliary and teenagers involved in a volunteer program. | Volunteers |