MEMORIAL HOSPITAL OF WILLIAM F AND GERTRUDE F JONES INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: MEMORIAL HOSPITAL OF WILLIAM F AND GERTRUDE F JONES INC (EIN 22-2807681)
Tax period: 2012-01-01 to 2012-12-31
Filed: 2013-11-05
IRS object ID: 201333199349307133
Schema version: 2012v2.0
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule D
Schedule H
Schedule J
Schedule O
Reasonable Cause Explanation

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-11-05T14:09:12-07:00	Timestamp
Tax Period End Date	2012-12-31	TaxPeriodEndDate
Return Type	990	ReturnType
Tax Period Begin Date	2012-01-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	222807681	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	MEMORIAL HOSPITAL OF WILLIAM F AND GERTRUDE F JONES INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	MEMO	NameControl
Phone	5855931100	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	191 N Main Street	AddressLine1
City	Wellsville	City
State	NY	State
ZIP Code	14895	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	Tracy Gates	Name
Title	CFO	Title
Phone	5855964002	Phone
Date Signed	2013-11-05	DateSigned

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2016-03-07 17:11:31Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	Rich Shear	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	191 North Main Street	AddressLine1
City	Wellsville	City
State	NY	State
ZIP Code	14895	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	36540652	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	www.jmhny.org	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1921	YearFormation
State Legal Domicile	NY	StateLegalDomicile
Activity Or Mission Description	JONES MEMORIAL HOSPITAL IS COMMITTED TO ENSURING ACCESS TO THE HIGHEST QUALITY HEALTHCARE FOR OUR COMMUNITY IN A CARING MANNER.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	12	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	11	NbrIndependentVotingMembers
Total Nbr Employees	448	TotalNbrEmployees
Total Nbr Volunteers	60	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	1252897	ContributionsGrantsPriorYear
Contributions Grants Current Year	2804442	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	30875356	ProgramServiceRevenuePriorYear
Program Service Revenue CY	31310728	ProgramServiceRevenueCY
Investment Income Prior Year	799473	InvestmentIncomePriorYear
Investment Income Current Year	344442	InvestmentIncomeCurrentYear
Other Revenue Prior Year	1664170	OtherRevenuePriorYear
Other Revenue Current Year	2081040	OtherRevenueCurrentYear
Total Revenue Prior Year	34591896	TotalRevenuePriorYear
Total Revenue Current Year	36540652	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	19798355	SalariesEtcPriorYear
Salaries Etc Current Year	20633841	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	13172460	OtherExpensePriorYear
Other Expenses Current Year	13939210	OtherExpensesCurrentYear
Total Expenses Prior Year	32970815	TotalExpensesPriorYear
Total Expenses Current Year	34573051	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	1621081	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	1967601	RevenuesLessExpensesCY
Total Assets BOY	26317742	TotalAssetsBOY
Total Assets EOY	29677209	TotalAssetsEOY
Total Liabilities BOY	24232015	TotalLiabilitiesBOY
Total Liabilities EOY	24532390	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	2085727	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	5144819	NetAssetsOrFundBalancesEOY
Mission Description	Provision of healthcare services	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	27814656	Expense
Grants	0	Grants
Revenue	0	Revenue
Description	QUALITY OF HEALTH CARE: THE MEMORIAL HOSPITAL OF WILLIAM F. & GERTRUDE F. JONES, INC. A/K/A JONES MEMORIAL HOSPITAL IS A SOLE COMMUNITY PROVIDER WITH 70 ACUTE CARE BEDS, NOT FOR PROFIT, LOCATED IN RURAL WELLSVILLE NY IN A PROFESSIONALLY UNDERSERVED AREA. WE PROVIDE PRIMARY CARE, AMBULATORY CARE, EMERGENCY CARE AND ACUTE (MEDICAL, SURGICAL, PEDIATRIC, OB AND GYN) AND INTENSIVE CARE PLUS COMMUNITY OUTREACH PROGRAMS. WE ADMITTED 1729 PATIENTS PLUS 278 BIRTHS AND HAD 89408 PATIENT ENCOUNTERS ON AN OUTPATIENT BASIS. THE HOSPITAL HAS PROVIDED CHARITY CARE TO INDIGENT PATIENTS TOTALING $994,824.	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	27814656	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	1	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	0	ReportOtherAssets
Report Other Liabilities	0	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	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	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	61	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	448	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
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	12	NbrVotingGoverningBodyMembers
Number Independent Voting Members	11	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
States Where Copy Of Return Is Filed	NY	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	TRACY GATES CFO	NamePerson
Telephone Number	5855964002	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	191 N Main Street	AddressLine1
City	Wellsville	City
State	NY	State
ZIP Code	14895	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Average Hours Per Week RelatedAverageHoursPerWeekRelated	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Institutional TrusteeInstitutionalTrustee	OfficerOfficer	Key EmployeeKeyEmployee	Highest Compensated EmployeeHighestCompensatedEmployee
ROBERT GILFERT
BOARD MEMBER	2	0	X	0	0	0
MICHAEL BERARDI
BOARD MEMBER	2	0	X	0	0	0
KIMBERLY TOOT
BOARD MEMBER	2	0	X	0	0	0
WILLIAM COCH
BOARD MEMBER	2	0	X	0	0	0
GARY BALCOM
BOARD MEMBER	2	0	X	0	0	0
REV MARIAN SCHNEIDER
BOARD MEMBER	2	0	X	0	0	0
MARK HUNTER
BOARD MEMBER	2	0	X	0	0	0
RICHARD SHEAR
CHAIRMAN	2	0		0	0	0	X
SAMANTHA GILKEY
VICE CHAIRPERSON	2	0		0	0	0	X
BARRY KULP
SECRETARY	2	0		0	0	0	X
DANIEL GUINEY
TREASURER	2	0		0	0	0	X
EVA BENEDICT
Exec Director/CEO	40	0		207568	0	7951		X
TRACY GATES
CFO	40	0		147884	0	23025			X
HEATHER LANPHERE
OB/GYN	40	0		305769	0	43397				X
F CLIFTON MILLER
OB/GYN	40	0		292000	0	40425				X
LU-ANNE KAYE
MD	40	0		185000	0	31692				X
MARK ELLIOTT
CRNA	40	0		185000	0	18722				X
BILLY CARSTENS
D.O.	40	0		180000	0	31332				X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	1503221	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	196544	TotalOtherCompensation
Number Individuals GT100 K	16	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
DELPHI HOSPITALIST SERVICE
2701 CULVER ROAD	ROCHESTER	NY	14622	STAFFING	501278
DELPHI HEALTHCARE LLC
2701 CULVER ROAD	ROCHESTER	NY	14622	Staffing	318503
DR STEVEN COLLINS
6801 GLEASON HILL ROAD	BELFAST	NY	14711	MEDICAL PHYSICIAN	217050
JAMES R RUMMEL JR
153 WEST STATE STREET	WELLSVILLE	NY	14895	STAFFING	214000
AMN HEALTHCARE
2735 COLLECTION CTR DRIVE	CHICAGO	IL	60693	STAFFING	158008

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	7	NumberOfContractorsGT100K
Federated Campaigns	0	FederatedCampaigns
Membership Dues	0	MembershipDues
Fundraising Events	0	FundraisingEvents
Related Organizations	0	RelatedOrganizations
Government Grants	2719617	GovernmentGrants
All Other Contributions	84825	AllOtherContributions
Noncash Contributions	0	NoncashContributions
Total Contributions	2804442	TotalContributions

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	31310728	TotalRevenueColumn
Related Or Exempt Function Income	31310728	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Field	Value	IRS element (for citing)
Total Program Service Revenue	31310728	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	341942	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$341,942	ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

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

Royalties Revenue RoyaltiesRevenue

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

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	18968	Real
Personal	0	Personal

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	0	Real
Personal	0	Personal

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	18968	Real
Personal	0	Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	18968	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$18,968	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	0	Securities
Other	2500	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	0	Securities
Other	0	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	0	Securities
Other	2500	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	2500	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$2,500	ExclusionAmount

Field	Value	IRS element (for citing)
Cntrbtns Rprtd Fundraising Events	0	CntrbtnsRprtdFundraisingEvents

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	ExclusionExclusionAmount
PT & OT CONSULTING INCOME	900099	448218	$448,218
BAD DEBT CHARITY CARE POOL	900099	994824	$994,824
CAFETERIA	900099	230309	$230,309

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	388721	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$388,721	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	2062072	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	36540652	TotalRevenueColumn
Related Or Exempt Function Income	31310728	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$2,425,482	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices

Foreign Grants ForeignGrants

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices

Benefits To Members BenefitsToMembers

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	355452	Total
Program Services	0	ProgramServices
Management And General	355452	ManagementAndGeneral
Fundraising	0	Fundraising

Comp Disqual Persons CompDisqualPersons

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	15874971	Total
Program Services	12980834	ProgramServices
Management And General	2894137	ManagementAndGeneral
Fundraising	0	Fundraising

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	745756	Total
Program Services	596444	ProgramServices
Management And General	149312	ManagementAndGeneral
Fundraising	0	Fundraising

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	2542871	Total
Program Services	2175144	ProgramServices
Management And General	367727	ManagementAndGeneral
Fundraising	0	Fundraising

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	1114791	Total
Program Services	891592	ProgramServices
Management And General	223199	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	137079	Total
Program Services	0	ProgramServices
Management And General	137079	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	85627	Total
Program Services	0	ProgramServices
Management And General	85627	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	0	Total
Fundraising	0	Fundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	50000	Total
Program Services	0	ProgramServices
Management And General	50000	ManagementAndGeneral
Fundraising	0	Fundraising

Advertising Advertising

Field	Value	IRS element (for citing)
Total	30153	Total
Program Services	0	ProgramServices
Management And General	30153	ManagementAndGeneral
Fundraising	0	Fundraising

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	5155454	Total
Program Services	4745641	ProgramServices
Management And General	409813	ManagementAndGeneral
Fundraising	0	Fundraising

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Royalties Royalties

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Travel Travel

Field	Value	IRS element (for citing)
Total	36996	Total
Program Services	28605	ProgramServices
Management And General	8391	ManagementAndGeneral
Fundraising	0	Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	45137	Total
Program Services	13050	ProgramServices
Management And General	32087	ManagementAndGeneral
Fundraising	0	Fundraising

Interest Interest

Field	Value	IRS element (for citing)
Total	452561	Total
Program Services	0	ProgramServices
Management And General	452561	ManagementAndGeneral
Fundraising	0	Fundraising

Payments To Affiliates PaymentsToAffiliates

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	1390988	Total
Program Services	1112790	ProgramServices
Management And General	278198	ManagementAndGeneral
Fundraising	0	Fundraising

Insurance Insurance

Field	Value	IRS element (for citing)
Total	367818	Total
Program Services	0	ProgramServices
Management And General	367818	ManagementAndGeneral
Fundraising	0	Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
PURCHASED SERVICES	4336574	3954406	382168
LICENSES AND TAXES	230225	35567	194658
LEASES	620102	585598	34504
RECRUITMENT	88070	0	88070

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	912426	Total
Program Services	694985	ProgramServices
Management And General	217441	ManagementAndGeneral
Fundraising	0	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	34573051	Total
Program Services	27814656	ProgramServices
Management And General	6758395	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	1176678	BOY
EOY	2507055	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	6081898	BOY
EOY	6948617	EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	717986	BOY
EOY	786993	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	221010	BOY
EOY	368891	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	25754731	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	18020041	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	7687866	BOY
EOY	7734690	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	10432304	BOY
EOY	11330963	EOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Intangible Assets IntangibleAssets

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	26317742	BOY
EOY	29677209	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	15761488	BOY
EOY	17114675	EOY

Grants Payable GrantsPayable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	8470527	BOY
EOY	7417715	EOY

Escrow Account Liability EscrowAccountLiability

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Loans From Officers Directors LoansFromOfficersDirectors

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	24232015	BOY
EOY	24532390	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	362015	BOY
EOY	3295106	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	1723712	BOY
EOY	1849713	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	2085727	BOY
EOY	5144819	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	26317742	BOY
EOY	29677209	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	1967601	ReconcilationRevenueExpenses
Reconciliation Unrealized Invest	0	ReconciliationUnrealizedInvest
Reconcilation Donated Services	0	ReconcilationDonatedServices
Reconcilation Invest Expenses	0	ReconcilationInvestExpenses
Reconcilation Prior Adjustment	0	ReconcilationPriorAdjustment
Reconcilation Other Changes	1091491	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	0	FederalGrantAuditRequired

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)
Investment Cost Or Other Basis	145541	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	0	OtherCostOrOtherBasis
Book Value	145541	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	12319192	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	0	OtherCostOrOtherBasis
Depreciation	9117289	Depreciation
Book Value	3201903	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	754868	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	0	OtherCostOrOtherBasis
Depreciation	576497	Depreciation
Book Value	178371	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	12137141	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	0	OtherCostOrOtherBasis
Depreciation	8326255	Depreciation
Book Value	3810886	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	397989	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	0	OtherCostOrOtherBasis
Depreciation	0	Depreciation
Book Value	397989	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	7734690	TotalOfBookValueLandBuildings

Other Securities OtherSecurities (4 entries)

DescriptionDescription	Book ValueBookValue	Method Of ValuationMethodOfValuation
DEPRECIATION RESERVE FUND/KEY BANK	2829707	F
CAPITAL IMPROVEMENTS/MORGAN STANLEY	6502376	F
TEMP RESTRICTED/STEUBEN TRUST	149167	F
HELD IN TRUST/KEY BANK	1849713	F

Field	Value	IRS element (for citing)
Total Of Book Value Securities	11330963	TotalOfBookValueSecurities
Tot Revenue Etc Audited Fincl Stmt	36540652	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	36540652	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	36540652	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	34573051	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	34573051	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	34573051	TotalExpensesPerForm990

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	1	CharityCarePolicy
Written Policy	1	WrittenPolicy
FPG Reference Free Care	1	FPGReferenceFreeCare
Pcent100	X	Pcent100
FPG Reference Discounted Care	1	FPGReferenceDiscountedCare
Pcent250	X	Pcent250
Free Disc Care Medically Indigent	1	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	1	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	1	ExpensesExceededBudget
Unable To Provide Care	0	UnableToProvideCare
Annual Community Benefit Report	1	AnnualCommunityBenefitReport
Report Publically Available	1	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Benefit Expense	650662	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	650662	NetCommunityBenefitExpense
Percent Of Total Expense	0.0193	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Benefit Expense	5272087	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2835249	DirectOffsettingRevenue
Net Community Benefit Expense	2436838	NetCommunityBenefitExpense
Percent Of Total Expense	0.0724	PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Benefit Expense	1185993	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	1185993	NetCommunityBenefitExpense
Percent Of Total Expense	0.0352	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Benefit Expense	7108742	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2835249	DirectOffsettingRevenue
Net Community Benefit Expense	4273493	NetCommunityBenefitExpense
Percent Of Total Expense	0.1269	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	11	NumberOfActivitiesOrPrograms
Persons Served	2648	PersonsServed
Total Community Benefit Expense	18270	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	18270	NetCommunityBenefitExpense
Percent Of Total Expense	0.0005	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Benefit Expense	0	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	0	NetCommunityBenefitExpense
Percent Of Total Expense	0	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Benefit Expense	4910	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	4910	NetCommunityBenefitExpense
Percent Of Total Expense	0.0001	PercentOfTotalExpense

Research Research

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Benefit Expense	0	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	0	NetCommunityBenefitExpense
Percent Of Total Expense	0	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	1	NumberOfActivitiesOrPrograms
Persons Served	28	PersonsServed
Total Community Benefit Expense	61877	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	61877	NetCommunityBenefitExpense
Percent Of Total Expense	0.0018	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	12	NumberOfActivitiesOrPrograms
Persons Served	2676	PersonsServed
Total Community Benefit Expense	85057	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	85057	NetCommunityBenefitExpense
Percent Of Total Expense	0.0024	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	12	NumberOfActivitiesOrPrograms
Persons Served	2676	PersonsServed
Total Community Benefit Expense	7193799	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2835249	DirectOffsettingRevenue
Net Community Benefit Expense	4358550	NetCommunityBenefitExpense
Percent Of Total Expense	0.1293	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	1	BadDebtExpenseReported
Bad Debt Expense	$910,624	BadDebtExpenseAmount
Amount Attributable To	910624	AmountAttributableTo
Amount Reimbursed By Medicare	6038119	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	6851385	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-813266	MedicareSurplusOrShortfall

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	7	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (7 entries)

Facility NumberFacilityNumber	Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Licensed HospitalLicensedHospital	General Medical And SurgicalGeneralMedicalAndSurgical	Er OtherErOther	OtherOther
JONES MEMORIAL HOSPITAL
1	191 NORTH MAIN STREET	WELLSVILLE	NY	14895	X	X
JONES MEMORIAL HEALTH CARE CLINIC
2	127 NORTH MAIN STREET	WELLSVILLE	NY	14895			X	EXTENSION CLINIC
JONES MEMORIAL HEALTH CARE CLINIC
3	15 LODER STREET	WELLSVILLE	NY	14895			X	EXTENSION CLINIC
JONES MEMORIAL HEALTH CARE CLINIC
4	13 LODER STREET	WELLSVILLE	NY	14895			X
JONES MEMORIAL HEALTH CARE CLINIC
5	20 MAIN STREET	ANDOVER	NY	14806			X	EXTENSION CLINIC
JONES MEMORIAL HEALTH CARE CLINIC
6	5877 OLD STATE ROUTE 19	BELMONT	NY	14813			X	EXTENSION CLINIC
JONES MEMORIAL HEALTH CARE CLINIC
7	120 FIRST STREET	BOLIVAR	NY	14715			X	EXTENSION CLINIC

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (7 entries)

Hospital Facility NumberHospitalFacilityNumber	CHNA ConductedCHNAConducted	Community DefinitionCommunityDefinition	Community DemographicsCommunityDemographics	Existing ResourcesExistingResources	How Data ObtainedHowDataObtained	Community Health NeedsCommunityHealthNeeds	Other Health IssuesOtherHealthIssues	Identifying ProcessIdentifyingProcess	Needs Assessment ConductedNeedsAssessmentConducted	Take Into AccountTakeIntoAccount	Other FacilitiesOtherFacilities	CHNA Widely AvailableCHNAWidelyAvailable	Other MethodOtherMethod	Adopt Implement StrategyAdoptImplementStrategy	Execute Implement StrategyExecuteImplementStrategy	Develop Community PlanDevelopCommunityPlan	Participate Community PlanParticipateCommunityPlan	Include Operational PlansIncludeOperationalPlans	Adopt BudgetAdoptBudget	Prioritize Health NeedsPrioritizeHealthNeeds	Prioritize ServicesPrioritizeServices	All Needs AddressedAllNeedsAddressed	Organization Incur Excise TaxOrganizationIncurExciseTax	Eligibility Criteria ExplainedEligibilityCriteriaExplained	Uses FPG FreeUsesFPGFree	Uses FPG DiscountedUsesFPGDiscounted	FPG Discount PercentFPGDiscountPercent	Explains BasisExplainsBasis	Medicaid MedicareMedicaidMedicare	Explains Application MethodExplainsApplicationMethod	Includes Publicity MeasuresIncludesPublicityMeasures	Posted On WebsitePostedOnWebsite	Available On RequestAvailableOnRequest	Actions On NonpaymentActionsOnNonpayment	Permit LawsuitPermitLawsuit	Permit Lien On ResidencePermitLienOnResidence	Collection ActivitiesCollectionActivities	Report To Credit AgencyReportToCreditAgency	LawsuitLawsuit	Lien On ResidenceLienOnResidence	Notify Upon AdmissionNotifyUponAdmission	Notify Before DischargeNotifyBeforeDischarge	Notified All PatientsNotifiedAllPatients	Documented DeterminationDocumentedDetermination	Nondiscrim Emergency Care PolicyNondiscrimEmergencyCarePolicy	Lowest Negotiated RatesLowestNegotiatedRates	Amounts Generally BilledAmountsGenerallyBilled	Gross ChargesGrossCharges
JONES MEMORIAL HOSPITAL
1	1	X	X	X	X	X	X	X	10	1	1	1	X	X	X	X	X	X	X	X	X	1	0	1	0	1	300	1	X	1	1	X	X	1	X	X	1	X	X	X	X	X	X	X	1	X	0	0
JONES MEMORIAL HEALTH CARE CLINIC
2	1	X	X	X	X	X	X	X	10	1	1	1	X	X	X	X	X	X	X	X	X	1	0	1	0	1	300	1	X	1	1	X	X	1	X	X	1	X	X	X	X	X	X	X	1	X	0	0
JONES MEMORIAL HEALTH CARE CLINIC
3	1	X	X	X	X	X	X	X	10	1	1	1	X	X	X	X	X	X	X	X	X	1	0	1	0	1	300	1	X	1	1	X	X	1	X	X	1	X	X	X	X	X	X	X	1	X	0	0
JONES MEMORIAL HEALTH CARE CLINIC
4	1	X	X	X	X	X	X	X	10	1	1	1	X	X	X	X	X	X	X	X	X	1	0	1	0	1	300	1	X	1	1	X	X	1	X	X	1	X	X	X	X	X	X	X	1	X	0	0
JONES MEMORIAL HEALTH CARE CLINIC
5	1	X	X	X	X	X	X	X	10	1	1	1	X	X	X	X	X	X	X	X	X	1	0	1	0	1	300	1	X	1	1	X	X	1	X	X	1	X	X	X	X	X	X	X	1	X	0	0
JONES MEMORIAL HEALTH CARE CLINIC
6	1	X	X	X	X	X	X	X	10	1	1	1	X	X	X	X	X	X	X	X	X	1	0	1	0	1	300	1	X	1	1	X	X	1	X	X	1	X	X	X	X	X	X	X	1	X	0	0
JONES MEMORIAL HEALTH CARE CLINIC
7	1	X	X	X	X	X	X	X	10	1	1	1	X	X	X	X	X	X	X	X	X	1	0	1	0	1	300	1	X	1	1	X	X	1	X	X	1	X	X	X	X	X	X	X	1	X	0	0

Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
SchH_P01_S00_L07	Schedule H, Part I, Line 7	WORKSHEET 2 RATIO OF PATIENT CARE COST TO CHARGES CALCULATION WAS USED FOR LINE 7.
SchH_P01_S00_L07g	Schedule H, Part I, Line 7g	JONES MEMORIAL HOSPITAL OPERATES A DIABETIC CLINIC AS A SERVICE TO THE PUBLIC DUE TO THE HIGH NEED FOR IT IN ALLEGANY COUNTY.
SchH_P03_S0A_L04	Schedule H, Part III, Section A, Line 4	PATIENT ACCOUNTS RECEIVABLE ARE DUE 30 DAYS AFTER THE DATE OF DISCHARGE. RECEIVABLES PAST DUE MORE THAN 120 DAYS ARE CONSIDERED DELINQUENT. DELINQUENT RECEIVABLES ARE GENERALLY WRITTEN OFF BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE PATIENT AND OTHER THIRD PARTY PAYORS.
SchH_P03_S0B_L08	Schedule H, Part III, Section B, Line 8	THE AMOUNT ON LINE 6 IS CALCULATED FROM WORKSHEET E PARTS A AND B ON THE COST REPORT. THE FULL LOSS SHOULD BE CONSIDERED A COMMUNITY BENEFIT.
SchH_P03_S0C_L09b	Schedule H, Part III, Section C, Line 9b	THE HOSPITALS CHARITY CARE FINANCIAL ASSISTANCE POLICY REQUIRES APPLICANTSTO APPLY FOR MEDICAID. THE CRITERIA USED BY THE HOSPITAL FOR THOSE PATIENTS WHO APPLY FOR MEDICAID WILL BE A SLIDING FEE SCHEDULE BASED ON THE FEDERAL POVERY GUIDELINES.
SchH_P05_S0B_L04	Schedule H, Part V, Section B, Line 4	SAME AS FACILITY 1
SchH_P05_S0B_L05	Schedule H, Part V, Section B, Line 5	SAME AS FACILITY 1
SchH_P06_S00_L02	Schedule H, Part VI, Line 2	THE HOSPITAL USES SEVERAL METHODS TO ASSES THE HEALTHCARE NEEDS OF THOSE IN THE SERVICE AREA. PUBLIC SURVEY INCLUDES SOME DEMOGRAPHIC INFORMATION AND A RATINGS SYSTEM FOR 48 ITEMS IDENTIFIED AS HEALTH NEEDS. THE PUBLIC WAS NOTIFIED OF THE SURVEY PROCESS AND ENCOURAGED TO PARTCIPATE THROUGH PAID ADVERTISING IN THE WELLSVILLE DAILY REPORTER AND HORNELL EVENING TRIBUNE, PRESS RELEASES TO LOCAL NEWS AGENCIES, INVITATIONS ON THE HOSPITAL WEBSITE HOME PAGE, DISTRIBUTION OF PAPER SURVEYS THROUGH THE JMH MEDICAL PRACTICES SITES (FIVE IN TOTAL THROUGHOUT ALLEGANY COUNTY) AND THROUGH EMAIL DISTRIBUTION OF THE SURVEY TO AGENCY LIST SERVES IN THE REGION. THE SURVEY WAS ALSO DISTRIBUTED VIA SURVEY MONKEY, AN ONLINE SURVEY SERVICE TO ALLOW RECIPIENTS TO RECEIVE AND RESPOND VIA EMAIL.
SchH_P06_S00_L03	Schedule H, Part VI, Line 3	OUR PATIENT STATEMENTS PROVIDE A NOTICE INFORMING OUR PATIENTS ABOUT OUR FINANCIAL ASSISTANCE PROGRAM. WE HAVE FINANCIAL COUNSELORS THAT CONTACT OUR SELF PAY POPULATION AND INFORM THEM OF OUR PROGRAM. THEY SEND LETTERS FOR THOSE THEY ARE UNABLE TO REACH BY TELEPHONE. WE HAVE SIGNAGE THROUGHOUT OUR CAMPUS INDICATING WE HAVE A FINANCIAL ASSISTANCE PROGRAM WITH THE CONTACT INFORMATION. EACH SELF PAY INPATIENT IS SEEN AND EDUCATED ABOUT OUR PROCESS FOR APPLYING FOR FINANCIAL ASSISTANCE.
SchH_P06_S00_L04	Schedule H, Part VI, Line 4	THE HOSPITAL SERVICE AREA IS PRIMARILY ALLEGANY COUNTY. WHILE 80 PERCENT OF THE INPATIENT AND OUTPATIENT VISITS ORIGINATE FROM WELLSVILLE, BOLIVAR, ANDOVER, BELMONT, SCIO, FRIENDSHIP, BELFAST, ANGELICA AND WHITESVILLE, FOR THE PURPOSES OF COMMUNITY HEALTH NEED AND COLLABORATIVE EFFORTS, JONES MEMORIAL HOSPITAL VIEWS THE GREATER ALLEGANY COUNTY REGION AS THE SERVICE AREA. JONES MEMORIAL HOSPITAL IS THE ONLY ACUTE CARE HOSPITAL IN ALLEGANY COUNTY HPSA DESIGNATION.

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
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 (7 entries)

TitleTitle	Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
EVA BENEDICT
Exec Director/CEO	207568	0	0	0	0	0	0	0	7951	0	215519	0	0	0
TRACY GATES
CFO	147884	0	0	0	0	0	0	0	23025	0	170909	0	0	0
HEATHER LANPHERE
OB/GYN	305769	0	0	0	0	0	0	0	43397	0	349166	0	0	0
F CLIFTON MILLER
OB/GYN	292000	0	0	0	0	0	0	0	40425	0	332425	0	0	0
LU-ANNE KAYE
MD	185000	0	0	0	0	0	0	0	31692	0	216692	0	0	0
BILLY CARSTENS
D.O.	180000	0	0	0	0	0	0	0	31332	0	211332	0	0	0
MARK ELLIOTT
CRNA	185000	0	0	0	0	0	0	0	18722	0	203722	0	0	0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
F990_P06_S0B_L11b	Form 990, Part VI, Section B, Line 11b	THE 990 WAS PRESENTED TO THE BOARD OF DIRECTORS PRIOR TO FILING. THE 990 IS PREPARED BY THE ACCOUNTING DEPARTMENT AND REVIEWED BY THE CHIEF FINANCIAL OFFICER.
F990_P06_S0B_L12c	Form 990, Part VI, Section B, Line 12c	ANNUALLY, THE HOSPITAL REQUIRES ALL BOARD MEMBERS, SENIOR MANAGERS AND DEPARTMENT MANAGERS TO COMPLETE THE CONFLICT OF INTEREST STATEMENT. THE STATEMENTS ARE REVIEWED BY THE HOSPITAL'S COMPLIANCE OFFICER FOR ANY POTENTIAL CONFLICTS.
F990_P06_S0B_L15	Form 990, Part VI, Section B, Line 15	THE CEO'S SALARY IS SET FOR A SPECIFIC CONTRACT PERIOD BY THE BOARD OF DIRECTORS AND INCLUDES AN ESCALATION CLAUSE FOR INCREASES DURING THE CONTRACT PERIOD. THE PROCESS INCLUDES A REVIEW OF COMPARABLE DATA FOR THE MARKET AREA AND THE COMPLETE CONTRACT IS APPROVED BY THR BOARD OF DIRECTORS. A GENERAL INCREASE IS APPROVED BY THE BOARD OF DIRECTORS FOR ALL EMPLOYEES, INCLUDING KEY EMPLOYEES OF THE ORGANIZATION AS PART OF THEIR APPROVAL OF THE ANNUAL OPERATING BUDGET. THE BASIS FOR THE INCREASE IS BASED ON COMPARABLE DATA FOR THE ORGANIZATION'S MARKET AREA.
F990_P06_S0C_L19	Form 990, Part VI, Section C, Line 19	THE ORGANIZATION DOES MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. THE HOSPITAL PUBLISHES AN ANNUAL FINANCIAL AND STATISTICAL REPORT IN THE LOCAL NEWSPAPER EACH SPRING. IT ALSO HAS THESE DOCUMENTS AVAILABLE FOR IN PERSON REVIEW OR WITHIN 30 DAYS OF A WRITTEN REQUEST FROM THE GENERAL PUBLIC. COPIES OF THESE DOCUMENTS ARE STORED IN THE ADMINISTRATIVE OFFICE OF THE HOSPITAL FOR THIS PURPOSE.
F990_P11_S00_L09	Form 990, Part XI, Line 9	CHANGE IN UNREALIZED GAINS/LOSSES ON INVESTMENTS = 326,589, PENSION LIABILITY ADJUSTMENT = -777,686, NET APPRECIATION OF FUNDS IN TRUST = 126,001, NET ASSETS RELEASED FROM RESTRICTION = 562,241, INCREASE IN TEMP RESTRICTED = 854,346. TOTAL = 1,091,491.

Reasonable Cause Explanation ReasonableCauseExplanation

Field	Value	IRS element (for citing)
Explanation	FORM 8868 WAS FILED AND APPROVED OF	Explanation