BUCKTAIL MEDICAL CENTER: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- BUCKTAIL MEDICAL CENTER (EIN 24-0701920)
- Tax period
- 2010-07-01 to 2011-06-30
- Filed
- 2012-05-15
- IRS object ID
- 201211369349300971
- Schema version
- 2010v3.4
- 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 C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-05-15T07:53:39-05:00 | Timestamp |
| Tax Period End Date | 2011-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARBIS WALKER LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5700 CORPORATE DRIVE STE 650 | AddressLine1 |
| City | PITTSBURGH | City |
| State | PA | State |
| ZIP Code | 15237 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 240701920 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BUCKTAIL MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | BUCK | NameControl |
| Phone | 5709231000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1001 PINE STREET | AddressLine1 |
| City | RENOVO | City |
| State | PA | State |
| ZIP Code | 17764 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MICHELE C BRAGUE NHA MHA | Name |
| Title | ADMINISTRATOR | Title |
| Phone | 5709231000 | Phone |
| Date Signed | 2012-05-11 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JEFFREY J PETRELL CPA | Name |
| Phone | 4126356270 | Phone |
| Date Prepared | 2012-05-11 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | ORPHA S KING NHA | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1001 PINE STREET | AddressLine1 |
| City | RENOVO | City |
| State | PA | State |
| ZIP Code | 17764 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 6079721 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1909 | YearFormation |
| State Legal Domicile | PA | StateLegalDomicile |
| Activity Or Mission Description | BUCKTAIL MEDICAL CENTER IS A NON-PROFIT CORPORATION SERVING THE HEALTHCARE NEEDS OF WESTERN CLINTON COUNTY, PA THROUGH A 21-BED HOSPITAL, 43-BED NURSING HOME, AND AN OUTPATIENT COMMUNITY HEALTH CLINIC. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 119 | TotalNbrEmployees |
| Total Nbr Volunteers | 45 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 160988 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 60944 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 5961916 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 5805748 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 106 | InvestmentIncomePriorYear |
| Investment Income Current Year | -19037 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 205251 | OtherRevenuePriorYear |
| Other Revenue Current Year | 212945 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 6328261 | TotalRevenuePriorYear |
| Total Revenue Current Year | 6060600 | 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 | 3106906 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 3182172 | 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 | 3019774 | OtherExpensePriorYear |
| Other Expenses Current Year | 2968270 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 6126680 | TotalExpensesPriorYear |
| Total Expenses Current Year | 6150442 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 201581 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -89842 | RevenuesLessExpensesCY |
| Total Assets BOY | 3318967 | TotalAssetsBOY |
| Total Assets EOY | 2708948 | TotalAssetsEOY |
| Total Liabilities BOY | 2819046 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 2313725 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 499921 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 395223 | NetAssetsOrFundBalancesEOY |
| Mission Description | BUCKTAIL MEDICAL CENTER IS A NON-PROFIT CORPORATION SERVING THE HEALTHCARE NEEDS OF WESTERN CLINTON COUNTY, PA THROUGH A 21-BED HOSPITAL, 43-BED NURSING HOME, AND AN OUTPATIENT COMMUNITY HEALTH CLINIC. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 1749530 | Expense |
| Revenue | 1901312 | Revenue |
| Description | BUCKTAIL MEDICAL CENTER PROVIDED NURSING HOME SERVICES TO OVER 28 DIFFERENT RESIDENTS FOR A TOTAL OF 11,263 RESIDENT DAYS. SERVICES INCLUDED PHYSICAL THERAPY, SPEECH THERAPY, AND OCCUPATIONAL THERAPY AND ACTIVITIES. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 3552075 | Expense |
| Revenue | 3904436 | Revenue |
| Description | BUCKTAIL MEDICAL CENTER PROVIDES HOSPITAL INPATIENT AND OUTPATIENT SERVICES. THE INPATIENT SERVICE ADMISSIONS TOTALED 126 IN FISCAL YEAR 2011 FOR A TOTAL OF 1,071 INPATIENT AND SWING BED DAYS. BUCKTAIL'S OUTPATIENT SERVICES TOTALED 10,342 OUTPATIENT VISITS, WHICH INCLUDE 4,236 LABORATORY VISITS, 3,132 BMC COMMUNITY CLINIC VISITS, 2,109 EMERGENCY ROOM VISITS, 427 RADIOLOGY VISITS, AND 293 AMBULANCE TRIPS. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 5301605 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 1 | 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 | 1 | 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 | 1 | 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 |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 25 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 119 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Excess Business Holdings | 0 | ExcessBusinessHoldings |
| Taxable Distributions | 0 | TaxableDistributions |
| Distribution To Donor | 0 | DistributionToDonor |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | 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 | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | PA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ORGANIZATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5709231000 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1001 PINE STREET | AddressLine1 |
| City | RENOVO | City |
| State | PA | State |
| ZIP Code | 17764 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (16 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Individual Trustee Or DirectorIndividualTrusteeOrDirector |
|---|---|---|---|---|---|---|
| LENNEA BROWN | ||||||
| BOARD PRESIDENT | 1.00 | X | 0 | 0 | 0 | |
| GEORGE CRIGHTON | ||||||
| BOARD VICE-PRESIDENT | 1.00 | X | 0 | 0 | 0 | X |
| ANNA KNAUFF | ||||||
| BOARD SECRETARY/TREASURER | 1.00 | X | 0 | 0 | 0 | X |
| PAUL FANTASKEY | ||||||
| BOARD MEMBER | 1.00 | 0 | 0 | 0 | X | |
| JOHN BRUNO | ||||||
| BOARD MEMBER | 1.00 | 0 | 0 | 0 | X | |
| JOHN KURUTZ | ||||||
| BOARD MEMBER | 1.00 | 0 | 0 | 0 | X | |
| HARRIET NUSS | ||||||
| BOARD MEMBER | 1.00 | 0 | 0 | 0 | X | |
| MARTHA SYKES | ||||||
| BOARD MEMBER | 1.00 | 0 | 0 | 0 | X | |
| ROBERT PICKERING | ||||||
| BOARD MEMBER | 1.00 | 0 | 0 | 0 | X | |
| ALVIN BERLOT DO | ||||||
| MEDICAL DIRECTOR | 72.00 | 267815 | 0 | 0 | X | |
| ELEANOR KEPLER | ||||||
| BOARD MEMBER | 1.00 | 0 | 0 | 0 | X | |
| ROY SCHOONOVER | ||||||
| BOARD MEMBER | 1.00 | 0 | 0 | 0 | X | |
| ORPHA S KING NHA | ||||||
| ADMINISTRATOR | 40.00 | X | 30433 | 0 | 2328 | |
| ANITA RATHGEBER | ||||||
| ADMINISTRATOR | 40.00 | X | 45604 | 0 | 13849 | |
| GEORGE K HALAMA | ||||||
| CONTROLLER | 40.00 | X | 55805 | 0 | 9977 | |
| WENDY D JANERELLA | ||||||
| CONTROLLER | 40.00 | X | 3837 | 0 | 294 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 403494 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 26448 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (3 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| JAMES P HERBERG MD | |||||
| 2475 UPPER BRUSH VALLEY ROAD | CENTRE HALL | PA | 16828 | PHYSICIAN | 268042 |
| ALVIN J BERLOT DO | |||||
| RR 4 BOX 4479 | MOSCOW | PA | 18444 | PHYSICIAN | 267815 |
| JERSEY SHORE HOSPITAL | |||||
| 1020 THOMPSON STREET | JERSEY SHORE | PA | 17740 | LAB, PHYSICAL THERAPY, RADIOLOGY | 104733 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 3 | NumberOfContractorsGT100K |
| Government Grants | 15405 | GovernmentGrants |
| All Other Contributions | 45539 | AllOtherContributions |
| Total Contributions | 60944 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| OUTPATIENT REVENUE | 900099 | 2743459 | 2743459 |
| LONG-TERM CARE | 623000 | 1901312 | 1901312 |
| INPATIENT REVENUE | 900099 | 1160977 | 1160977 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 5805748 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 84 | TotalRevenueColumn |
| Exclusion | $84 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 19121 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -19121 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -19121 | TotalRevenueColumn |
| Exclusion | -$19,121 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| MISCELLANEOUS REVENUE | 900099 | 194207 | $194,207 |
| CAFETERIA INCOME | 900099 | 18738 | $18,738 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 212945 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6060600 | TotalRevenueColumn |
| Related Or Exempt Function Income | 5805748 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $193,908 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 429942 | Total |
| Program Services | 267815 | ProgramServices |
| Management And General | 162127 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2166669 | Total |
| Program Services | 1915946 | ProgramServices |
| Management And General | 250723 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 391816 | Total |
| Program Services | 355524 | ProgramServices |
| Management And General | 36292 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 193745 | Total |
| Program Services | 164683 | ProgramServices |
| Management And General | 29062 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12834 | Total |
| Management And General | 12834 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 298767 | Total |
| Program Services | 189657 | ProgramServices |
| Management And General | 109110 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 676328 | Total |
| Program Services | 650443 | ProgramServices |
| Management And General | 25885 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 86396 | Total |
| Program Services | 86396 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 173855 | Total |
| Program Services | 173855 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 113968 | Total |
| Program Services | 96873 | ProgramServices |
| Management And General | 17095 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 227288 | Total |
| Program Services | 193195 | ProgramServices |
| Management And General | 34093 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 112473 | Total |
| Program Services | 95602 | ProgramServices |
| Management And General | 16871 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| PROFESSIONAL FEES | 691491 | 587767 | 103724 |
| BAD DEBT EXPENSE | 279126 | 279126 | |
| AGENCY EXPENSE | 149196 | 149196 | |
| MISCELLANEOUS EXPENSE | 93943 | 50813 | 43130 |
| MAINTENANCE EXPENSE | 52605 | 44714 | 7891 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6150442 | Total |
| Program Services | 5301605 | ProgramServices |
| Management And General | 848837 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 187188 | BOY |
| EOY | 31152 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 962299 | BOY |
| EOY | 745769 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 73440 | BOY |
| EOY | 88878 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 93254 | BOY |
| EOY | 39096 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 6477146 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 4704165 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1969279 | BOY |
| EOY | 1772981 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5877 | BOY |
| EOY | 6426 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27630 | BOY |
| EOY | 24646 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3318967 | BOY |
| EOY | 2708948 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 790178 | BOY |
| EOY | 602658 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2017404 | BOY |
| EOY | 1643535 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11464 | BOY |
| EOY | 67532 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2819046 | BOY |
| EOY | 2313725 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 415628 | BOY |
| EOY | 326335 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 84293 | BOY |
| EOY | 68888 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 499921 | BOY |
| EOY | 395223 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3318967 | BOY |
| EOY | 2708948 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -89842 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -14856 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $108 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 108 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF OTHER LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1I: | ReturnReference |
| Explanation | DUES TO THE HOSPITAL AND HEALTH SYSTEM ASSOCIATION OF PENNSYLVANIA (HAP) | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Protection Of Natural Habitat | X | ProtectionOfNaturalHabitat |
| Preservation Of Open Space | X | PreservationOfOpenSpace |
| Total Number Of Easements | 3 | TotalNumberOfEasements |
| Total Acreage | 570.71 | TotalAcreage |
| Nmbr Hist Struct Easements | 0 | NmbrHistStructEasements |
| Nmbr Hist Struct Easements After | 0 | NmbrHistStructEasementsAfter |
| Nmbr States In Which Easements Held | 1 | NmbrStatesInWhichEasementsHeld |
| Written Policy Monitoring | 0 | WrittenPolicyMonitoring |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 85487 | OtherCostOrOtherBasis |
| Book Value | 85487 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3120037 | OtherCostOrOtherBasis |
| Depreciation | 2015669 | Depreciation |
| Book Value | 1104368 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2848970 | OtherCostOrOtherBasis |
| Depreciation | 2408702 | Depreciation |
| Book Value | 440268 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 422652 | OtherCostOrOtherBasis |
| Depreciation | 279794 | Depreciation |
| Book Value | 142858 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 1772981 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| OTHER LIABILITIES | $20,106 |
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | $47,426 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 67532 | TotalOfAmounts |
| Total Revenue | 6060600 | TotalRevenue |
| Total Expenses | 6150442 | TotalExpenses |
| Excess Or Deficit For Year | -89842 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 549 | NetUnrealizedGLOnInvestments |
| Other | -$15,405 | OtherAmount |
| Total Adjustments | -14856 | TotalAdjustments |
| Excess Or Deficit Per FS | -104698 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 6056015 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 6056015 | RevenueSubtotal |
| Other Revenues Not Included | 4585 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 4585 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 6060600 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 6150442 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 6150442 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 6150442 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF HOW ORGANIZATION REPORTS CONSERVATION EASEMENTS: | PART II, LINE 9: | IN OCTOBER 2008 BUCKTAIL MEDICAL CENTER RECEIVED APPROVAL OF TWO APPLICATIONS, "APPLICATION OF USE VALUE ASSESSMENT OF LAND FOR REAL ESTATE TAX PURPOSES UNDER ACT 319, 156" AND "TITLE 7 PA CODE, CHAPTER 137B, CLEAN & GREEN." UNDER THESE PROGRAMS, BMC IS NOT ALLOWED TO DEVELOP 570.71 ACRES OF LAND COVERED BY THESE APPLICATIONS. DUE TO THE NATURE OF THE LAND INVOLVED AND THE IMMATERIAL COST BASIS, THE ORGANIZATION DOES NOT REPORT THE EASEMENTS ON THE FINANCIAL STATEMENTS. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE CENTER FOLLOWS THE GUIDANCE FOR ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS THAT PRESCRIBES A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. THE GUIDANCE ALSO ADDRESSES DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, AND DISCLOSURE. THE CENTER'S POLICY IS TO RECOGNIZE INTEREST RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST EXPENSE AND PENALTIES IN OPERATING EXPENSES. THERE WERE NO INTEREST OR PENALTIES RECOGNIZED ON THE STATEMENTS OF OPERATIONS AS A RESULT OF THIS GUIDANCE. GENERALLY, TAX RETURNS FOR YEARS ENDED JUNE 30, 2008, AND THEREAFTER REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | TEMPORARILY RESTRICTED - NET ASSETS RELEASED FROM RESTRICTIONS -15,405. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | NET ASSETS RELEASED FROM RESTRICTIONS 4,585. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| 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 | 17096 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 17096 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00290 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2163789 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1983000 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 180789 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03080 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2180885 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1983000 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 197885 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03370 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1501 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1501 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 909 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 909 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7038 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 7038 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00120 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9448 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 9448 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00170 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2190333 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1983000 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 207333 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03540 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 121 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 121 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 171 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 171 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 292 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 292 | NetCommunityBuildingExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $182,425 | BadDebtExpenseAmount |
| Amount Attributable To | 63828 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 1623122 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 815549 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 807573 | 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 | 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 | BUCKTAIL MEDICAL CENTER | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1001 PINE STREET | AddressLine1 |
| City | RENOVO | City |
| State | PA | State |
| ZIP Code | 17764 | 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 | OUTPATIENT CLINIC | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BUCKTAIL MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
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 | BUCKTAIL MEDICAL CENTER | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1001 PINE STREET | AddressLine1 |
| City | RENOVO | City |
| State | PA | State |
| ZIP Code | 17764 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Type | SKILLED NURSING FACILITY | FacilityType |
Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)
| ExplanationExplanation |
|---|
| PART I, LINE 7: A COST-TO-CHARGE RATIO CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COSTS-TO-CHARGES IS THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON PART I, LINE 7. |
| PART I, LINE 7G: THE HOSPITAL'S CLINIC, LONG-TERM CARE AND EMERGENCY DEPARTMENT OPERATED AT A LOSS. IF DEPARTMENTS WERE CLOSED, PATIENTS WOULD HAVE TO TRAVEL 28 MILES THROUGH MOUNTAINOUS TERRAIN TO THE NEAREST HOSPITAL FOR THESE SERVICES. THIS WOULD CREATE A HARDSHIP FOR MANY TO HAVE TO TRAVEL THAT DISTANCE. |
| PART I, L7 COL(F): THE BAD DEBT EXPENSE OF 279,126 INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN A WAS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE OF TOTAL EXPENSES. |
| PART III, LINE 4: BUCKTAIL MEDICAL CENTER'S FINANCIAL STATEMENTS DO NOT INCLUDE A BAD DEBT FOOTNOTE. THE BAD DEBT EXPENSE CONSISTS OF BALANCES THAT ARE SENT TO COLLECTIONS AS WELL AS AN ADDITIONAL AMOUNT ASSESSED BY MANAGEMENT. EVERY MONTH MANAGEMENT REVIEWS THE ACCOUNTS RECEIVABLE BALANCE AND WRITES OFF ADDITIONAL AMOUNTS BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL COLLECTIONS AND ECONOMIC CONDITIONS.A COST-TO-CHARGE RATIO CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COSTS-TO-CHARGES IS THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON LINES 2 AND 3 OF PART III. |
| PART III, LINE 8: A COST-TO-CHARGE RATIO CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COSTS-TO-CHARGES IS THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON PART III, LINE 6. |
| PART III, LINE 9B: IT IS THE POLICY OF BUCKTAIL MEDICAL CENTER TO ALLOW DISCOUNTS AND ALLOWANCES FROM STATED CHARGES WHEN HOSPITAL SERVICES ARE PROVIDED TO SELF-PAY INDIVIDUALS WHOSE SUBSTANTIATED INCOME FALLS BELOW CERTAIN PREDETERMINED LEVELS. |
| PART VI, LINE 2: BUCKTAIL MEDICAL CENTER IS CURRENTLY WORKING WITH THE SUSQUEHANNA VALLEY RURAL HEALTH PARTNERSHIP TO DEVELOP AND IMPLEMENT A COMMUNITY HEALTH NEEDS ASSESSMENT. BUCKTAIL MEDICAL CENTER IS ALSO WORKING WITH OUR LOCAL UNITED WAY, WEST BRANCH VALLEY DRUG AND ALCOHOL AND THE CLINTON COUNTY COLLABORATIVE BOARD. WE ESTIMATE THE ASSESSMENT WILL BE READY FOR USE IN LATE 2012 OR EARLY 2013. |
| PART VI, LINE 3: HILL-BURTON NOTICES WERE DISPLAYED AT EACH AREA OF SERVICE, INCLUDING: MAIN REGISTRATION; EMERGENCY ROOM; OUTPATIENT AREAS (LABORATORY/X-RAY) AND BUSINESS/BILLING OFFICE. HILL-BURTON "PACKETS" ARE MADE AVAILABLE TO EVERY PATIENT AT EACH OF THESE LOCATIONS AS WELL. FOR INPATIENT, SWING BED AND SKILLED NURSING SERVICES, THE HILL-BURTON "PACKET" WITH NOTICE WAS INCLUDED WITH EACH INPATIENT RELATED ADMISSION PACKET. THESE MATERIALS ARE REVIEWED BY THE PERSON PROVIDING THE ADMISSION PAPERWORK (E.G. SOCIAL SERVICES; NURSING).DURING THE BILLING PROCESS, IF ANY PATIENT APPEARS TO BE HAVING DIFFICULTY PAYING A BILL, BUCKTAIL MEDICAL CENTER BILLING STAFF WILL INCLUDE A HILL-BURTON PACKET WITH THE BILLING STATEMENT. BUCKTAIL MEDICAL CENTER ALSO PROVIDES A HILL-BURTON PACKET TO ANYONE REQUESTING ASSISTANCE AT ANY TIME BEFORE, DURING OR AFTER SERVICES ARE PROVIDED, INCLUDING ACCOUNTS IN COLLECTION.THE HILL-BURTON PACKET PROVIDED BY BUCKTAIL MEDICAL CENTER INCLUDES:-COVER LETTER DESCRIBING STEPS NEEDED IN ORDER TO APPLY-INDIVIDUAL NOTICE-APPLICATION-ITEMS REQUIRED FOR ELIGIBILITYHILL-BURTON INDIVIDUAL NOTICES ARE PUBLISHED THREE (3) TIMES IN A LOCAL NEWSPAPER OF GENERAL CIRCULATION TO ALL OF CLINTON COUNTY, PA AND CERTAIN AREAS OF POTTER COUNTY, PA. |
| PART VI, LINE 4: THE MEDICAL CENTER IS NESTLED IN A SCENIC VALLEY ALONG THE WEST BRANCH OF THE SUSQUEHANNA RIVER IN THE TOWN OF RENOVO. THE TOWN AND OUTLYING COMMUNITIES HAVE A POPULATION OF APPROXIMATELY 3,600 AND ARE SURROUNDED BY THE LARGEST STATE FOREST LAND IN PENNSYLVANIA; LENDING ITS BEAUTY TO RESIDENTS AND VISITORS THROUGHOUT THE YEAR. THE 2009 ESTIMATED MEDIAN HOUSEHOLD INCOME WAS $20,277 WHICH IS WELL BELOW THE PENNSYLVANIA ESTIMATED HOUSEHOLD INCOME OF $49,520. APPROXIMATELY 35% OF RESIDENTS LIVE IN POVERTY. |
| PART VI, LINE 6: THE MEDICAL CENTER IS A 64 BED FACILITY COMPRISED OF TWENTY-ONE (21) CRITICAL ACCESS HOSPITAL/SWING BEDS AND FORTY-THREE (43) SKILLED NURSING BEDS. THE CENTER PROVIDES A FULL-SERVICE EMERGENCY DEPARTMENT AND A COMMUNITY CLINIC, STAFFED WITH A BOARD CERTIFIED FAMILY PRACTICE PHYSICIAN AND CERTIFIED PHYSICIAN'S ASSISTANT. IN ADDITION, BUCKTAIL MEDICAL CENTER PROVIDES LABORATORY, RADIOLOGY, AMBULANCE, OCCUPATIONAL THERAPY, PHYSICAL THERAPY AND SPEECH THERAPY SERVICES. THE BOARD OF TRUSTEES IS MADE UP OF INDIVIDUALS WHO LIVE AND WORK IN THE COMMUNITY WHO VOLUNTEER THEIR TIME AND SERVICES TO ASSIST IN THE GOVERNANCE OF THE ORGANIZATION. THE ORGANIZATION USES SURPLUS FUNDS TO PROVIDE THE LATEST IN TECHNOLOGY TO IMPROVE PATIENT CARE. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | X | WrittenEmploymentContract |
| 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | ALVIN BERLOT DO | NamePerson |
| Base Compensation Filing Org | 267815 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 0 | CompBasedOnRelatedOrgs |
| Bonus Filing Org | 0 | BonusFilingOrg |
| Bonus Related Orgs | 0 | BonusRelatedOrgs |
| Other Compensation Filing Org | 0 | OtherCompensationFilingOrg |
| Other Compensation Related Orgs | 0 | OtherCompensationRelatedOrgs |
| Deferred Comp Filing Org | 0 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 0 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 0 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 0 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 267815 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 0 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 0 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 0 | CompReportPrior990RelatedOrgs |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)
| Sharing Of RevenuesSharingOfRevenues | RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction |
|---|---|---|---|
| (no name) | |||
| 0 | |||
| DAVID KNAUFF | |||
| 0 | FAMILY MEMBER OF ANNA KNAUFF, BOARD MEMBER | 26465 | EMPLOYEE OF BUCKTAIL MEDICAL CENTER |
| JOANN KNAUFF | |||
| 0 | FAMILY MEMBER OF ANNA KNAUFF, BOARD MEMBER | 20078 | EMPLOYEE OF BUCKTAIL MEDICAL CENTER |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | BUCKTAIL MEDICAL CENTER HAS TWO TYPES OF CORPORATE MEMBERS. THE FIRST TYPE OF CORPORATE MEMBER ARE THOSE INDIVIDUALS WHO LIVE WITHIN THE BMC SERVICE AREA AND PAY AN ANNUAL MEMBERSHIP FEE OF $15, WHICH IS SET BY THE BOARD OF DIRECTORS. THE SECOND TYPE OF CORPORATE MEMBER ARE THOSE INDIVIDUALS WHO WANT A LIFELONG MEMBERSHIP AND PAY A ONE TIME FEE OF $500. THESE INDIVIDUALS DO NOT NEED TO LIVE IN THE BMC SERVICE AREA. EACH CORPORATE MEMBER HAS THE RESPONSIBILITY TO VOTE FOR BOARD MEMBERS AT THE ANNUAL MEETING HELD IN APRIL OF EACH YEAR. | |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMBERS OF THE ORGANIZATION HAVE THE RESPONSIBLITY TO VOTE FOR ANY OPEN SEATS ON THE BOARD. THIS ANNUAL MEETING IS HELD EACH YEAR IN APRIL. | |
| FORM 990, PART VI, SECTION B, LINE 11 | BUCKTAIL MEDICAL CENTER HAS A CPA FIRM PREPARE ITS 990. THE RETURN IS COMPLETED IN DRAFT FORM AND REVIEWED BY MANAGEMENT OF THE ORGANIZATION. | |
| BUCKTAIL MEDICAL CENTER ANNUALLY REQUIRES ITS BOARD MEMBERS AND OFFICERS TO FILL OUT A CONFLICTS OF INTEREST FORM. DURING BOARD MEETINGS, IF AN INTERESTED PARTY HAS A CONFLICT OF INTEREST, HE OR SHE RECUSES THEMSELVES FROM VOTING. | FORM 990, PART VI, SECTION B, LINE 12C | |
| BUCKTAIL MEDICAL CENTER'S BOARD OF DIRECTORS DETERMINES THE COMPENSATION OF THE TOP MANAGEMENT OFFICIAL, OFFICERS, AND KEY EMPLOYEES OF THE ORGANIZATION. | FORM 990, PART VI, SECTION B, LINE 15 | |
| BUCKTAIL MEDICAL CENTER MAKES ITS FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST. | FORM 990, PART VI, SECTION C, LINE 18 | |
| AT THIS TIME, BUCKTAIL MEDICAL CENTER DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC. | FORM 990, PART VI, SECTION C, LINE 19 | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED GAINS ON INVESTMENTS: 549. TEMPORARILY RESTRICTED - NET ASSETS RELEASED FROM RESTRICTIONS -15,405. TOTAL TO FORM 990, PART XI, LINE 5: -14,856. | FORM 990, PART XI, LINE 5: |
| THE BOARD OF DIRECTORS OF BUCKTAIL MEDICAL CENTER ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THE PROCESS IS CONSISTENT WITH PRIOR YEARS AND HAS NOT CHANGED. | FORM 990, PART XII, LINE 2C | |
| LENNEA BROWN, BOARD PRESIDENT DOES NOT VOTE ON GENERAL ISSUES EXCEPT IN CASE OF A TIE. | FORM 990, PART VI, SECTION A, LINE 1A |
Comments