POWELL VALLEY HEALTH CARE INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- POWELL VALLEY HEALTH CARE INC (EIN 83-0300467)
- Tax period
- 2010-07-01 to 2011-06-30
- Filed
- 2012-05-08
- IRS object ID
- 201231299349301693
- 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 D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-05-08T17:25:33-05:00 | 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 | EIDE BAILLY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 NICOLLET MALL STE 1300 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 554027033 | 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 | 830300467 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POWELL VALLEY HEALTH CARE INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | POWE | NameControl |
| Phone | 3077542267 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 777 AVENUE H | AddressLine1 |
| City | POWELL | City |
| State | WY | State |
| ZIP Code | 82435 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BILL PATTEN | Name |
| Title | CEO | Title |
| Phone | 3077542267 | Phone |
| Date Signed | 2012-05-03 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KIM HUNWARDSEN | Name |
| Phone | 6122536500 | Phone |
| Date Prepared | 2012-05-03 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POWELL VALLEY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | BILL PATTEN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 777 AVENUE H | AddressLine1 |
| City | POWELL | City |
| State | WY | State |
| ZIP Code | 82435 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 41462041 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.PVHC.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1992 | YearFormation |
| State Legal Domicile | WY | StateLegalDomicile |
| Activity Or Mission Description | PROVISION OF HEALTHCARE SERVICES | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 611 | TotalNbrEmployees |
| Total Nbr Volunteers | 115 | TotalNbrVolunteers |
| Total Gross UBI | 40524 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -35667 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 326245 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 491244 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 42673206 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 40812619 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 117398 | InvestmentIncomePriorYear |
| Investment Income Current Year | 126138 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 85641 | OtherRevenuePriorYear |
| Other Revenue Current Year | 32040 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 43202490 | TotalRevenuePriorYear |
| Total Revenue Current Year | 41462041 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 102398 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 68095 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 27087646 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 28285953 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 61283 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 15012337 | OtherExpensePriorYear |
| Other Expenses Current Year | 14033280 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 42202381 | TotalExpensesPriorYear |
| Total Expenses Current Year | 42387328 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1000109 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -925287 | RevenuesLessExpensesCY |
| Total Assets BOY | 19218453 | TotalAssetsBOY |
| Total Assets EOY | 17616900 | TotalAssetsEOY |
| Total Liabilities BOY | 7503996 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 6811525 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 11714457 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 10805375 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO PROVIDE EXCELLENT HEALTH CARE, CREATE EXCEPTIONAL CUSTOMER EXPERIENCES, AND PROMOTE COMMUNITY HEALTH. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 34403870 | Expense |
| Grants | 68095 | Grants |
| Revenue | 40772095 | Revenue |
| Description | POWELL VALLEY HEALTH CARE, INC. (HOSPITAL) PROVIDES QUALITY CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION OF THE HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE THESE ESSENTIAL SERVICES. IT IS THE HOSPITAL'S MISSION TO SERVE THE SURROUNDING AREA BY PROVIDING HEALTH CARE SERVICES AND HEALTH CARE EDUCATION TO ALL COMMUNITY MEMBERS.DURING THE YEAR ENDED JUNE 30, 2011, THE HOSPITAL PROVIDED $1,252,951 OF MEDICAL SERVICES, BASED ON THE AMOUNTS OF CHARGES FOREGONE, TO INDIVIDUALS WHO WERE DETERMINED UNABLE TO PURCHASE SUCH SERVICES UNDER THE HOSPITAL'S CHARITY CARE POLICY AND GUIDELINES. IN ADDITION TO FREE CARE AND/OR SUBSIDIZED CARE, CARE IS ALSO PROVIDED AT BELOW COST RATES TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. THE UNREIMBURSED VALUE OF PROVIDING CARE TO ALL PATIENTS WAS $14,545,511 FOR THE YEAR ENDED JUNE 30, 2011.DURING THE FISCAL YEAR ENDED JUNE 30, 2011, THE HOSPITAL PROVIDED OVER 3,000 DAYS OF HOSPITAL SERVICES. THE NURSING HOME PROVIDED APPROXIMATELY 33,300 DAYS OF RESIDENT SERVICES, AND THE ASSISTED LIVING FACILITY PROVIDED OVER 7,900 DAYS OF RESIDENT SERVICES DURING THE YEAR.THE HOSPITAL ALSO PROVIDES COMMUNITY CARE AND SERVICES THROUGH MANY HEALTH ACTIVITIES AND PROGRAMS PROVIDED TO SUPPORT THE COMMUNITY. THESE ACTIVITIES INCLUDE: SUPPORT TO THE HEART MOUNTAIN VOLUNTEER MEDICAL CLINIC, WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, SPECIAL PROGRAMS FOR SPECIFIC PURPOSES, AND A VARIETY OF COMMUNITY SUPPORTED ACTIVITIES. | Description |
| Total Program Service Expense | 34403870 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 1 | 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 | 0 | 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 | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 1 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 32 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 611 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 0 | MinutesOfCommittees |
| Officer Mailing Address | 1 | 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 | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RUSS LUNDVALL ACCOUNTANT | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3077547722 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 777 AVENUE H | AddressLine1 |
| City | POWELL | City |
| State | WY | State |
| ZIP Code | 82435 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (25 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| MARK WURZEL MD | |||||||
| PRESIDENT | 40.00 | X | X | 144006 | 0 | 14737 | |
| DEB KLEINFELDT | |||||||
| VICE PRESIDENT | 1.00 | X | X | 0 | 0 | 0 | |
| LARRY PARKER | |||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| JIM BEUKELMAN | |||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 | |
| KATHLEEN BIEKE | |||||||
| SECRETARY - PARTIAL YEAR | 1.00 | X | X | 0 | 0 | 0 | |
| BRENT FOULGER | |||||||
| DIRECTOR - PARTIAL YEAR | 1.00 | X | 0 | 0 | 0 | ||
| RENEE HUMPHRIES | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| MARK KITCHEN | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| ROBERT CHANDLER MD | |||||||
| DIRECTOR, CHIEF OF STAFF | 40.00 | X | 243404 | 0 | 27456 | ||
| MICHAEL K BOHLMAN MD | |||||||
| DIRECTOR - PARTIAL YEAR | 40.00 | X | 246734 | 0 | 29519 | ||
| LAURA BIRKY | |||||||
| DIRECTOR - PARTIAL YEAR | 1.00 | X | 0 | 0 | 0 | ||
| RJ KOST | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| JIM CARLSON | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| ELIZABETH SPOMER MD | |||||||
| DIRECTOR | 1.00 | X | 192864 | 0 | 18667 | ||
| PAUL CARDWELL | |||||||
| CEO (AS OF 3-11) | 40.00 | X | 0 | 0 | 0 | ||
| CALVIN CAREY | |||||||
| CFO (AS OF 12-10) | 40.00 | X | 3600 | 0 | 0 | ||
| ROBIN ROLING | |||||||
| INTERIM CEO (THRU 3-11) | 40.00 | X | 125212 | 0 | 25621 | ||
| ROD BARTON | |||||||
| CEO (THRU 9-10) | 40.00 | X | 0 | 0 | 0 | ||
| LARRY MAGERS | |||||||
| INTERIM CFO (THRU 12-10) | 40.00 | X | 0 | 0 | 0 | ||
| STEVE RAMSEY | |||||||
| CFO (THRU 10-10) | 40.00 | X | 0 | 0 | 0 | ||
| JEFFREY HANSEN | |||||||
| PHYSICIAN | 40.00 | 809992 | 0 | 43926 | X | ||
| KELLY CHRISTENSEN | |||||||
| PHYSICIAN | 40.00 | 329321 | 0 | 26520 | X | ||
| MICHAEL TRACY | |||||||
| PHYSICIAN | 40.00 | 314326 | 0 | 31617 | X | ||
| ANDREW BAKER | |||||||
| CRNA | 40.00 | 317472 | 0 | 31717 | X | ||
| LAWRENCE DIRKSEN MD | |||||||
| PHYSICIAN | 40.00 | 555658 | 0 | 27656 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3282589 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 277436 | TotalOtherCompensation |
| Number Individuals GT100 K | 32 | 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 |
|---|---|---|---|---|---|
| NORTH PLATTE PHYSICAL THERAPY | |||||
| PO BOX 1790 | DOUGLAS | WY | 82633 | PHYSICAL THERAPY SERVICES | 745135 |
| HEALTHTECH MANAGEMENT SERVICES INC | |||||
| 105 WESTWOOD PLACE SUITE 300 | BRENTWOOD | TN | 37037 | MANAGEMENT COMPANY | 622181 |
| HEALTHLAND | |||||
| DEPT CH 17945 | PLANTINE | IL | 60055 | HOSPITAL INFORMATION SYSTEMS | 382150 |
| WESTERN IMAGING SERVICES | |||||
| 821 N 27TH ST 249 | BILLINGS | MT | 59101 | RADIOLOGY EQUIPMENT SERVICE | 174060 |
| DMS HEALTH TECHNOLOGIES | |||||
| PO BOX 86 | MINNEAPOLIS | MN | 554892208 | SERVICE CONTRACT REPAIR | 136732 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| Government Grants | 22436 | GovernmentGrants |
| All Other Contributions | 468808 | AllOtherContributions |
| Total Contributions | 491244 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| NET PATIENT SERVICE RE | 622110 | 40292891 | 40292891 | |
| OTHER INCOME | 900099 | 256371 | 256371 | |
| CAFETERIA | 722210 | 111623 | 111623 | |
| AUXILIARY INCOME | 900099 | 111210 | 111210 | |
| PHYSICIAN BILLING SERV | 561499 | 40524 | 40524 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 40812619 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 126138 | TotalRevenueColumn |
| Exclusion | $126,138 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 32040 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 32040 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 32040 | TotalRevenueColumn |
| Exclusion | $32,040 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 41462041 | TotalRevenueColumn |
| Related Or Exempt Function Income | 40772095 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 40524 | UnrelatedBusinessRevenue |
| Exclusion | $158,178 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 68095 | Total |
| Program Services | 68095 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1137986 | Total |
| Program Services | 900928 | ProgramServices |
| Management And General | 237058 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19554889 | Total |
| Program Services | 16464332 | ProgramServices |
| Management And General | 3038505 | ManagementAndGeneral |
| Fundraising | 52052 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 267951 | Total |
| Program Services | 219668 | ProgramServices |
| Management And General | 47282 | ManagementAndGeneral |
| Fundraising | 1001 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5868202 | Total |
| Program Services | 4716500 | ProgramServices |
| Management And General | 1151072 | ManagementAndGeneral |
| Fundraising | 630 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1456925 | Total |
| Program Services | 1189241 | ProgramServices |
| Management And General | 263425 | ManagementAndGeneral |
| Fundraising | 4259 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 413164 | Total |
| Management And General | 413164 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34518 | Total |
| Management And General | 34518 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30425 | Total |
| Management And General | 30425 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3270902 | Total |
| Program Services | 2494887 | ProgramServices |
| Management And General | 776015 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 141525 | Total |
| Management And General | 141525 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5702461 | Total |
| Program Services | 5374888 | ProgramServices |
| Management And General | 324813 | ManagementAndGeneral |
| Fundraising | 2760 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1336991 | Total |
| Program Services | 1293887 | ProgramServices |
| Management And General | 43104 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 385252 | Total |
| Program Services | 215603 | ProgramServices |
| Management And General | 169624 | ManagementAndGeneral |
| Fundraising | 25 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 74487 | Total |
| Program Services | 74487 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 920717 | Total |
| Program Services | 564814 | ProgramServices |
| Management And General | 355903 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 453719 | Total |
| Program Services | 8221 | ProgramServices |
| Management And General | 445498 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| EQUIPMENT RENT | 270012 | 243228 | 26784 |
| DUES & SUBSCRIPTIONS | 205788 | 80643 | 125145 |
| AUXILIARY EXPENSES | 119315 | 119315 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 674004 | Total |
| Program Services | 375133 | ProgramServices |
| Management And General | 298315 | ManagementAndGeneral |
| Fundraising | 556 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42387328 | Total |
| Program Services | 34403870 | ProgramServices |
| Management And General | 7922175 | ManagementAndGeneral |
| Fundraising | 61283 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5003112 | BOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 3212132 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7499631 | BOY |
| EOY | 8056282 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 738214 | BOY |
| EOY | 823883 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 193908 | BOY |
| EOY | 217691 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 7990429 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 4238589 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4045487 | BOY |
| EOY | 3751840 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1157893 | BOY |
| EOY | 1174853 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 150000 | BOY |
| EOY | 127686 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 430208 | BOY |
| EOY | 252533 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19218453 | BOY |
| EOY | 17616900 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5266846 | BOY |
| EOY | 5398381 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12387 | BOY |
| EOY | 12387 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1664174 | BOY |
| EOY | 1400757 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 560589 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7503996 | BOY |
| EOY | 6811525 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11714457 | BOY |
| EOY | 8454292 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 2351083 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11714457 | BOY |
| EOY | 10805375 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19218453 | BOY |
| EOY | 17616900 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -925287 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 16205 | ReconcilationOtherChanges |
| 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 D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 1 | AgentTrusteeEtc |
| Beginning Balance | 31426 | BeginningBalance |
| Additions During Year | 111210 | AdditionsDuringYear |
| Distributions During Year | 127415 | DistributionsDuringYear |
| Ending Balance | 15221 | EndingBalance |
| Included On FS | 1 | IncludedOnFS |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2107490 | OtherCostOrOtherBasis |
| Depreciation | 888060 | Depreciation |
| Book Value | 1219430 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 656786 | OtherCostOrOtherBasis |
| Depreciation | 235499 | Depreciation |
| Book Value | 421287 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5226153 | OtherCostOrOtherBasis |
| Depreciation | 3115030 | Depreciation |
| Book Value | 2111123 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 3751840 | TotalOfBookValueLandBuildings |
| Total Revenue | 41462041 | TotalRevenue |
| Total Expenses | 42387328 | TotalExpenses |
| Excess Or Deficit For Year | -925287 | ExcessOrDeficitForYear |
| Other | $16,205 | OtherAmount |
| Total Adjustments | 16205 | TotalAdjustments |
| Excess Or Deficit Per FS | -909082 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 41200153 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -150678 | OtherRevenues |
| Revenue Not Rptd F990 | -150678 | RevenueNotRptdF990 |
| Revenue Subtotal | 41350831 | RevenueSubtotal |
| Other Revenues Not Included | 111210 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 111210 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 41462041 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 42109235 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 42109235 | ExpensesSubtotal |
| Other Expenses Not Included | 278093 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 278093 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 42387328 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART IV, LINE 1B: | THE ORGANIZATION IS ACTING AS AGENT FOR THE PVHC AUXILIARY. | |
| PART IV, LINE 2B: | ORGANIZATION HOLDS FUNDS IN TRUST ON BEHALF OF NURSING HOME RESIDENTS. | |
| PART X: | THE HOSPITAL UNDERGOES AN ANNUAL ANALYSIS OF ITS VARIOUS TAX POSITIONS, ASSESSING THE LIKELIHOOD OF THOSE POSITIONS BEING UPHELD UPON EXAMINATION WITH RELEVANT TAX AUTHORITIES. AS OF JUNE 30,2011 AND 2010, THE UNRECOGNIZED TAX BENEFIT ACCRUAL IS ZERO. THE HOSPITAL WILL RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS IN INCOME TAX EXPENSE, IF INCURRED. THE HOSPITAL IS NO LONGER SUBJECT TO FEDERAL OR STATE TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2008. | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: |
| CHANGES IN CURRENT YEAR AUXILIARY ACTIVITY NOT REPORTED FOR AUDIT PURPOSES 16,205. | PART XI, LINE 8 - OTHER ADJUSTMENTS: | |
| PHYSICIAN BILLING EXPENSE RECORDED IN REVENUE FOR FINANCIAL STATEMENTS -76,191. INTEREST EXPENSE RECORDED IN REVENUE FOR FINANCIAL STATEMENTS -74,487. | PART XII, LINE 2D - OTHER ADJUSTMENTS: | |
| AUXILIARY INCOME NOT RECORDED FOR FINANCIAL STATEMENTS 111,210. | PART XII, LINE 4B - OTHER ADJUSTMENTS: | |
| PHYSICIAN BILLING EXPENSE RECORDED IN REVENUE FOR FINANCIAL STATEMENTS 76,191. AUXILIARY EXPENSES NOT RECORDED FOR FINANCIAL STATEMENTS 127,415. INTEREST EXPENSE RECORDED IN REVENUE FOR FINANCIAL STATEMENTS 74,487. | PART XIII, LINE 4B - OTHER ADJUSTMENTS: |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| 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 | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 863000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 863000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02040 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5860642 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7261112 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -1400470 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6723642 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7261112 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -537470 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02040 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 11 | NumberOfActivitiesOrPrograms |
| Persons Served | 2349 | PersonsServed |
| Total Community Benefit Expense | 28496 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 19145 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 9351 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Total Community Benefit Expense | 172680 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 10000 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 162680 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00380 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10305678 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7481835 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2823843 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06660 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Total Community Benefit Expense | 30471 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 30471 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 17 | NumberOfActivitiesOrPrograms |
| Persons Served | 2349 | PersonsServed |
| Total Community Benefit Expense | 10537325 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7510980 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3026345 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07130 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 17 | NumberOfActivitiesOrPrograms |
| Persons Served | 2349 | PersonsServed |
| Total Community Benefit Expense | 17260967 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 14772092 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2488875 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09170 | PercentOfTotalExpense |
Physical Improvements And Housing PhysicalImprovementsAndHousing
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 192 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 192 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 6400 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 6400 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1460 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1460 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 40 | PersonsServed |
| Total Community Building Expense | 45956 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 45956 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 40 | PersonsServed |
| Total Community Building Expense | 54008 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 54008 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00130 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $1,206,433 | BadDebtExpenseAmount |
| Amount Attributable To | 410187 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 8306412 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 8191118 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 115294 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 0 | 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 | POWELL VALLEY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 777 AVENUE H | AddressLine1 |
| City | POWELL | City |
| State | WY | State |
| ZIP Code | 82435 | 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 | PHYSICIAN PROVIDER BASED CLINIC | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NOT REQUIRED | 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 | 6 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (6 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| POWELL VALLEY CLINIC | ||||
| 777 AVENUE H | POWELL | WY | 82435 | OUTPATIENT PHYSICIAN CLINIC |
| POWELL VALLEY CARE CENTER | ||||
| 777 AVENUE H | POWELL | WY | 82435 | NURSING HOME |
| HEARTLAND ASSISTED LIVING | ||||
| 777 AVENUE H | POWELL | WY | 82435 | ASSISTED LIVING FACILITY |
| POWELL VALLEY HOME HEALTH | ||||
| 777 AVENUE H | POWELL | WY | 82435 | HOME HEALTH AGENCY |
| POWELL VALLEY HOSPICE | ||||
| 777 AVENUE H | POWELL | WY | 82435 | HOSPICE |
| EXPRESS CARE CLINIC | ||||
| 777 AVENUE H | POWELL | WY | 82435 | IMMEDIATE CARE CENTER |
Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)
| ExplanationExplanation |
|---|
| PART I, LINE 3C: IN ADDITION TO PROVIDING FREE OR DISCOUNTED CARE BASED ON FEDERAL POVERTY GUIDELINES, WE REVIEW INCOME TAX RETURNS AND PAY STUBS. THIS INFORMATION HELPS US MORE ACCURATELY DETERMINE A PATIENT'S ABILITY TO PAY.PART I, LINE 6B: THE COMMUNITY BENEFIT REPORT IS POSTED ON THE ORGANIZATION'S WEBSITE. |
| PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST TO CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. UNREIMBURSED MEDICAID ON LINE 7B WAS CALCULATED USING THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2. THE EXPENSES ASSOCIATED WITH COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, AND HEALTH PROFESSIONS EDUCATION, LINE 7F WERE DETERMINED USING AN AVERAGE HOURLY RATE FOR STAFF TIME, SPACE USE, AND AMBULANCES. CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS, LINE 7I, WERE REPORTED BASED ON ACTUAL EXPENSES RECORDED IN THE ORGANIZATION'S GENERAL LEDGER. THE COST FOR SUBSIDIZED HEALTH SERVICES REPORTED ON LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT. |
| PART II: POWELL VALLEY HEALTH CARE COORDINATED AND HOSTED VARIOUS COMMUNITY COALITIONS SUCH AS SUICIDE PREVENTION COALITION, HUMAN SERVICES PROVIDERS COALITION, AND PARK COUNTY HEALTH COALITION. INVOLVEMENT IN THE COALITIONS ARE ALL HEALTH RELATED AND THEREFORE PROMOTE HEALTH IN THE COMMUNITY.POWELL VALLEY HEALTH CARE COORDINATED THE TEMPORARY ASSISTANCE FOR NEEDY FAMILIES PROGRAM WHICH BENEFITS SELECT CNA STUDENTS WHO NEED FINANCIAL ASSISTANCE.THE EMS OF POWELL VALLEY HEALTH CARE PROVIDED COMMUNITY TRAINING DRILLS FOR DISASTER PREPAREDNESS AND PANDEMIC PLANNING.POWELL VALLEY HEALTH CARE PROVIDED AN EMPLOYEE TO ASSIST INDIVIDUALS IN NEED OF HELP WITH THE COST OF THEIR MEDICATION.POWELL VALLEY HEALTH CARE ALSO PROVIDED EMT SUPPORT FOR HIGH SCHOOL FOOTBALLS GAMES, WRESTLING, AND THE PARK COUNTY FAIR. |
| PART III, LINE 4: THE ORGANIZATION'S BAD DEBT EXPENSE WAS CONVERTED TO COST USING THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2.POWELL VALLEY HEALTH CARE HAS WRITE-OFFS TO BAD DEBT EXPENSES AFTER ALL PAYMENTS ARE APPLIED INCLUDING CONTRACTUAL ALLOWANCES AND DISCOUNTS, ELIGIBLE CHARITY CARE DISCOUNTS, AND EVERY EFFORT HAS BEEN MADE WITH THE CLIENT TO COLLECT THE OUTSTANDING BALANCE. A PAYMENT ON AN ACCOUNT PREVIOUSLY WRITTEN OFF REDUCES BAD DEBT EXPENSE IN THE CURRENT YEAR.THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON A PERCENTAGE OF INCOMPLETE CHARITY CARE APPLICATIONS DENIED DUE TO LACK OF INFORMATION.FOOTNOTE TO FINANCIAL STATEMENTS:THE CARRYING AMOUNT OF RECEIVABLES IS REDUCED BY A VALUATION ALLOWANCE THAT REFLECTS MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT REVIEWS PATIENT AND RESIDENT RECEIVABLES BY PAYOR CLASS AND APPLIES PERCENTAGES TO DETERMINE ESTIMATED AMOUNTS THAT WILL NOT BE COLLECTED FROM THIRD PARTIES UNDER CONTRACTUAL AGREEMENTS AND AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS OR RESIDENTS DUE TO BAD DEBTS. MANAGEMENT CONSIDERS HISTORICAL WRITE OFF AND RECOVERY INFORMATION IN DETERMINING THE ESTIMATED BAD DEBT PROVISION. |
| PART III, LINE 8: MEDICARE ALLOWABLE COSTS OF CARE ARE BASED ON THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CMS. |
| PART III, LINE 9B: POWELL VALLEY HEALTH CARE, INC. TRIES TO DETERMINE IF A PATIENT NEEDS FINANCIAL ASSISTANCE BEFORE SERVICES ARE RENDERED, EXCEPT IN EMERGENCY SITUATIONS. NO PATIENT IS DENIED ACUTE CARE IN AN EMERGENCY SITUATION. THE HEALTH CENTER WILL PURSUE ALL POSSIBLE FORMS OF THIRD-PARTY PAYMENTS SUCH AS INSURANCE, STATE MEDICAID PROGRAMS, AND COUNTY INDIGENT CARE PROGRAMS BEFORE GRANTING FINANCIAL ASSISTANCE. COLLECTION EFFORTS ARE NOT PURSUED DURING THIS TIME. COLLECTION EFFORTS ARE NOT PURSUED WHILE A COMPLETED CHARITY CARE APPLICATION IS UNDER REVIEW. DECISIONS ON CHARITY CARE APPLICATIONS ARE MADE WITHIN 30 DAYS OF THE COMPLETED APPLICATION. ONCE A DECISION IS MADE, ANY PERSONAL PORTION DUE WILL FOLLOW THE SAME COLLECTION PROCEDURES AS OTHER ACCOUNTS. IF A DETERMINATION FOR FINANCIAL ASSISTANCE IS MADE ON AN ACCOUNT OR FURTHER INSURANCE PROCESSING IS NEEDED AFTER AN ACCOUNT IS SENT TO COLLECTIONS, ALL COLLECTION EFFORTS WILL CEASE AND ANY NEGATIVE REPORTING WILL BE REVERSED. |
| PART VI, LINE 2: POWELL VALLEY HEALTH CARE IS SERVED BY A PUBLICLY ELECTED DISTRICT BOARD. THE BOARD MEMBERS ACTIVELY PROVIDE INFORMATION RELATIVE TO THE HEALTH CARE NEEDS OF THE COMMUNITY. ADDITIONALLY, WE SURVEY PATIENTS, RESIDENTS, AND THEIR FAMILIES AND IN DOING SO, LOOK FOR TRENDS AND/OR SUGGESTIONS FOR IMPROVEMENTS/ EXPANSION/OR INITIATION OF SERVICES. OUR GUEST RELATIONS PROCESS ALSO ASSISTS US IN IDENTIFYING ANY UNMET COMMUNITY HEALTH NEEDS. ADMINISTRATION, PROVIDERS, AND THE BOARD TRUSTEES ALSO REVIEW COUNTY-WIDE MARKET/UTILIZATION DATA ANNUALLY. |
| PART VI, LINE 3: POWELL VALLEY HEALTH CARE IS COMMITTED TO PROVIDING FINANCIAL ASSISTANCE TO PERSONS WHO HAVE HEALTH CARE NEEDS AND ARE UNABLE TO PAY FOR MEDICALLY NECESSARY CARE. WE STRIVE TO ENSURE THAT PEOPLE WHO ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR A GOVERNMENT PROGRAM, OR OTHERWISE UNABLE TO PAY ARE STILL ABLE TO RECEIVE CARE. NOTIFICATIONS ABOUT CHARITY CARE ARE INCLUDED IN PATIENT BILLS, POSTED IN EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, THE BUSINESS OFFICE, AND WAITING ROOMS. INFORMATION IS ALSO INCLUDED IN PATIENT INFORMATION PACKETS. STAFF ALSO DISCUSSES FINANCIAL ASSISTANCE UPON ADMITTING AND DISCHARGE. |
| PART VI, LINE 4: POWELL VALLEY HEALTH CARE IS A 25 BED CRITICAL ACCESS HOSPITAL, 100 BED INTERMEDIATE CARE NURSING FACILITY, A 24 APARTMENT ASSISTED LIVING FACILITY, AND A DOCTOR'S CLINIC LOCATED IN THE NORTHWEST CORNER OF WYOMING, 75 MILES EAST OF YELLOWSTONE NATIONAL PARK, AND 98 MILES SOUTH OF BILLINGS, MT. POWELL HAS A DIVERSE COMMERCIAL, INDUSTRIAL, EDUCATIONAL, AND AGRICULTURAL/RANCHING BASED ECONOMY. IN 2010, 7.4% OF THE RESIDENTS LIVED IN POVERTY. THE MEDIAN HOUSEHOLD INCOME WAS $41,429 AND THE POPULATION WAS 6,314. THE NEAREST CITY WITH A POPULATION OF 50,000+ IS BILLINGS, MT. THE NEAREST HOSPITALS ARE NORTH BIG HORN HOSPITAL DISTRICT, A CRITICAL ACCESS HOSPITAL LOCATED APPROXIMATELY 22 MILES NORTHEAST AND WEST PARK HOSPITAL, A CRITICAL ACCESS HOSPITAL LOCATED APPROXIMATELY 25 MILES SOUTHWEST.NET REVENUE FROM MEDICARE AND MEDICAID ACCOUNT FOR APPROXIMATELY 29.7% AND 17% RESPECTIVELY. |
| PART VI, LINE 6: AT POWELL VALLEY HEALTH CARE, WE UNDERSTAND THAT HEALTHCARE IS EVOLVING. THE ADVANCE IN MEDICINE AND STRIDES IN TECHNOLOGY ARE PROVIDING LOCAL COMMUNITIES ACCESS TO BETTER HEALTHCARE. OUR BOARD OF TRUSTEES IS COMPRISED PRIMARILY OF LOCAL BUSINESS LEADERS WHO RESIDE IN OUR PRIMARY SERVICE AREA. TO MEET THE NEEDS OF OUR COMMUNITY, THE HOSPITAL EXTENDS PRIVILEGES TO MEDICAL STAFF THAT ARE QUALIFIED THROUGH LICENSURE. OUR EMERGENCY ROOM IS AVAILABLE 7 DAYS A WEEK AND IS AVAILABLE TO ALL REGARDLESS OF A PATIENT'S ABILITY TO PAY. EXCESS FUNDS ARE REINVESTED AND USED FOR PATIENT CARE AND FACILITY UPGRADES. |
| PART VI, LINE 7: |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII (2 entries)
| Type Of GrantTypeOfGrant | Number Of RecipientsNumberOfRecipients | Amount Of Cash GrantAmountOfCashGrant |
|---|---|---|
| SCHOLARSHIPS | 5 | 8100 |
| TUITION REIMBURSEMENT | 36 | 59995 |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: THE ORGANIZATION PROVIDED SCHOLARSHIPS TO INDIVIDUALS AND REQUIRED THE INDIVIDUAL TO PROVIDE INFORMATION TO SUPPORT THE PURPOSE OF THE SCHOLARSHIP. TUITION AND STUDENT LOAN REIMBURSEMENT IS PROVIDED TO EMPLOYEES PURSUING OR ADVANCING THEIR CAREER IN HEALTHCARE. PAYMENT IS MADE DIRECTLY TO INSTITUTION. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (10 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARK WURZEL MD | |||||||||||||
| 144006 | 0 | 0 | 0 | 0 | 0 | 4446 | 0 | 11094 | 0 | 159546 | 0 | 0 | 0 |
| ROBERT CHANDLER MD | |||||||||||||
| 125720 | 0 | 117684 | 0 | 0 | 0 | 7581 | 0 | 20666 | 0 | 271651 | 0 | 0 | 0 |
| MICHAEL K BOHLMAN MD | |||||||||||||
| 152747 | 0 | 93987 | 0 | 0 | 0 | 7770 | 0 | 22943 | 0 | 277447 | 0 | 0 | 0 |
| ELIZABETH SPOMER MD | |||||||||||||
| 122776 | 0 | 70088 | 0 | 0 | 0 | 5853 | 0 | 12814 | 0 | 211531 | 0 | 0 | 0 |
| ROBIN ROLING | |||||||||||||
| 125212 | 0 | 0 | 0 | 0 | 0 | 3158 | 0 | 22462 | 0 | 150832 | 0 | 0 | 0 |
| JEFFREY HANSEN | |||||||||||||
| 238651 | 0 | 571341 | 0 | 0 | 0 | 22000 | 0 | 23120 | 0 | 855112 | 0 | 0 | 0 |
| KELLY CHRISTENSEN | |||||||||||||
| 134628 | 0 | 194693 | 0 | 0 | 0 | 10041 | 0 | 17298 | 0 | 356660 | 0 | 0 | 0 |
| MICHAEL TRACY | |||||||||||||
| 128738 | 0 | 185588 | 0 | 0 | 0 | 9768 | 0 | 23043 | 0 | 347137 | 0 | 0 | 0 |
| ANDREW BAKER | |||||||||||||
| 258737 | 0 | 58735 | 0 | 0 | 0 | 9862 | 0 | 23049 | 0 | 350383 | 0 | 0 | 0 |
| LAWRENCE DIRKSEN MD | |||||||||||||
| 248441 | 0 | 307217 | 0 | 0 | 0 | 16716 | 0 | 12134 | 0 | 584508 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SUPPLEMENTAL INFORMATION | Identifier |
| Return Reference | PART III | ReturnReference |
| Explanation | SCHEDULE J, PART I, LINE 3: THE ORGANIZATION DOES NOT PAY COMPENSATION TO THE CEO DIRECTLY. THE CEO IS COMPENSATED BY AN UNRELATED MANAGEMENT COMPANY. THE BOARD OF DIRECTORS APPROVES THE COMPENSATION PAID BY THE MANAGEMENT COMPANY. | Explanation |
Schedule L IRS990ScheduleL
DQP Table DQPTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | PAUL CARDWELL | NamePerson |
| Description Of Transaction | AFTER THE TAX YEAR, AND BEFORE THE FILING OF THE TAX RETURN, THE ORGANIZATION LEARNED THAT FROM APRIL 7 THROUGH SEPTEMBER 20, 2011, THE CEO ENGAGED IN A FRAUDULENT SCHEME IN WHICH HE DIRECTED TWELVE PAYMENTS TOTALING $847,884 TO A PURPORTED PHYSICIAN RECRUITER WHOM THE CEO KNEW WOULD NEVER PROVIDE SERVICES TO THE ORGANIZATION. IT IS BELIEVED THAT THE CEO RECEIVED A "KICKBACK" FROM THE PURPORTED RECRUITER OF APPROXIMATELY 75% OF THE AMOUNT SENT BY THE ORGANIZATION TO THE RECRUITER, WHILE THE PURPORTED RECRUITER KEPT APPROXIMATELY 25%. ON MARCH 15, 2012, THE GRAND JURY FOR THE FEDERAL DISTRICT OF WYOMING INDICTED THE CEO, PAUL CARDWELL, AND THE PURPORTED RECRUITER, MICHAEL J. PLAKE ON MULTIPLE COUNTS OF MAIL FRAUD, WIRE FRAUD, CONSPIRACY TO COMMIT MAIL AND WIRE FRAUD, AND CONSPIRACY TO COMMIT MONEY LAUNDERING. ATTEMPTS ARE BEING MADE TO GET RESTITUTION BUT HAVE NOT BEEN SUCCESSFUL TO DATE. | DescriptionOfTransaction |
| Transaction Corrected | 0 | TransactionCorrected |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE CEO IS AN EMPLOYEE OF HEALTHTECH MANAGEMENT SERVICES, INC, A HEALTHCARE MANAGEMENT COMPANY. AS THIS POSITION IS HELD OUTSIDE THE ORGANIZATION, THE CONTROL OVER MANAGEMENT DUTIES CUSTOMARILY PERFORMED BY AND UNDER DIRECT SUPERVISION OF OFFICERS, DIRECTORS OR TRUSTEES, OR KEY EMPLOYEES HAS EFFECTIVELY BEEN DELEGATED OUTSIDE OF THE ORGANIZATION. | |
| FORM 990, PART VI, SECTION A, LINE 7A | SEVEN BOARD MEMBERS FROM THE HOSPITAL DISTRICT BOARD OF TRUSTEES SHALL BE APPOINTED BY VIRTUE OF THEIR ELECTION TO THE HOSPITAL DISTRICT BOARD. | |
| FORM 990, PART VI, SECTION A, LINE 7B | A BOARD MEMBER WHO IS FROM THE HOSPITAL DISTRICT BOARD OF TRUSTEES MAY ONLY BE REMOVED BY ACTION OF THE DISTRICT BOARD. | |
| FORM 990, PART VI, SECTION A, LINE 8B | THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES THAT HAVE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BOARD. IF THE ORGANIZATION HAD SUCH A COMMITTEE, THEIR MEETINGS WOULD HAVE BEEN DOCUMENTED IN THE SAME MANNER AS THE GOVERNING BODY. | |
| FORM 990, PART VI, SECTION B, LINE 11 | A COPY OF FORM 990 IS PROVIDED TO THE CEO AND CFO TO REVIEW. THE CEO OR CFO WILL EITHER MAKE CHANGES OR APPROVE THE FORM 990. AFTER FORM 990 IS FINALIZED, BUT PRIOR TO BEING FILED, A COPY WILL BE PROVIDED TO THE BOARD OF DIRECTORS AT A BOARD MEETING. | |
| INDIVIDUALS COVERED BY THE CONFLICT OF INTEREST POLICY INCLUDE MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS AND KEY EMPLOYEES (IF APPLICABLE). THE PROCESS USED TO DETERMINE IF ANY CONFLICTS OF INTEREST EXIST, CONSISTS OF SENDING THE MEMBERS A DOCUMENT FOR THEM TO COMPLETE PRIOR TO THE BOARD OF DIRECTORS MEETING. EACH INDIVIDUAL COMPLETES THE DOCUMENT WHICH ENTAILS DISCLOSING ANY POSSIBLE CONFLICTS AND RETURNS FOR REVIEW TO THE PRESIDENT OF THE BOARD. IF A MEMBER HAS A CONFLICT THEY ARE NOT ALLOWED TO VOTE ON THE CONFLICTED ISSUES. IN ADDITION, EMPLOYEES HAVE ACCESS TO OCTOBER ODYSSEY WHICH IS A PROGRAM FOR EMPLOYEES TO DISCLOSE CONFLICTS. ADMINISTRATION TRACKS THE EMPLOYEE CONFLICTS AND BRINGS TO THE NEXT BOARD MEETING. | FORM 990, PART VI, SECTION B, LINE 12C | |
| FORM 990, PART VI, SECTION B, LINE 15: COMPENSATION FOR THE CEO IS DETERMINED BY HEALTHTECH MANAGEMENT SERVICES, INC. WHICH IS THE MANAGEMENT COMPANY THAT EMPLOYS THE CEO. ONCE HEALTHTECH MANAGEMENT SERVICES, INC. HAS DETERMINED THE COMPENSATION, THEY PRESENT THE COMPENSATION TO THE BOARD OF DIRECTORS FOR THEM TO APPROVE. THIS PROCESS OCCURS YEARLY AND WAS LAST COMPLETED DURING FISCAL YEAR END 2011. THE COMPENSATION OF PHYSICIANS IS NOT WITHIN THE BOARD OF DIRECTORS ADMINISTRATIVE POWERS, THEREFORE A SENIOR MANAGEMENT TEAM DETERMINES COMPENSATION FOR THE PHYSICIANS. THE STEPS TAKEN INCLUDE COMPARING TO OTHER HOSPITALS SIMILAR IN SIZE AND EXPERIENCE, BUDGET CONSTRAINTS, MARKET, HEALTHTECH MANAGEMENT SERVICES, INC. PROFESSIONAL RECRUITING RESOURCES AND SALARY SURVEYS. THE MANAGEMENT TEAM DISCUSSES AND COMES TO AN AGREEMENT FOR COMPENSATION AND REPORTS IT TO THE HUMAN RESOURCE DEPARTMENT. | ||
| THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIALS STATEMENTS AVAILABLE TO THE PUBLIC BY REQUEST. THE PUBLIC MAY REQUEST A COPY BY CALLING, VIA MAIL, OR WALK-IN. | FORM 990, PART VI, SECTION C, LINE 19 | |
| ALL BOARD MEMBERS, OTHER THAN EMPLOYED PHYSICIANS, SERVE ON THE DISTRICT BOARD SERVING THE DISTRICT ONE HOUR PER MONTH. | FORM 990, PART VII, SECTION A | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | CHANGES IN CURRENT YEAR AUXILIARY ACTIVITY NOT REPORTED FOR AUDIT PURPOSES 16,205. TOTAL TO FORM 990, PART XI, LINE 5: 16,205. | FORM 990, PART XI, LINE 5: |
| THE FOLLOWING OFFICERS MAY BE REACHED AT THE ADDRESSES BELOW, RATHER THAN AT THE ORGANIZATION'S MAILING ADDRESS: CALVIN CAREY 431 MORGAN DR REXBURG, ID 83440 ROBIN ROLING 844 RIVERSIDE AVE POWELL, WY 82435 PAUL CARDWELL 1407 INDIAN HILLS MONTICELLO, IN 47960 | FORM 990, PART VI, LINE 9: | |
| AFTER THE TAX YEAR AND BEFORE THE FILING OF THE TAX RETURN, THE ORGANIZATION BECAME AWARE OF EMBEZZLEMENT BY THE CEO, AN EMPLOYEE OF HEALTHTECH MANAGEMENT SERVICES, INC. SEE SCHEDULE L, PART I FOR ADDITIONAL INFORMATION. | FORM 990, PART VI, LINE 5: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Public Charity StatusPublicCharityStatus |
|---|---|---|---|---|---|---|---|---|---|---|
| POWELL HOSPITAL DISTRICT #1 | ||||||||||
| 777 AVENUE H | POWELL | WY | 82435 | 830200759 | RELATED - PROVISION OF HEALTH CARE SERVICES | WY | GOVERNMENT | N/A | 0 | |
| POWELL MEDICAL FOUNDATION | ||||||||||
| PO BOX 801 | POWELL | WY | 82435 | 742275540 | PROMOTE PUBLIC HEALTH AND IMPROVE FACILITIES AROUND THE CITY OF POWELL, WY | WY | 501(C)(3) | N/A | 0 | LINE 8 |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POWELL INTEGRATED HEALTH SERVICES INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 777 AVENUE H | AddressLine1 |
| City | POWELL | City |
| State | WY | State |
| ZIP Code | 82435 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 830319855 | EIN |
| Primary Activity | PUBLIC BENEFIT CORPORATION/HEALTH CARE CONTRACT | PrimaryActivity |
| Legal Domicile State | WY | LegalDomicileState |
| Type Of Entity | C | TypeOfEntity |
| Share Of Total Income | 887186 | ShareOfTotalIncome |
| Share Of EOY Assets | 457269 | ShareOfEOYAssets |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POWELL VALLEY INTEGRATED HEALTH SERVICES INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | Q | TransactionType |
| Amount Involved | 90572 | AmountInvolved |
| Method Of Amt Determination | FINANCIAL STATEMENTS | MethodOfAmtDetermination |
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