FURP.ORG / PUBLIC DATA EXPLORER

UPMC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
UPMC (EIN 24-0802108)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-04-06
IRS object ID
201240979349300404
Schema version
2010v3.7
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-04-06T08:33:33-04:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1910 E ST LOUIS 200/PO BOX 1190AddressLine1
CitySPRINGFIELDCity
StateMOState
ZIP Code658062523ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN240802108EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CHARLES COLE MEMORIAL HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCHARNameControl
Phone8142749300Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11001 EAST SECOND STREETAddressLine1
CityCOUDERSPORTCity
StatePAState
ZIP Code16915ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameEDWARD C PITCHFORDName
TitleCEOTitle
Date Signed2012-01-30DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBrian D ToddName
Phone4178658701Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonEDWARD PITCHFORDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11001 EAST SECOND STREETAddressLine1
CityCOUDERSPORTCity
StatePAState
ZIP Code16915ZIPCode
FieldValueIRS element (for citing)
Gross Receipts75794561GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitehttp://www.charlescolehospital.com/WebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1967YearFormation
State Legal DomicilePAStateLegalDomicile
Activity Or Mission DescriptionCCMH PROVIDES EXCELLENT HEALTH CARE SERVICES BY PROVIDING INPATIENT, OUTPATIENT AND PRIMARY CARE SERVICES TO THE SURROUNDING COMMUNITY. SEE SCHEDULE O FOR MORE INFORMATION.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees691TotalNbrEmployees
Total Nbr Volunteers82TotalNbrVolunteers
Total Gross UBI70457TotalGrossUBI
Net Unrelated Business Txbl Income69098NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year692259ContributionsGrantsPriorYear
Contributions Grants Current Year350224ContributionsGrantsCurrentYear
Program Service Revenue Prior Year63883574ProgramServiceRevenuePriorYear
Program Service Revenue CY69567713ProgramServiceRevenueCY
Investment Income Prior Year882589InvestmentIncomePriorYear
Investment Income Current Year1031244InvestmentIncomeCurrentYear
Other Revenue Prior Year63394OtherRevenuePriorYear
Other Revenue Current Year361647OtherRevenueCurrentYear
Total Revenue Prior Year65521816TotalRevenuePriorYear
Total Revenue Current Year71310828TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year29387358SalariesEtcPriorYear
Salaries Etc Current Year30837009SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year19904TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY84000TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year115937TotalFundrsngExpCurrentYear
Other Expense Prior Year36903321OtherExpensePriorYear
Other Expenses Current Year38318324OtherExpensesCurrentYear
Total Expenses Prior Year66310583TotalExpensesPriorYear
Total Expenses Current Year69239333TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-788767RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2071495RevenuesLessExpensesCY
Total Assets BOY52729110TotalAssetsBOY
Total Assets EOY55302779TotalAssetsEOY
Total Liabilities BOY37784281TotalLiabilitiesBOY
Total Liabilities EOY35146860TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY14944829NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY20155919NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE PURPOSE OF CHARLES COLE MEMORIAL HOSPITAL IS TO PROVIDE EXCELLENT HEALTHCARE SERVICES, RESPONDING TO THE NEEDS OF THE COMMUNITIES WE SERVE.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense16852645Expense
Revenue37283295Revenue
DescriptionCCMH OFFERS OUTPATIENT SERVICES, EXCEEDING 351,200 VISITS ANNUALLY THROUGHOUT THE HOSPITAL'S FOUR-COUNTY AREA AND INCLUDING IMAGING, LAB, AND REHABILITATION SERVICES. OUTPATIENT SURGERIES EXCEED 4,400 ANNUALLY. THE PATTERSON CANCER CARE CENTER OFFERS FULL SERVICE RADIATION AND MEDICAL ONCOLOGY SERVICES AND HOUSES AN AMERICAN CANCER SOCIETY PATIENT RESOURCE CENTER ONSITE. THE CANCER CENTER IS HOME TO A VARIETY OF SUPPORT GROUPS, AS WELL AS FREQUENT FREE CANCER SCREENINGS FOR THE PUBLIC. CCMH'S HOME HEALTH AND HOSPICE SERVICES ASSIST PATIENTS THROUGHOUT THE REGION, WITH A GROWING NUMBER OF REFERRALS AND LOWER INFECTION RATES AMONG STATE AND NATIONAL AVERAGES.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense14710615Expense
Revenue11299546Revenue
DescriptionCHARLES COLE MEMORIAL HOSPITAL PROVIDES PRIMARY CARE TO ITS SURROUNDING COMMUNITIES. THE HOSPITAL PROVIDES PRIMARY CARE TO THE SURROUNDING COMMUNITIES IN FOUR COUNTIES AT RURAL HEALTH CENTERS (RHCS), LOCATED IN COUDERSPORT, GALETON, ULYSSES, WESTFIELD, SHINGLEHOUSE, PORT ALLEGANY, ELDRED, SMETHPORT, AND EMPORIUM. FOUR OF THOSE LOCATIONS ALSO INCLUDE WELLNESS AND REHABILITATION CENTERS, MAKING IT MORE CONVENIENT FOR PATIENTS TO RECEIVE THE CARE THEY NEED CLOSE TO HOME. ONE OUTLYING CENTER OFFERS IMAGING SERVICES, WHILE ALL RHCS PROVIDE LAB DRAWS SO PATIENTS DON'T HAVE TO DRIVE TO RECEIVE NECESSARY TESTING. SEE SCHEDULE O FOR FURTHER DETAIL.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense11319571Expense
Revenue18016788Revenue
DescriptionCHARLES COLE MEMORIAL HOSPITAL OFFERS VARIOUS INPATIENT SERVICES. CCMH ADMITTED 1,980 PATIENTS LAST YEAR (5,400 ACUTE CARE DAYS) TO INPATIENT SERVICES INCLUDING MEDICAL/SURGICAL, INTENSIVE CARE AND OBSTETRICS UNITS. CCMH'S 24-HOUR EMERGENCY DEPARTMENT ADMITTED 840 PATIENTS LAST YEAR AND SAW 9,400 VISITS LAST YEAR. THE HOSPITAL'S MATERNITY UNIT WELCOMED 250 BABIES INTO THE WORLD LAST YEAR AND ALSO SUPPORTS MOTHERS-TO-BE WITH REGULAR LAMAZE AND BREASTFEEDING SUPPORT PROGRAMS AND THE HEALTHY BEGINNINGS PLUS PROGRAM FOR LOW INCOME MOTHERS. SEE SCHEDULE O FOR FURTHER DETAIL.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp17456033TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev2968084TotalOfOtherProgramServiceRev
Total Program Service Expense60338864TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingtrueCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingtrueProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MembertrueBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109654NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees691NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionstrueQuidProQuoContributions
Quid Pro Quo DisclosuretrueQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocstrueChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturetrueInvestmentInJointVenture
Written Policy Or ProceduretrueWrittenPolicyOrProcedure
States Where Copy Of Return Is FiledPAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonRON RAPP CONTROLLERNamePerson
Telephone Number8142745250TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11001 EAST SECOND STREETAddressLine1
CityCOUDERSPORTCity
StatePAState
ZIP Code16915ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (22 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
MICHAEL E CALLAHAN
PHYSICIAN, SECRETARY40.0XX173164016221
JASON TRONETTI
PHYSICIAN, DIRECTOR40.0X313676021296
CHARLES UPDEGRAFF
CHAIRMAN1.0XX000
RON CASKEY
DIRECTOR1.0X000
REVEREND RANDALL HEADLEY
2ND VICE CHAIRMAN1.0XX000
ROBERT MARTIN
DIRECTOR THROUGH 10/101.0X000
HOWARD MILLER
DIRECTOR THROUGH 9/101.0X000
PAUL PRITCHARD
TREASURER1.0XX000
ROBERT SMITH
1ST VICE CHAIRMAN1.0XX000
RUSSELL STREICH
DIRECTOR1.0X000
SUSAN KEFOVER
DIRECTOR THROUGH 4/111.0X000
DAVID BUCKLER
DIRECTOR BEG. 10/101.0X000
DAVID CRANDALL
DIRECTOR1.0X000
JEANNE MIGLICIO
DIRECTOR BEG. 10/101.0X000
THOMAS SHAFFER
DIRECTOR BEG. 10/101.0X000
EDWARD C PITCHFORD
PRESIDENT, CEO, & ASST. SEC.40.0X268657022017
CYNTHIA L HARDESTY
VICE PRESIDENT, CNE40.0151729010421X
BRADLEY F GIANNOTTI
PHYSICIAN40.0897858019724X
CHRISTAN M CARAMIA
PHYSICIAN40.0477697022788X
SAKET PRASAD
PHYSICIAN40.0560843022156X
TERRANCE FOUST
PHYSICIAN40.0555512012837X
CELSO BACKES
PHYSICIAN40.038098604862X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3780122TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation152322TotalOtherCompensation
Number Individuals GT100 K29NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Description Of ServicesDescriptionOfServicesCompensationCompensation
JAMES BARKE MD
PHYSICIAN649062
FOOT ANKLE INNOV
PHYSICIAN317136
BKD LLP
AUDIT/TAX/CONSULTING105762
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K
Fundraising Events30227FundraisingEvents
Government Grants214375GovernmentGrants
All Other Contributions105622AllOtherContributions
Total Contributions350224TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT SERVICE REVENUE6219906748745067487450
OTHER REVENUE62199020802632080263
FieldValueIRS element (for citing)
Total Program Service Revenue69567713TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column157026TotalRevenueColumn
Exclusion$157,026ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column53561TotalRevenueColumn
Exclusion$53,561ExclusionAmount

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real336762Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real347816Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-11054Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-11054TotalRevenueColumn
Exclusion-$11,054ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities3742029Securities
Other1151269Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities3251508Securities
Other821133Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities490521Securities
Other330136Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column820657TotalRevenueColumn
Exclusion$820,657ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events8000GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events30227CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses13339FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-5339TotalRevenueColumn
Exclusion-$5,339ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Gross Sales Of Inventory76779GrossSalesOfInventory
Cost Of Goods Sold49937CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column26842TotalRevenueColumn
Exclusion$26,842ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountUnrelated Business RevenueUnrelatedBusinessRevenue
GAIN ON INVESTMENT IN EQUITY INVESTEE900099129727$129,727
INCOME FROM INVESTMENT IN SUBSIDIARIES90009992929$22,47270457
GAIN ON EXTINGUISHMENT OF DEBT900099128542$128,542
FieldValueIRS element (for citing)
Total Other Revenue351198TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column71310828TotalRevenueColumn
Related Or Exempt Function Income69567713RelatedOrExemptFunctionIncome
Unrelated Business Revenue70457UnrelatedBusinessRevenue
Exclusion$1,322,434ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total977181Total
Program Services525078ProgramServices
Management And General452103ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total126190Total
Management And General126190ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total22797219Total
Program Services19561408ProgramServices
Management And General3235811ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total945978Total
Program Services805443ProgramServices
Management And General140535ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total4296532Total
Program Services3454435ProgramServices
Management And General842097ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1693909Total
Program Services1425722ProgramServices
Management And General268187ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total379708Total
Program Services379708ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total115523Total
Management And General115523ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total108769Total
Management And General108769ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total84000Total
Fundraising84000Fundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total99576Total
Management And General99576ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total14086375Total
Program Services13334942ProgramServices
Management And General751433ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total97873Total
Program Services2001ProgramServices
Management And General95872ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total13780208Total
Program Services12716773ProgramServices
Management And General1063435ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total972113Total
Program Services813650ProgramServices
Management And General158463ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total301693Total
Program Services270840ProgramServices
Management And General30853ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total245234Total
Program Services146572ProgramServices
Management And General98662ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1180126Total
Program Services1056444ProgramServices
Management And General123682ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2411220Total
Program Services2158514ProgramServices
Management And General252706ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1028588Total
Program Services536046ProgramServices
Management And General492542ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
BAD DEBT30391633039163
LICENSES, DUES & SUBSCRIPTIONS299596112125187471
RECRUITING140622140622
OTHER AUXILIARY EXPENSES3193731937

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total69239333Total
Program Services60338864ProgramServices
Management And General8784532ManagementAndGeneral
Fundraising115937Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY5018474BOY
EOY6770890EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY206716BOY
EOY71851EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY7106477BOY
EOY7510740EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY981423BOY
EOY1081698EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY2099925BOY
EOY1785764EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis63106763LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec40093165LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY24055090BOY
EOY23013598EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY10756526BOY
EOY12716424EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY1171705BOY
EOY1532975EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY117496BOY
EOY396598EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1215278BOY
EOY422241EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY52729110BOY
EOY55302779EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY13430176BOY
EOY12962644EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY20292611BOY
EOY19534724EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY10229BOY
EOY14430EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY2268171BOY
EOY1239449EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1783094BOY
EOY1395613EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY37784281BOY
EOY35146860EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY10850438BOY
EOY15669621EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY426591BOY
EOY205421EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY3667800BOY
EOY4280877EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY14944829BOY
EOY20155919EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY52729110BOY
EOY55302779EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses2071495ReconcilationRevenueExpenses
Reconcilation Other Changes3139595ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$9,940OtherActivitiesAmount
Total Lobbying Expenditures IIB9940TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierLOBBYING ACTIVITIESIdentifier
Return ReferenceSCHEDULE C, PART II-B, LINE 1IReturnReference
ExplanationTHE ORGANIZATION IS A MEMBER OF HAP, AHA, AND HCWP. $9,940 OF DUES ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FStrueIncludedOnFS

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance3667800BeginningOfYearBalance
Investment Earnings Or Losses942900InvestmentEarningsOrLosses
Other Expenditures329823OtherExpenditures
End Of Year Balance4280877EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance3616355BeginningOfYearBalance
Investment Earnings Or Losses437150InvestmentEarningsOrLosses
Other Expenditures385705OtherExpenditures
End Of Year Balance3667800EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance4837234BeginningOfYearBalance
Investment Earnings Or Losses-1006344InvestmentEarningsOrLosses
Other Expenditures214535OtherExpenditures
End Of Year Balance3616355EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Endowments Held By Unrelated OrgstrueEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1135847OtherCostOrOtherBasis
Book Value1135847BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis26779607OtherCostOrOtherBasis
Depreciation14157789Depreciation
Book Value12621818BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis9812494OtherCostOrOtherBasis
Depreciation5259488Depreciation
Book Value4553006BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis22938686OtherCostOrOtherBasis
Depreciation19505318Depreciation
Book Value3433368BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2440129OtherCostOrOtherBasis
Depreciation1170570Depreciation
Book Value1269559BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings23013598TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO THIRD PARTIESDescription
Amount$1,395,613Amount
FieldValueIRS element (for citing)
Total Of Amounts1395613TotalOfAmounts
Total Revenue71310828TotalRevenue
Total Expenses69239333TotalExpenses
Excess Or Deficit For Year2071495ExcessOrDeficitForYear
Net Unrealized GL On Investments1444493NetUnrealizedGLOnInvestments
Other$1,721,486OtherAmount
Total Adjustments3165979TotalAdjustments
Excess Or Deficit Per FS5237474ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt74806025TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments1444493NetUnrealizedGainsInvestments
Other Revenues1770102OtherRevenues
Revenue Not Rptd F9903214595RevenueNotRptdF990
Revenue Subtotal71591430RevenueSubtotal
Other Revenues Not Included-280602OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-280602RevenueNotRptdOnFinStmt
Total Revenue Per Form99071310828TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt69568551TotExpensesEtcAuditedFinclStmt
Other Expenses Included361155OtherExpensesIncluded
Expenses Not Rptd F990361155ExpensesNotRptdF990
Expenses Subtotal69207396ExpensesSubtotal
Other Expenses Not Included31937OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt31937ExpensesNotRptdOnFinStmt
Total Expenses Per Form99069239333TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ESCROW ACCOUNTSSCHEDULE D, PART IV, LINE 2BTHE CORPORATION HAS AN ESCROW ACCOUNT FOR THEIR SKILLED NURSING FACILITY PATIENTS WHO REQUEST THE USE OF THE ACCOUNT. THIS AMOUNT IS REPORTED ON FORM 990, PART X, LINE 21.
ENDOWMENT FUNDSCHEDULE D, PART V, LINE 4THE ENDOWMENT FUND WAS ESTABLISHED TO ALLOW THE HOSPITAL TO PROVIDE HEALTHCARE SERVICES TO POOR AND NEEDY PATIENTS. UNCERTAIN TAX POSITIONS SCHEDULE D, PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.
OTHER CHANGES IN NET ASSETSSCHEDULE D, PART XI, LINE 8DEFINED BENEFIT PENSION COSTS: AMORTIZATION OF NET LOSS 242,842 NET GAIN ARISING DURING YEAR 1,452,260 AUXILIARY NET INCOME (48,616) AUXILIARY TRANSFER TO CCMH 75,000
OTHER REVENUE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12SCHEDULE D, PART XII, LINE 2DDEFINED BENEFIT PENSION COSTS: AMORTIZATION OF NET LOSS 242,842 NET GAIN ARISING DURING YEAR 1,452,260 AUXILIARY TRANSFER TO CCMH 75,000
OTHER REVENUE INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1SCHEDULE D, PART XII, LINE 4BRENTAL EXPENSES (347,816) SPECIAL EVENT EXPENSE (13,339) AUXILIARY SPECIAL EVENT REVENUE 38,227 AUXILIARY SALES OF INVENTORY 76,779 AUXILIARY COST OF GOODS SOLD (49,937) AUXILIARY INTEREST INCOME 74 AUXILIARY OTHER INCOME 15,410
OTHER EXPENSES INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25SCHEDULE D, PART XIII, LINE 2DRENTAL EXPENSES 347,816 SPECIAL EVENT EXPENSES 13,339
OTHER EXPENSES INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1SCHEDULE D, PART XIII, LINE 4BOTHER AUXILIARY EXPENSES 31,937

Schedule G IRS990ScheduleG

FieldValueIRS element (for citing)
Solicitation Of Non Govt GrantsXSolicitationOfNonGovtGrants
Solicitation Of Govt GrantsXSolicitationOfGovtGrants
Agreement Ref FundraisingtrueAgreementRefFundraising

Fundraiser Activity Information FundraiserActivityInformation

FieldValueIRS element (for citing)
Name Of IndividualDELTA DEVELOPMENT GROUP INCNameOfIndividual
ActivityGRANT WRITINGActivity
Fundraiser Control Of FundsfalseFundraiserControlOfFunds
Amount Retained By Contractor84000AmountRetainedByContractor
FieldValueIRS element (for citing)
Total Retained By Contractors84000TotalRetainedByContractors
Licensed StatesPALicensedStates

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF TOURNAMENTNameOfEvent1
Gross Receipts Event138227GrossReceiptsEvent1
Charitable Contributions Event130227CharitableContributionsEvent1
Gross Revenue Event18000GrossRevenueEvent1
Non Cash Prizes Event14504NonCashPrizesEvent1
Rent Facility Costs Event13379RentFacilityCostsEvent1
Food And Beverage Event14606FoodAndBeverageEvent1
Other Direct Expenses Event1850OtherDirectExpensesEvent1
Total Number Of Other Events0TotalNumberOfOtherEvents
Gross Receipts Total38227GrossReceiptsTotal
Charitable Contributions Total30227CharitableContributionsTotal
Gross Revenue Total Events8000GrossRevenueTotalEvents
Non Cash Prizes Total Events4504NonCashPrizesTotalEvents
Rent Facility Costs Total Events3379RentFacilityCostsTotalEvents
Food And Beverage Total Events4606FoodAndBeverageTotalEvents
Other Direct Expenses Total Events850OtherDirectExpensesTotalEvents
Direct Expense Summary Events13339DirectExpenseSummaryEvents
Net Income Summary-5339NetIncomeSummary

Form990 Schedule G Part IV Form990ScheduleGPartIV

FieldValueIRS element (for citing)
IdentifierFUNDRAISING ACTIVITIESIdentifier
Return ReferenceSCHEDULE G, PART I, LINE 2BReturnReference
ExplanationTHE ORGANIZATION HIRED DELTA DEVELOPMENT GROUP, INC., FOR GRANT WRITING SERVICES. THE AGREEMENT PROVIDED FOR A MONTHLY FEE FOR PROFESSIONAL FUNDRAISING SERVICES AS WELL AS REIMBURSEMENT OF ADDITIONAL FUNDRAISING EXPENSES.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense631213TotalCommunityBenefitExpense
Net Community Benefit Expense631213NetCommunityBenefitExpense
Percent Of Total Expense0.00910PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense12553658TotalCommunityBenefitExpense
Direct Offsetting Revenue8223671DirectOffsettingRevenue
Net Community Benefit Expense4329987NetCommunityBenefitExpense
Percent Of Total Expense0.06250PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense13184871TotalCommunityBenefitExpense
Direct Offsetting Revenue8223671DirectOffsettingRevenue
Net Community Benefit Expense4961200NetCommunityBenefitExpense
Percent Of Total Expense0.07160PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense96734TotalCommunityBenefitExpense
Direct Offsetting Revenue23973DirectOffsettingRevenue
Net Community Benefit Expense72761NetCommunityBenefitExpense
Percent Of Total Expense0.00110PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense366055TotalCommunityBenefitExpense
Net Community Benefit Expense366055NetCommunityBenefitExpense
Percent Of Total Expense0.00530PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense22923622TotalCommunityBenefitExpense
Direct Offsetting Revenue17270015DirectOffsettingRevenue
Net Community Benefit Expense5653607NetCommunityBenefitExpense
Percent Of Total Expense0.08160PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense1092TotalCommunityBenefitExpense
Net Community Benefit Expense1092NetCommunityBenefitExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense23387503TotalCommunityBenefitExpense
Direct Offsetting Revenue17293988DirectOffsettingRevenue
Net Community Benefit Expense6093515NetCommunityBenefitExpense
Percent Of Total Expense0.08800PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense36572374TotalCommunityBenefitExpense
Direct Offsetting Revenue25517659DirectOffsettingRevenue
Net Community Benefit Expense11054715NetCommunityBenefitExpense
Percent Of Total Expense0.15960PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served66PersonsServed
Total Community Building Expense5940TotalCommunityBuildingExpense
Net Community Building Expense5940NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Leadership Development LeadershipDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs12NumberOfActivitiesOrPrograms
Persons Served156PersonsServed
Total Community Building Expense4858TotalCommunityBuildingExpense
Net Community Building Expense4858NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Number Of Activities Or Programs4NumberOfActivitiesOrPrograms
Total Community Building Expense3956TotalCommunityBuildingExpense
Net Community Building Expense3956NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Number Of Activities Or Programs20NumberOfActivitiesOrPrograms
Persons Served540PersonsServed
Total Community Building Expense1260TotalCommunityBuildingExpense
Net Community Building Expense1260NetCommunityBuildingExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs3NumberOfActivitiesOrPrograms
Persons Served216PersonsServed
Total Community Building Expense447TotalCommunityBuildingExpense
Net Community Building Expense447NetCommunityBuildingExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs41NumberOfActivitiesOrPrograms
Persons Served978PersonsServed
Total Community Building Expense16461TotalCommunityBuildingExpense
Net Community Building Expense16461NetCommunityBuildingExpense
Percent Of Total Expense0.00030PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$1,502,381BadDebtExpenseAmount
Amount Attributable To235874AmountAttributableTo
Amount Reimbursed By Medicare21123777AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare20598431CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall525346MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost Accounting SystemXCostAccountingSystem
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1CHARLES COLE MEMORIAL HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11001 EAST 2ND STREETAddressLine1
CityCOUDERSPORTCity
StatePAState
ZIP Code16915ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1CHARLES COLE MEMORIAL HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities10NumberOfOtherFacilities

Other Facilities OtherFacilities (10 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
PORT ALLEGANY HEALTH CENTER
45 PINE STREETPORT ALLEGANYPA16743RURAL HEALTH CENTER REHABILITATION LAB SERVICES, RADIOLOGY
SHINGLEHOUSE HEALTH CENTER
128 LYONS STREETSHINGLEHOUSEPA16748RURAL HEALTH CENTER LAB SERVICES
ELDRED HEALTH CENTER
139 MAIN STREETELDREDPA16371RURAL HEALTH CENTER LAB SERVICES
EMPORIUM HEALTH CENTER
SIZERVILLE ROADEMPORIUMPA15834RURAL HEALTH CENTER LAB SERVICES
GALETON HEALTH CENTER
30 RIVER STREETGALETONPA16922RURAL HEALTH CENTER LAB SERVICES
WESTFIELD RURAL HEALTH CLINIC
222 CHURCH STREETWESTFIELDPA16950RURAL HEALTH CENTER LAB SERVICES
HEWITT MANOR
111 WEST HONEOYE STREETSHINGLEHOUSEPA16748REHABILITATION
SMETHPORT HEALTH CENTER
83 MARVIN STREETSMETHPORTPA16749RURAL HEALTH CENTER LAB SERVICES
NORTHERN POTTER HEALTH CENTER
511 ACADEMY STREETULYSSESPA16948RURAL HEALTH CENTER LAB SERVICES
CENTRAL POTTER HEALTH CENTER
46 ELK STREETCOUDERSPORTPA16915RURAL HEALTH CENTER LAB SERVICES

Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)

IdentifierIdentifierExplanationExplanation
PART I, LINE 7G:SEVERAL RURAL HEALTH CLINICS WERE INCLUDED IN THE COMPUTATION OF SUBSIDIZED HEALTH SERVICES ON LINE 7G. CCMH PROVIDES PRIMARY CARE TO THE SURROUNDING COUNTIES AT THESE RURAL HEALTH CENTERS. THESE SERVICES ARE PROVIDED IN RURAL AREAS WHERE THERE WOULD BE A SHORTAGE OF QUALITY MEDICAL CARE WITHOUT THE SERVICES. CCMH CONTINUES TO PROVIDE THESE SERVICES AS A BENEFIT TO THE COMMUNITY DESPITE KNOWING THAT FINANCIAL SHORTFALLS WILL BE SUSTAINED. PART III, LINE 4: THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS, WHICH IS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE PATIENT OR THIRD-PARTY PAYER. LINE 2 WAS DETERMINED BY TAKING THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS TIMES THE RATIO OF PATIENT CARE COST TO CHARGES FROM WORKSHEET 2, LINE 11. LINE 3 WAS DETERMINED BY TAKING THE BAD DEBT EXPENSE AT COST (LINE 2) TIMES THE PERCENT OF PERSONS BELOW THE POVERTY LEVEL FOR 2008 BASED ON US CENSUS BUREAU DATA.
PART III, LINE 8:MEDICARE DATA COMPUTED USING THE MEDICARE COST REPORT FILED WITH CMS WAS UTILIZED FOR THE COMPUTATIONS IN PART III, SECTION B. MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT, AS CCMH IS CLASSIFIED AS A CRITICAL ACCESS HOSPITAL. THIS CLASSIFICATION SHOWS THAT CCMH IS IN A MEDICALLY UNDERSERVED AREA AND AT A HEALTH PROFESSIONAL SHORTAGE AREA. THIS DEMONSTRATES THAT CCMH IS THE ONLY REASONABLE SOURCE OF HOSPITAL CARE AVAILABLE TO MEDICARE BENEFICIARIES IN OUR SERVICE AREA, AND LIKEWISE TREATS ALL BENEFICIARIES IN OUR SERVICE AREA THAT PRESENT THEMSELVES FOR CARE, DESPITE KNOWING WE WILL GENERALLY LOSE MONEY CARING FOR MEDICARE PATIENTS. ADDITIONALLY, SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.
PART III, LINE 9B:EFFORTS ARE MADE TO IDENTIFY PATIENTS WHO MAY BE ELIGIBLE FOR CHARITY CARE IN ACCORDANCE WITH THE HOSPITAL'S CHARITY CARE POLICY OR THE PHYSICIAN NETWORK SLIDING FEE SCALE PRIOR TO THE STATEMENT PROCESS WHEN POSSIBLE.
PART V, SECTION B, LINE 19D:ALL PATIENTS REGARDLESS OF ABILITY TO PAY ARE BILLED THE SAME AMOUNT FOR THEIR SERVICES. FOR CUSTOMERS THAT HAVE NO INSURANCE (SELF-PAY) WE OFFER 40% DISCOUNT IF BILL IS PAID WITHIN 2 WEEKS.
PART V, SECTION B, LINE 21:ALL PATIENTS ARE CHARGED THE SAME REGARDLESS OF PAYOR.
NEEDS ASSESSMENT:CHARLES COLE MEMORIAL HOSPITAL ENGAGED OKLAHOMA STATE UNIVERSITY IN COMPLETING A SERVICE AREA (4 COUNTIES) COMMUNITY HEALTH NEEDS ASSESSMENT WITH THE PROCESS BEGINNING IN JANUARY 2010 AND CONCLUDING IN MARCH 2010 WHEN CHARLES COLE MEMORIAL HOSPITAL RECEIVED OUTCOMES FROM THE SURVEY. SURVEYS WERE CONDUCTED BY TELEPHONE BY OKLAHOMA STATE UNIVERSITY. QUESTIONS WERE DETERMINED AT THE RECOMMENDATION OF OKLAHOMA STATE UNIVERSITY AND REVISED, AS DEEMED NECESARY, BY CCMH. A TOTAL OF 200 PHONE SURVEYS WERE COMPLETED AND 48 ONLINE SURVEYS WERE SUBMITTED FROM ALL SERVICE AREA ZIP CODES. RESULTS WERE TALLIED AND ANALYZED BY OKLAHOMA STATE UNIVERSITY AND THEN PRESENTED TO CCMH AND A GROUP OF APPROXIMATELY 100 INDIVIDUALS FROM OUR COMMUNITY BENEFIT ADVISORY COMMITTEES (NOW KNOWN AS CORPORATE ADVISORS), CCMH PUBLIC RELATIONS COMMITTEE (A BOARD OF DIRECTOR'S SUB-COMMITTEE AND NOW KNOWN AS THE COMMUNITY RELATIONS COMMITTEE), CCMH LEADERSHIP AND CCMH BOARD OF DIRECTORS. IN ADDITION TO THE RECENT COMMUNITY HEALTH NEEDS ASSESSMENT, CCMH DETERMINES HEALTHCARE NEEDS OF THE COMMUNITIES WHICH WE SERVE THROUGH SURVEYS OF OUR COMMUNITY BENEFIT ADVISORY COMMITTEE MEMBERS, INDIVIDUAL RECOMMENDATIONS, BOARD OF DIRECTORS RECOMMENDATIONS, COMMUNITY EVENT SATISFACTION SURVEYS, AND LOCAL AND STATE HEALTHCARE TRENDS.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:THE PATIENT FINANCIAL COUNSELOR CONTACTS SELF-PAY PATIENTS/GUARANTORS TO DISCUSS PAYMENT ARRANGEMENTS. IF THEY ARE UNABLE TO PAY - SHE EXPLAINS THE PROCESS OF APPLYING FOR CHARITY WHICH INCLUDES APPLYING FOR PA MEDICAL ASISSTANCE FIRST AND IF THEY ARE DENIED OR HAVE A PORTION TO PAY, THEN THEY CAN APPLY FOR CHARITY. THE CHARITY APPLICATION IS ON THE BACK OF OUR SELF-PAY STATEMENTS. ALSO, THE HOSPITAL OWNED PHYSICIAN PRACTICES ARE AWARE OF THIS PROGRAM AND REFER PATIENTS/GUARANTORS TO THE PATIENT FINANCIAL COUNSELOR.
COMMUNITY INFORMATION:CCMH SERVES PATIENTS MAINLY FROM POTTER, MCKEAN, TIOGA, CAMERON AND ELK COUNTIES IN NORTHCENTRAL PA. ALL OF THE COUNTIES THAT WE SERVE ARE CONSIDERED RURAL AND MOUNTAINOUS. CAMERON COUNTY CURRENTLY HAS THE HIGHEST UNEMPLOYMENT RATE IN THE STATE AND ALL OF THE COUNTIES SERVED ARE BATTLING THE EFFECTS OF THE ECONOMY AND JOB LOSS. OUR POPULATION IS ALSO AGING AS THE AREA OFFERS LITTLE FOR A YOUNGER DEMOGRAPHIC IN THE WAY OF EMPLOYMENT, EDUCATION AND CULTURE.
PROMOTION OF COMMUNITY HEALTH:THE MISSION OF CHARLES COLE MEMORIAL HOSPITAL INDICATES THAT THE HOSPITAL RESPONDS TO THE HEALTHCARE NEEDS OF THE COMMUNITIES IT SERVES AND IS LARGELY DEPENDENT ON PROVIDING SERVICES AND CARE TO THOSE INDIVIDUALS WHO MAY NOT HAVE THE RESOURCES TO BE AWARE OF, ABLE TO PAY FOR, OR HAVE THE EDUCATION/KNOWLEDGE ABOUT CARE, PROGRAMS AND SERVICES THAT ARE AVAILABLE TO THEM. THROUGH VARIOUS ACTIVITIES CHARLES COLE REACHES OUT TO OUR COMMUNITIES TO EDUCATE, IMPROVE HEALTH, PREVENT AND TREAT DISEASE AND SUPPORT INDIVIDUALS AND GROUPS. CHARLES COLE, IN COOPERATION WITH COMMUNITY BASED GROUPS SUCH AS ROTARY, PROVIDE FIVE COMPREHENSIVE BLOOD ANALYSIS ANNUALLY. COMPREHENSIVE BLOOD ANALYSIS SCREENINGS ARE PROVIDED IN FIVE RURAL COMMUNITIES: GALETON, SMETHPORT, PORT ALLEGANY, SHINGLEHOUSE AND COUDERSPORT. CBA'S SCREEN OVER 30 OF THE MOST COMMON BLOOD TESTS THAT DETECT HEALTH ISSUES SUCH AS CORONARY HEART DISEASE, LIVER DISEASE, KIDNEY DISEASE, CANCER, THYROID DISEASE, DIABETES, ANEMIA, BONE DISEASE AND RESPIRATORY DISEASE. THESE SCREENINGS ARE PROVIDED AT A FRACTION OF THE COST OF HAVING THESE TESTS PERFORMED THROUGH A FAMILY PHYSICIAN. ALL PARTICIPANTS AND THEIR PRIMARY MEDICAL PROVIDER ARE SENT THE RESULTS AND PROVIDERS FOLLOW-UP WITH INDIVIDUALS WHOSE SCREENING RESULTS INDICATE ABNORMALITIES. FOR MANY INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED AND LIKELY WOULD NOT SEEK MEDICAL CARE UNTIL IT WAS EMERGENT, THESE EVENTS PROVIDE AN AVENUE TO MONITOR THEIR HEALTH AND DETECT POTENTIAL ISSUES BEFORE THEY BECOME EMERGENT. IN ADDITION, THE LOCAL CO-SPONSORS RECEIVE A PORTION OF THE PROCEEDS FROM THESE EVENTS AND UTILIZE THE FUNDS TO PROVIDE SCHOLARSHIPS AND SUPPORT TO LOCAL STUDENTS AND PROJECTS TO BENEFIT THE COMMUNITY. ANNUALLY, CHARLES COLE PARTNERS WITH THE AREA AGENCY ON AGING AND THE PENNSYLVANIA DEPARTMENT OF HEALTH TO ADMINISTER SEASON INFLUENZA AND PNEUMOCCOCAL VACCINE TO COUNTY SENIORS, THE INDIGENT, THE HOUSE-BOUND AND THE UNINSURED AT NO COST. FY2010 800 NO-COST INFLUENZA VACCINES AND 123 PNEUMOCOCCAL VACCINES WERE ADMINISTERED THROUGH 9 CLINICS IN 7 COMMUNITIES. IN MANY CASES THE UNDERSERVED POPULATIONS ARE MORE LIKELY TO BECOME ILL AND POTENTIALLY FACE EMERGENT HEALTH NEEDS FROM VACCINE-PREVENTABLE DISEASE. BY PROVIDING CLINICS AT COUNTY SENIOR CENTERS AND IN RURAL COMMUNITY SETTINGS MANY INDIVIDUALS WHO WOULD LIKELY NOT RECEIVE THESE COMMON VACCINES CAN BE IMMUNIZED AT NO COST AND IN CLOSE PROXIMITY TO THEIR HOMES. IN ADDITION, WITH THE OUTBREAK OF THE H1N1 INFLUENZA VIRUS IN THE FALL OF 2009, CCMH ADMINISTERED APPROXIMATELY 5500 DOSES OF H1N1 VACCINE TO ANY INDIVIDUAL WHO MET CRITERIA. ALSO IN CONJUNCTION WITH THE AREA AGENCY ON AGING, CHARLES COLE PROVIDES NO-COST EDUCATION TO COUNTY SENIOR CENTERS. IN FY 2010, CCMH PROVIDED 7 HEALTH EDUCATION PROGRAMS, EACH PRESENTED AT 4 SENIOR CENTERS FOR A TOTAL OF 30+ SESSIONS. TOPICS INCLUDED IMMUNIZATIONS, OSTEOPOROSIS, HEEL SCREENINGS, WINTER SKIN & FOOT CARE, THE DIABETIC FOOT & GOUT, INCONTINENCE AND GASTROINTESTINAL ISSUES IN SENIORS. FINALLY, AS AN ON-GOING EFFORT TO PROVIDE FULL-SPECTRUM CANCER CARE TO INDIVIDUALS IN RURAL NORTHCENTRAL PENNSYLVANIA, THE PATTERSON CANCER CARE CENTER PHYSICIANS AND STAFF PROVIDED APPROXIMATELY 170 NO-COST CANCER SCREENINGS. SCREENINGS INCLUDED SCREENINGS FOR PROSTATE, COLORECTAL AND SKIN CANCER. SCREENINGS WERE PERFORMED BY ONCOLOGY PHYSICIANS WHO SPECIALIZE IN THE DETECTION, DIAGNOSIS AND TREATMENT OF CANCER. INDIVIDUALS PARTICIPATING IN THESE SCREENINGS WERE BOTH MALE AND FEMALE, ADULT AND SENIOR AND UNINSURED/UNDERINSURED. IN ADDITION TO THE SCREENINGS, PARTICIPANTS WERE ALSO EDUCATED ON HEALTHY HABITS TO REDUCE RISK OF CANCER AND SIGNS AND SYMPTOMS OF CANCER. ALONG WITH MANY OTHER PROGRAMS SUCH AS SUPPORT GROUPS, SPEAKER'S BUREAU, WORKFORCE DEVELOPMENT, ECONOMIC SUPPORT, COMMUNITY LEADERSHIP, PARTNERSHIPS WITH LOCAL CIVIC, GOVERNMENT, SCHOOL DISTRICTS AND COMMUNITY GROUPS, CHARLES COLE MEMORIAL HOSPITAL CONTINUES EFFORTS TO ASSURE THAT HEALTHCARE, IN ALL FORMS, IS ACCESSIBLE AND AVAILABLE TO THOSE WHO MAY OTHERWISE GO WITHOUT.
OTHER INFORMATION:CCMH PROVIDES THE COMMUNITY WITH SPACE FOR EVENTS, MEETINGS AND PROGRAMS SUCH AS SUPPORT GROUPS AND YOUTH SPORTS. CCMH'S EMPLOYEE GIVING CLUB, HEART OF COLE, HAS A DESIGNATED GROUP THAT FOCUSES ON COMMUNITY CONNECTIONS. THE GROUP ANNUALLY UTILIZES APPROXIMATELY $10,000 ON COMMUNITY CONNECTIONS INCLUDING DONATIONS, IN FY09 SPECIFICALLY TO SERVE INDIVIDUALS AND FAMILIES THROUGH MONETARY AND NON-PERISHABLE FOOD DONATIONS TO LOCAL FOOD BANKS AND TO PURCHASE OF HEALTHCARE-RELATED ITEMS TO BE USED AS GIVE-AWAYS AT COMMUNITY EVENTS. CHARLES COLE STRIVES TO LIVE UP TO ITS NON-PROFIT MISSION EVERY DAY, PROVIDING EXCELLENT HEALTHCARE SERVICES TO OUR AREA AND LISTENING AND RESPONDING TO THE COMMUNITIES WE SERVE. IN AN EFFORT TO PLAN FOR THE UNIQUE NEEDS OF COMMUNITIES IN THE SERVICE AREA, FIVE COMMUNITY BENEFIT ADVISORY COMMITTEES WERE ESTABLISHED AS A MAJOR INITIATIVE TO DEEPEN AND STRENGTHEN ITS CONNECTION WITH THE COMMUNITY AND TO LINK COMMUNITY BENEFIT ACTIVITIES TO STRATEGIC AND OPERATIONAL PLANS. THE ROLE OF THE COMMITTEES IS TO IDENTIFY THE NEEDS AND CONCERNS OF THE COMMUNITY, ADVISE ABOUT THE BEST WAY TO PARTNER WITH THE COMMUNITY, AID IN THE DEVELOPMENT OF MEANINGFUL COMMUNITY PROGRAMS AND ACTIVITIES, AND PROMOTE IMPROVED COMMUNICATIONS BETWEEN THE HOSPITAL AND THE COMMUNITY. THE HOSPITAL PROVIDES DEDICATED ADMINISTRATIVE TIME TO PLANNING AND CONDUCTING FIVE CBAC MEETINGS IN THE COMMUNITIES WE SERVE THREE TIMES PER YEAR. CCMH REACHED THE GOAL OF DOUBLING PARTICIPATION/MEMBERS OF THE CBAC GROUPS FROM 50 INDIVIDUALS TO 100 INDIVIDUALS. LASTLY, CCMH OFTEN PARTNERS WITH FUNDING FOUNDATIONS TO PROVIDE HEALTH SPECIFIC IMPROVEMENT INITIATIVES IN THE COMMUNITIES WHICH WE SERVE. AS AN EXAMPLE, CCMH, WITH FUNDING FROM THE GEORGE A. & MARGARET MEE FOUNDATION, PROVIDED COMPREHENSIVE NO-COST PHYSICALS TO THE UNINSURED AND UNDER INSURED POPULATION IN CAMERON COUNTY. IN ADDITION A FAMILY FITNESS PROGRAM WAS OFFERED IN CAMERON COUNTY GEARED TO EDUCATE YOUTH AND THEIR PARENTS ON THE IMPORTANCE OF GOOD HEALTH. THE FAMILY FITNESS CHALLENGE INCLUDES EXERCISE, EDUCATION, HEALTHY EATING, HEALTH INDICATOR GATHERING AND MONITORING. FINALLY, VISION TESTING EQUIPMENT AND NO-COST SCREENINGS WERE PROVIDED THROUGH CCMH BY A LOCAL OPHTHEMOLOGIST TO RESIDENTS MEETING CRITERIA IN CAMERON COUNTY. THIS IS JUST ONE EXAMPLE OF PARTNERSHIPS IN WHICH CCMH IS CLOSELY INVOLVED THAT PROMOTE HEALTH AND ADDRESS COMMUNITY NEEDS.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
MICHAEL E CALLAHAN
172316000848038780123430189385000
EDWARD C PITCHFORD
23863000030027061130159040290674000
JASON TRONETTI
19695801165550163060870152090334972000
CYNTHIA L HARDESTY
1339120001781703813066080162150000
BRADLEY F GIANNOTTI
88145800016400045150152090917582000
CHRISTAN M CARAMIA
477332000365059790168090500485000
SAKET PRASAD
54379500017048060520161040582999000
TERRANCE FOUST
55501300049906050067870568349000
CELSO BACKES
376003000498304862000385848000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierBONUSIdentifier
Return ReferenceSCHEDULE J, PART I, LINE 7ReturnReference
ExplanationNO DIRECTORS EARNED A BONUS FOR PARTICIPATING IN THE EXECUTIVE TEAM INCENTIVE COMPENSATION PROGRAM. EACH PARTICIPANT HAD AN ESTABLISHED TARGET TOTAL COMPENSATION BASED ON INDUSTRY SURVEYS AND THE INCENTIVE PROGRAM COMPRISED APPROXIMATELY 10% OF THE TARGETED TOTAL COMPENSATION. THE BONUS WAS BASED ON OVERALL PERFORMANCE. JASON TRONETTI'S BONUS WAS CALCULATED BY RVU'S BASED ON PRODUCTIVITY AND AN ESTABLISHED FORMULA.Explanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
COLE CARE
COMMON BOARD MEMBERS6276659RENT, DIVIDENDS, SERVICESfalse
EDMOND HARDESTY
HUSBAND OF C. HARDESTY126190EMPLOYEE OF HOSPITALfalse

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S MISSIONFORM 990, PART I, LINE 1CHARLES COLE MEMORIAL HOSPITAL IS A FULL SERVICE, COMPREHENSIVE HEALTH SYSTEM, SERVING POTTER, MCKEAN, CAMERON, AND TIOGA COUNTIES IN RURAL, NORTH CENTRAL PA AND PORTIONS OF NEW YORK STATE AND IS THE ONLY HOSPITAL IN POTTER COUNTY (COUDERSPORT, PA). CCMH IS A CRITICAL ACCESS HOSPITAL PROVIDING PRIMARY, EMERGENCY, AND SPECIALTY CARE, AS WELL AS REHABILITATION AND WELLNESS SERVICES TO PATIENTS WITHIN A 50-MILE RADIUS. CHARLES COLE STRIVES TO LIVE UP TO ITS NON-PROFIT MISSION EVERY DAY, PROVIDING EXCELLENT HEALTHCARE SERVICES TO OUR AREA AND LISTENING AND RESPONDING TO THE COMMUNITIES WE SERVE. IN AN EFFORT TO PLAN FOR THE UNIQUE NEEDS OF COMMUNITIES IN THE SERVICE AREA, FIVE COMMUNITY BENEFIT ADVISORY COMMITTEES WERE ESTABLISHED AS A MAJOR INITIATIVE TO DEEPEN AND STRENGTHEN OUR CONNECTION WITH THE COMMUNITY AND TO LINK COMMUNITY BENEFIT ACTIVITIES TO STRATEGIC AND OPERATIONAL PLANS. THE ROLE OF THE COMMITTEES ARE TO IDENTIFY THE NEEDS AND CONCERNS OF THE COMMUNITY, ADVISE ABOUT THE BEST WAY TO PARTNER WITH THE COMMUNITY, AID IN THE DEVELOPMENT OF MEANINGFUL COMMUNITY PROGRAMS AND ACTIVITIES, AND PROMOTE IMPROVED COMMUNICATIONS BETWEEN THE HOSPITAL AND THE COMMUNITY. THE HOSPITAL PROVIDES DEDICATED ADMINISTRATIVE TIME TO PLANNING AND CONDUCTING FIVE CBAC MEETINGS IN THE COMMUNITIES WE SERVE THREE TIMES PER YEAR. PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4 LINE 4B IN ADDITION TO THE FAMILY AND INTERNAL MEDICINE SERVICES AT RHCS, PHYSICIAN PRACTICES ALSO PROVIDE SPECIALTY CARE INCLUDING PEDIATRICS, GASTROENTEROLOGY, ORTHOPEDICS, PHYSIATRY, SURGERY, PODIATRY, OBSTETRICS/GYNECOLOGY AND ONCOLOGY. COLLECTIVELY, PHYSICIAN PRACTICES REPORTED 94,400 PATIENT VISITS LAST YEAR. LINE 4C INPATIENT SATISFACTION RANKS IN THE TOP 6% IN OUR OB SERVICES AND TOP 16% IN OUR IP SERVICES ACROSS THE NATION. IN ADDITION TO THE HOSPITAL'S ACUTE CARE FLOORS, CHARLES COLE CARES FOR PATIENTS IN ITS 49-BED LONG TERM CARE UNIT WHICH REPORTED 15,600 DAYS LAST YEAR. A 10-BED INPATIENT GERIATRIC BEHAVIORAL HEALTH UNIT ADMITTED 200 PATIENTS LAST YEAR. LINE 4D THE ORGANIZATION ALSO OFFERS CARDIO-PULMONARY SERVICES, CLINICAL SERVICES, CLINICS, AND CORPORATE SERVICES.
SIGNIFICANT CHANGES TO ORGANIZATIONAL DOCUMENTSFORM 990, PART VI, SECTION A, LINE 4THE ORGANIZATION AMENDED ITS BYLAWS IN JULY 2010. SIGNIFICANT CHANGES ARE AS FOLLOWS: FUNCTIONS AND QUALIFICATIONS FOR MEMBERS WERE ADDED. THEY INCLUDE THE PROMOTION OF THE PROGRAMS AND GOALS OF THE HOSPITAL, THE EDUCATION OF PUBLIC CONTACTS ON HEALTH CARE ISSUES AND SERVICES AVAILABLE THROUGH THE HOSPITAL, PROVIDING A LINK BETWEEN THE HOSPITAL AND OTHER INSTITUTIONS AND COMMUNITITES, ATTENDENCE OF REGULAR MEETINGS, PROVIDING SPECIAL ASSISTANCE ON PROJECTS OR ISSUES WHEN REQUESTED, PARTICIPATING IN FUNDRAISING EFFORTS TO BENEFIT HOSPITAL PROGRAMS, AND BEING A CITIZEN IN GOOD STANDING. NEW MEMBERS (ADVISORS), AFTER BEING NOMINATED BY THE EXECUTIVE COMMITTEE, ARE NOW ELECTED BY A TWO THIRDS VOTE OF VOTING MEMBERS AT A MEETING AT WHICH QUORUM IS PRESENT. AN ACTIVE ADVISOR SERVES A FIVE YEAR TERM, WITH NO LIMIT TO THE NUMBER OF TERMS HE OR SHE MAY SERVE. AN HONORARY ADVISOR MAY BE ELECTED BY THE ACTIVE ADVISORS AND SERVES FOR LIFE, IN RECOGNITION OF DISTINGUISHED ACHIEVEMENT OR FAITHFUL SERVICE TO THE HOSPITAL. NO ADVISOR SHOULD BE AN EMPLOYEE OF THE HOSPITAL OR ITS AFFILIATES, OR HAVE ANY VESTED RIGHT OR INTEREST IN THE HOSPITAL'S ASSETS, FUNCTIONS, AFFAIRS, OR FRANCHISES. THE NUMBER OF ADVISORS SHOULD BE AT LEAST 50 BUT NOT MORE THAN 100, EXCLUSIVE OF HONORARY ADVISORS. HONORARY ADVISORS MAY ATTEND ALL MEETINGS BUT ARE NOT ENTITLED TO VOTE ON ANY MATTERS. MEMBERS OF THE BOARD OF DIRECTORS MAY REMOVE (BY MAJORITY VOTE) ANY ADVISOR WHO IS DECLARED OF UNSOUND MIND, IS CONVICTED OF A FELONY, FAILS TO MEET ATTENDANCE REQUIREMENTS WITHOUT DUE CAUSE, FAILS TO FULFILL THEIR RESPONSIBILITIES AS ADVISOR, COMMITS FRAUDULENT OR DISHONEST ACTS, OR PERFORMS BEHAVIOR THAT IS DISRUPTIVE TO THE HOSPITAL OR REFLECTS ADVERSELY ON THE HOSPITAL. STANDING COMMITTEES ARE ALL CONSIDERED BOARD COMMITTEES AND INCLUDE EXECUTIVE, PERFORMANCE EXCELLENCE, COMMUNITY BENEFIT COUNCIL, QUALITY AND SAFETY COUNCIL, AND FINANCE COMMITTEES. THE EXECUTIVE COMMITTE NOW OVERSEES THE AUDIT, CORPORATE COMPLIANCE, COMPENSATION, AND NOMINATING FUNCTIONS, AND MUST MEET AT LEAST ANNUALLY WITH THE MEDICAL STAFF EXECUTIVE COMMITTEE AND PRESIDENT/CEO. THE BYLAWS NO LONGER INCLUDE THE OPTION FOR MEMBERS OF THE CORPORATION TO AMEND THE BYLAWS BY PROPOSED RECOMMENDATION BY AT LEAST 25% OF THE CORPORATION MEMBERSHIP, THEN VOTE AT A SPECIAL MEMBERSHIP MEETING. THE BYLAWS MAY ONLY BE AMENDED BY A TWO THIRDS VOTE OF THE BOARD OF DIRECTORS. MEMBERS FORM 990, PART VI, SECTION A, LINES 6 & 7A The members of the corporation, the Charles Cole Memorial Hospital, shall be known as Community Benefit Advisors ("Advisors"), whose functions and qualifications shall include the following: (a) promote the programs, goals and objectives of Charles Cole Memorial Hospital; (b) educate their public contacts, both on health care issues and on services and programs available through Charles Cole Memorial Hospital, and seek their services when necessary and appropriate; (c) provide an important link between Charles Cole Memorial Hospital, the other institutions and businesses which they represent, and the communities served by the Hospital; (d) attend regular meetings, to share information on activities and take appropriate action to support and guide Charles Cole Memorial Hospital; (e) provide special assistance on projects and issues when requested; (f) participate in fundraising efforts to benefit patient care programs for Charles Cole Memorial Hospital; and (g) be a citizen in good standing, as determined by the Executive Committee of the Board, in a community served by the Hospital. The members shall be divided into two classes: (a) Active Advisors (b) Honorary Advisors The Advisors shall annually elect: (a) Successors to the Board of Directors whose terms expire. (b) Honorary Directors and Honorary Advisors. Upon nomination by the Executive Committee per section 5.2.2.(e) of these bylaws, all Advisors shall be elected by a two thirds vote of the members present and voting at a duly called meeting of the members which a quorum is present. (a) An Active Advisor of Charles Cole Memorial Hospital shall be a member for a term of five (5) years after his election, or until his earlier resignation. There is no limit on the number of terms an Advisor can serve. (b) An Honorary Advisor may be elected by the Active Advisors and shall serve for life, in recognition of meritorious or faithful service to Charles Cole Memorial Hospital or in recognition of distinguished achievement. (c) Each Advisor owes a duty of undivided and unqualified loyalty to the organization. Advisors may not use their positions to profit personally or to assist others in profiting in any way at the expense of the organization. (d) Advisors shall avoid all conflicts of interest and the appearance of any conflict of interest. A conflict of interest occurs in any situation in which one is potentially not able to remain impartial or maintain objectivity in choosing between the interests of the organization and one's personal interests or the interests of third parties. To avoid the appearance of a conflict of interest, an Advisor shall not participate in the making of any decision or recommendation concerning a matter which may result in any benefit or financial gain, either directly or indirectly, to the Advisor or a member of his/her immediate family. In addition, full disclosure of the pertinent facts regarding the potential conflict of interest should be provided by the Advisor. (e) No Advisor shall have any vested right, interest or privilege of, in, or to the assets, functions, affairs or franchises of the Corporation or any such right, interest or privilege which may be transferable or inheritable, or which shall continue if his membership ceases. No Advisor shall be an employee of the Hospital or any of its affiliates. (f) Advisors shall include representatives from various economic, social and occupational groups broadly representative of the demographic characteristics of the communities served by the Hospital, and shall all have an interest in and commitment to further the health and well-being of the citizens of the Hospital's service area. (g) The Secretary of the Board shall act as liaison to the Community Benefit Advisors. The number of Advisors shall not be less than fifty (50) nor more than one hundred (100), exclusive of Honorary Advisors. Every Active Advisor shall be entitled to one (1) vote at any meeting of the Advisors in which a vote is taken for any election or on any matter or transaction. In the case of voting for the election of Directors, each Advisor must cast one (1) vote for each position to be filled or the ballot will be void as it pertains to the election of Directors. Voting for Directors shall be by written ballot by First Class Mail, postmarked no later than twenty (20) days prior to the date selected for the Annual meeting. Every Advisor shall be entitled in returning his ballot for the annual election of Directors, to direct that his vote be withheld from one (1) or more of the candidates submitted by the Nominating Committee and any such Advisor may, on his ballot, may set forth the name of any person for whom he wishes to record his vote for a Director of the Corporation. Results of the election process will be announced at the annual meeting of the Advisors. Honorary Advisors shall receive notices of and may attend all meetings of the Advisors but shall not be entitled to vote on any matter.
FORM 990 REVIEW PROCESSFORM 990, PART VI, SECTION B, LINE 11BTHE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE 990 IS THEN REVIEWED BY THE ACCOUNTING DEPARTMENT AND THE CONTROLLER. IT IS THEN PRESENTED TO THE AUDIT / COMP COMMITTEE FOR REVIEW. AFTER THE AUDIT / COMP COMMITTEE HAS REVIEWED, A FULL COPY IS DISTRIBUTED TO THE BOARD OF DIRECTORS and THE COMMITTEE WILL REPORT THEIR REVIEW OF FORM 990 TO THE ENTIRE BOARD OF DIRECTORS PRIOR TO THE CEO'S FINAL SIGNATURE.
CONFLICT OF INTEREST POLICYFORM 990, PART VI, SECTION B, LINE 12CMEMBERS OF THE BOARD OF DIRECTORS; BOARD COMMITTEES; MANAGEMENT EMPLOYEES; AND MEDICAL STAFF WITH ADMINISTRATIVE RESPONSIBILITIES ARE COVERED UNDER THE CONFLICT OF INTEREST POLICY. THE LEVELS AT WHICH ACTUAL CONFLICTS ARE REVIEWED ARE THE COMPLIANCE OFFICER AND AUDIT COMMITTEE OF THE BOARD OF DIRECTORS. RESTRICTIONS INCLUDE: A MEMBER OF THE BOARD/BOARD COMMITTEE MUST DISCLOSE THE EXISTENCE OF HIS/HER FINANCIAL INTEREST. A VOTING MEMBER OF ANY COMMITTEE WHOSE SCOPE OF RESPONSIBILITIES INCLUDES COMPENSATION MATTERS AND WHO RECEIVES COMPENSATION, DIRECTLY OR INDIRECTLY, FROM THE HOSPITAL FOR SERVICES IS PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION. PHYSICIANS WHO RECEIVE COMPENSATION, DIRECTLY OR INDIRECTLY, FROM THE HOSPITAL, WHETHER AS EMPLOYEES OR INDEPENDENT CONTRACTORS, ARE PRECLUDED FROM MEMBERSHIP ON ANY COMMITTEE WHOSE PRIMARY SCOPE OF RESPONSIBILITIES INCLUDES COMPENSATION MATTERS. A MANAGEMENT EMPLOYEE, OR A MEDICAL STAFF MEMBER WITH ADMINISTRATIVE RESPONSIBILITIES MUST DISCLOSE TO THE SENIOR LEADER THE EXISTENCE OF THE FINANCIAL INTEREST AND ALL RELATED MATERIAL FACTS.
COMPENSATION DETERMINATIONFORM 990, PART VI, SECTION B, LINE 15AA REVIEW WAS CONDUCTED IN AUGUST 2010 FOR PRESIDENT & CEO EDWARD PITCHFORD BY 3C COMPENSATION CONSULTING CONSORTIUM, LLC, LOCATED IN PITTSBURGH, PENNSYLVANIA. THE BOARD WOULD HAVE TO APPROVE ANY INCREASE RECOMMENDED BY THE AUDIT/COMPENSATION COMMITTEE.
DOCUMENT AVAILABILITYFORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS CAN BE VIEWED ONSITE THROUGH A WRITTEN REQUEST TO THE ORGANIZATION'S CORPORATE COMPLIANCE OFFICER. REQUESTS FOR FINANCIAL STATEMENTS AND 990'S ARE FORWARDED TO THE FINANCE / ACCOUNTING DEPARTMENT AND ARE OPEN FOR PUBLIC INSPECTION.
OTHER CHANGES IN NET ASSETSFORM 990, PART XI, LINE 5UNREALIZED GAINS ON INVESTMENTS 1,444,493 AMORTIZATION OF NET LOSS 242,842 NET GAIN ARISING DURING YEAR 1,452,260 OTHER AUXILIARY (77,729) --------------- TOTAL OTHER CHANGES 3,061,866

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
HENDORN INC DBA COLE MANOR
1001 EAST SECOND STREETCOUDERSPORTPA16915231972659RESIDENT CAREPA501(C)(3)11A INA
HAMOTCOLE VENTURES INC
1001 EAST SECOND STREETCOUDERSPORTPA16915273172100REAL ESTATEPA501(C)(3)11A INA

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1COLE CARE INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11001 EAST 2ND STREETAddressLine1
CityCOUDERSPORTCity
StatePAState
ZIP Code16915ZIPCode
FieldValueIRS element (for citing)
EIN251497347EIN
Primary ActivityDURABLE MED EQUIPPrimaryActivity
Legal Domicile StatePALegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityC CORPORATIONTypeOfEntity
Share Of Total Income7699947ShareOfTotalIncome
Share Of EOY Assets932148ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiestrueReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgtrueSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
COLE CARE INC
A193661
COLE CARE INC
L6029196
COLE CARE INC
K53802
HENDORN INC
K276854
HENDORN INC
L54900