GEISINGER JERSEY SHORE HOSPITAL: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- GEISINGER JERSEY SHORE HOSPITAL (EIN 24-0792115)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-05-12
- IRS object ID
- 201111329349302736
- Schema version
- 2009v1.7
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-05-12T16:04:38-05:00 | Timestamp |
| Tax Period End Date | 2010-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PARENTEBEARD LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 MARKET STREET | AddressLine1 |
| City | WILLIAMSPORT | City |
| State | PA | State |
| ZIP Code | 17701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 240792115 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JERSEY SHORE HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | JERS | NameControl |
| Phone | 5703980100 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1020 THOMPSON STREET | AddressLine1 |
| City | JERSEY SHORE | City |
| State | PA | State |
| ZIP Code | 17740 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CAREY W PLUMMER | Name |
| Title | PRESIDENT & CEO | Title |
| Phone | 5703980100 | Phone |
| Date Signed | 2011-05-12 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5703236023 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | CAREY W PLUMMER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1020 Thompson Street | AddressLine1 |
| City | Jersey Shore | City |
| State | PA | State |
| ZIP Code | 17740 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 29672321 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | www.jsh.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1922 | YearFormation |
| State Legal Domicile | PA | StateLegalDomicile |
| Activity Or Mission Description | PROVIDE INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR RESIDENTS OF JERSEY SHORE AREA. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 344 | TotalNbrEmployees |
| Total Nbr Volunteers | 10 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 182298 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 448563 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 51137846 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 28901185 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 10921 | InvestmentIncomePriorYear |
| Investment Income Current Year | 21130 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 260162 | OtherRevenuePriorYear |
| Other Revenue Current Year | 255384 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 51591227 | TotalRevenuePriorYear |
| Total Revenue Current Year | 29626262 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 10908284 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 11801828 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 204024 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 39133789 | OtherExpensePriorYear |
| Other Expenses Current Year | 15481101 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 50042073 | TotalExpensesPriorYear |
| Total Expenses Current Year | 27282929 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1549154 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2343333 | RevenuesLessExpensesCY |
| Total Assets BOY | 27479924 | TotalAssetsBOY |
| Total Assets EOY | 29001096 | TotalAssetsEOY |
| Total Liabilities BOY | 21961655 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 22153378 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 5518269 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 6847718 | NetAssetsOrFundBalancesEOY |
| Mission Description | Jersey Shore Hospital is a rural healthcare facility committed to providing quality health services with an efficient balance of outpatient care, acute and sub-acute inpatient care and outreach services. The hospital maximizes the effectiveness of its program through integration with other healthcare providers to assure the community access to a broad array of health care services. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 24418429 | Expense |
| Revenue | 28903513 | Revenue |
| Description | AS A RURAL HEALTHCARE FACILITY AND DEDICATED COMMUNITY HOSPITAL WITH A COMMITMENT TO PROVIDING A HIGH QUALITY CIRCLE OF CARE, JERSEY SHORE HOSPITAL HAS DEVELOPED DELIVERY SYSTEMS THAT PROVIDE AN EFFICIENT BALANCE OF OUTPATIENT CARE, ACUTE AND SUB-ACUTE INPATIENT CARE, PRIMARY CARE, AND OUTREACH SERVICES. THE HOSPITAL MAXIMIZES THE EFFECTIVENESS OF ITS PROGRAMS FOR QUALITY, EFFICIENCY, AND ACCESSIBILITY BY INTEGRATING WITH OTHER PROVIDERS AND ALTERNATIVE CARE ORGANIZATIONS IN THE SERVICE COMMUNITY TO ASSURE THE COMMUNITY ACCESS TO A BROAD ARRAY OF SERVICE OPTIONS.THE HOSPITAL PROVIDES AN ENVIRONMENT OF CARE THAT IS COMPASSIONATE, HIGHLY PERSONALIZED, AND FOCUSED ON THE PHYSICAL, PSYCHO-SOCIAL, AND SPIRITUAL NEEDS OF ITS PATIENTS THROUGH THE USE OF SKILLED NURSES, PHYSICIANS, TECHNICAL AND SUPPORT STAFF, MANAGEMENT, AND COMMUNITY LEADERS. THE HOSPITAL ALSO PROVIDES HEALTH EDUCATION, PROGRAMS IN PREVENTION, AND RELATED SUPPORT SERVICES TO THE COMMUNITY WITH THE GOAL OF IMPROVING THE OVERALL WELLNESS OF ITS RESIDENTS. THE HOSPITAL ENSURES THAT THE NECESSARY RESOURCES ARE AVAILABLE TO PROVIDE FOR COMPREHENSIVE, MANAGED HEALTH PROGRAMS IN THE MOST COST EFFECTIVE MANNER WHILE MAINTAINING A SAFE, PLEASANT, AND MEANINGFUL WORK AND PATIENT CARE ENVIRONMENT.THE HOSPITAL PROVIDES CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. CHARGES FORGONE FOR SERVICES RENDERED AND SUPPLIES FURNISHED UNDER THE CHARITY CARE POLICY AMOUNTED TO APPROXIMATELY $492,633 DURING THE YEAR ENDED JUNE 30, 2010. | Description |
| Total Program Service Expense | 24418429 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | 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 | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 110 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 344 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | 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 | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | PA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE CORPORATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5703980100 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1020 THOMPSON STREET | AddressLine1 |
| City | JERSEY SHORE | City |
| State | PA | State |
| ZIP Code | 17740 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (20 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 |
|---|---|---|---|---|---|---|---|
| CAREY PLUMMER | |||||||
| PRESIDENT & CEO | 40.00 | X | X | 194295 | 0 | 67150 | |
| HUBERT VALENICK | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| LEROY KEILOR III | |||||||
| CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 | |
| WILLIAM CAMERER III | |||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| CARMEN SPINNEY MD | |||||||
| SECRETARY | 1.00 | X | X | 0 | 160903 | 25751 | |
| GILBERT MATON | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DONALD GREENE MD | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JOHN A HUNTER DDS | |||||||
| MEMBER | 1.00 | X | 30000 | 0 | 0 | ||
| JAMES REESER | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| RICHARD BEATTY DMD | |||||||
| VICE CHAIRPERSON | 1.00 | X | X | 0 | 0 | 0 | |
| Paul Dempsey | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| Walter Eisenhauer | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| James Ely | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| STEVEN KATZ MD | |||||||
| MEMBER (MEDICAL DIRECTOR) | 1.00 | X | 0 | 388476 | 37932 | ||
| KURT WILLIAMS | |||||||
| CFO | 40.00 | X | 89356 | 0 | 11877 | ||
| AARON KOLB MD | |||||||
| Physician | 40.00 | 225112 | 0 | 34887 | X | ||
| THOMAS FORKER MD | |||||||
| PHYSICIAN | 40.00 | 175753 | 0 | 24162 | X | ||
| THOMAS BURGE | |||||||
| CRNA | 40.00 | 149715 | 0 | 24162 | X | ||
| Ronald Eister | |||||||
| Physician | 40.00 | 214604 | 0 | 31956 | X | ||
| JERRY CROSBY | |||||||
| PHARMACY DIRECTOR | 40.00 | 111659 | 0 | 27368 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1190494 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 549379 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 285245 | TotalOtherCompensation |
| Number Individuals GT100 K | 9 | 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 |
|---|---|---|---|---|---|
| SUSQUEHANNA HEALTH SYSTEM | |||||
| 1205 GRAMPIAN BOULEVARD | WILLIAMSPORT | PA | 17701 | IT SUPPORT/LAB TEST INTERPRETATION | 696850 |
| QUORUM HEALTH SYSTEM | |||||
| 105 CONTINENTAL PLACE | BRENTWOOD | TN | 370275014 | MANAGEMENT FEES | 518992 |
| Quest Diagnostics | |||||
| 315 Boulevard NE Ste 240 | Atlanta | GA | 30312 | Lab Services | 208450 |
| STAFF CARE | |||||
| PO BOX 281923 | ATLANTA | GA | 303841923 | ER PHYSICIAN LOCUMS | 107543 |
| Williamsport Pathology Assoc | |||||
| 777 Rural Avenue | WILLIAMSPORT | PA | 17701 | Lab TEST INTERPRETATION | 106994 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
| Fundraising Events | 19520 | FundraisingEvents |
| Government Grants | 266044 | GovernmentGrants |
| All Other Contributions | 162999 | AllOtherContributions |
| Total Contributions | 448563 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | GROSS PATIENT SVC REV | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 28901185 | TotalRevenueColumn |
| Related Or Exempt Function Income | 28901185 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 28901185 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 20002 | TotalRevenueColumn |
| Exclusion | $20,002 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 101686 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 27224 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 74462 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 74462 | TotalRevenueColumn |
| Exclusion | $74,462 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 1507 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 379 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 1128 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1128 | TotalRevenueColumn |
| Exclusion | $1,128 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 14062 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 19520 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 18456 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -4394 | TotalRevenueColumn |
| Exclusion | -$4,394 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| CAFETERIA/VENDING REV | 722210 | 108224 | $108,224 |
| REBATES/REFUNDS | 900099 | 41838 | $41,838 |
| RADIOLOGY ADMIN FEES | 900099 | 25000 | $25,000 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 10254 | TotalRevenueColumn |
| Related Or Exempt Function Income | 2328 | RelatedOrExemptFunctionIncome |
| Exclusion | $7,926 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 185316 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 29626262 | TotalRevenueColumn |
| Related Or Exempt Function Income | 28903513 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $274,186 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 362651 | Total |
| Management And General | 362651 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9042559 | Total |
| Program Services | 8166946 | ProgramServices |
| Management And General | 808801 | ManagementAndGeneral |
| Fundraising | 66812 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 301276 | Total |
| Program Services | 263827 | ProgramServices |
| Management And General | 35291 | ManagementAndGeneral |
| Fundraising | 2158 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1282993 | Total |
| Program Services | 1192695 | ProgramServices |
| Management And General | 80541 | ManagementAndGeneral |
| Fundraising | 9757 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 812349 | Total |
| Program Services | 711373 | ProgramServices |
| Management And General | 95157 | ManagementAndGeneral |
| Fundraising | 5819 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 282906 | Total |
| Program Services | 282906 | ProgramServices |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42477 | Total |
| Management And General | 42477 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 58724 | Total |
| Management And General | 58724 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5183908 | Total |
| Program Services | 4459801 | ProgramServices |
| Management And General | 713237 | ManagementAndGeneral |
| Fundraising | 10870 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 98082 | Total |
| Program Services | 5451 | ProgramServices |
| Fundraising | 92631 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3942734 | Total |
| Program Services | 3465189 | ProgramServices |
| Management And General | 463597 | ManagementAndGeneral |
| Fundraising | 13948 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 594161 | Total |
| Program Services | 594161 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26793 | Total |
| Program Services | 25143 | ProgramServices |
| Fundraising | 1650 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 39138 | Total |
| Program Services | 38964 | ProgramServices |
| Fundraising | 174 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 949407 | Total |
| Program Services | 949407 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1937480 | Total |
| Program Services | 1937480 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 513624 | Total |
| Program Services | 513624 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | FundraisingFundraising |
|---|---|---|---|
| Bad Debt Expense | 1630000 | 1630000 | |
| Dues & Books | 68450 | 68340 | 110 |
| Miscellaneous expenses | 59883 | 59788 | 95 |
| EmPLOYEE RECOGNITION | 53334 | 53334 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27282929 | Total |
| Program Services | 24418429 | ProgramServices |
| Management And General | 2660476 | ManagementAndGeneral |
| Fundraising | 204024 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1305 | BOY |
| EOY | 1425 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2446714 | BOY |
| EOY | 3423909 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 316751 | BOY |
| EOY | 217292 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2586744 | BOY |
| EOY | 2858519 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 280519 | BOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 286343 | BOY |
| EOY | 314915 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 367252 | BOY |
| EOY | 349860 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 32863090 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 14994281 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19270625 | BOY |
| EOY | 17868809 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1923671 | BOY |
| EOY | 3966367 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27479924 | BOY |
| EOY | 29001096 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2043074 | BOY |
| EOY | 2182949 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15000000 | BOY |
| EOY | 14838199 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4918581 | BOY |
| EOY | 5132230 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21961655 | BOY |
| EOY | 22153378 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5027326 | BOY |
| EOY | 6079759 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 490943 | BOY |
| EOY | 767959 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5518269 | BOY |
| EOY | 6847718 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27479924 | BOY |
| EOY | 29001096 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $2,419 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 2419 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part II-B, Line 1i: | Identifier |
| Return Reference | Explanation of Other Lobbying Activities: | ReturnReference |
| Explanation | THE HOSPITAL PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE HOSPITAL ASSOCIATION OF PENNSYLVANIA (HAP). A PORTION OF THE DUES PAID TO THESE TWO ORGANIZATIONS ($2,419 DURING THE YEAR ENDED JUNE 30, 2010) WAS USED FOR LOBBYING PURPOSES. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 147956 | OtherCostOrOtherBasis |
| Book Value | 147956 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 17344838 | OtherCostOrOtherBasis |
| Depreciation | 3330723 | Depreciation |
| Book Value | 14014115 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 14806013 | OtherCostOrOtherBasis |
| Depreciation | 11500980 | Depreciation |
| Book Value | 3305033 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 564283 | OtherCostOrOtherBasis |
| Depreciation | 162578 | Depreciation |
| Book Value | 401705 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 17868809 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | 57560 |
| DEFERRED FINANCING COSTS, NET | 127296 |
| DUE FROM AFFILIATES | 2081511 |
| Funded depreciation | 1700000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 3966367 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (7 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| OBLIGATIONS UNDER CAPITAL LEASES | $1,409,252 |
| DUE TO AFFILIATES | $816,091 |
| PATIENT REFUNDS PAYABLE | $49,169 |
| BLUE CROSS CURRENT FINANCING ADVANCE | $158,704 |
| ESTIMATED MEDICAL MALPRACTICE CLAIMS LIABILITY | $125,000 |
| Fair Value of Derivative Instrument | $373,900 |
| Accrued Pension Cost | $2,200,114 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 5132230 | TotalOfAmounts |
| Total Revenue | 29626262 | TotalRevenue |
| Total Expenses | 27282929 | TotalExpenses |
| Excess Or Deficit For Year | 2343333 | ExcessOrDeficitForYear |
| Other | -$1,013,884 | OtherAmount |
| Total Adjustments | -1013884 | TotalAdjustments |
| Excess Or Deficit Per FS | 1329449 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 28639601 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -1013884 | OtherRevenues |
| Revenue Not Rptd F990 | -1013884 | RevenueNotRptdF990 |
| Revenue Subtotal | 29653485 | RevenueSubtotal |
| Other Revenues Not Included | -27223 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -27223 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 29626262 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 27310152 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 27223 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 27223 | ExpensesNotRptdF990 |
| Expenses Subtotal | 27282929 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 27282929 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part X: | Description of Uncertain Tax Positions Under FIN 48: | The corporation accounts for uncertainty in income taxes using a recognition threshold of more-likely-than-not to be sustained upon examination by the appropriate taxing authority. Measurement of the tax uncertainty occurs if the recognition threshold has been met. Management determined there were no tax uncertainties that met the recognition threshold in 2010. |
| Part XI, Line 8 - Other Adjustments: | PENSION LIABILITY ADJUSTMENT: -675255. Change in Fair Value of Derivative Instrument: -338629. | |
| Part XII, Line 2d - Other Adjustments: | Change in Fair value of Derivative Instrument: -338629. PENSION LIABILITY ADJUSTMENT: -675255. | |
| Part XII, Line 4b - Other Adjustments: | RENTAL EXPENSE: -27223. | |
| Part XIII, Line 2d - Other Adjustments: | RENTAL EXPENSES: 27223. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Golf Tounament | NameOfEvent1 |
| Gross Receipts Event1 | 22881 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 14063 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 8818 | GrossRevenueEvent1 |
| Non Cash Prizes Event1 | 1200 | NonCashPrizesEvent1 |
| Food And Beverage Event1 | 2001 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 7600 | OtherDirectExpensesEvent1 |
| Name Of Event2 | Crab Fest | NameOfEvent2 |
| Gross Receipts Event2 | 10701 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 5457 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 5244 | GrossRevenueEvent2 |
| Food And Beverage Event2 | 4598 | FoodAndBeverageEvent2 |
| Other Direct Expenses Event2 | 3057 | OtherDirectExpensesEvent2 |
| Gross Receipts Total | 33582 | GrossReceiptsTotal |
| Charitable Contributions Total | 19520 | CharitableContributionsTotal |
| Gross Revenue Total Events | 14062 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 1200 | NonCashPrizesTotalEvents |
| Food And Beverage Total Events | 6599 | FoodAndBeverageTotalEvents |
| Other Direct Expenses Total Events | 10657 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 18456 | DirectExpenseSummaryEvents |
| Net Income Summary | -4394 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent250 | X | Pcent250 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 0 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 492633 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 492633 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01920 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2380817 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1543858 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 836959 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03260 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2873450 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1543858 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1329592 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05180 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 199164 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11824 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 187340 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00730 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 199164 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11824 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 187340 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00730 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3072614 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1555682 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1516932 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05910 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,630,000 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 5883131 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 4804279 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 1078852 | 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 | 1 | ProvisionForCharityCare |
Form990 Schedule H Part V Form990ScheduleHPartV
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jersey SHore Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1020 Thompson Street | AddressLine1 |
| City | Jersey Shore | City |
| State | PA | State |
| ZIP Code | 17740 | 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 |
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subsidized Health Services Expln | Part I, Line 7g: THERE ARE NO PHYSICIAN CLINICAL SERVICES INCLUDED. | SubsidizedHealthServicesExpln |
| Percent Of Total Expense Expln | Part I, Line 7f: Amount of bad debt expense from Part IX subtracted in order to calculate percent of total expense in Part I Line 7 column f was $1,630,000. | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | Part III, Line 4: Bad debt expense is based on a percentage of revenue during the year. The Allowance is evaluated at the end of the year and any adjustments are made to bad debt expense.discounts are not included in bad debt - they are included in contractual adjustments. payments on patient accounts are included in the allowance for bad debts. | BadDebtFootnote |
| Shortfall As Community Benefit | Part III, Line 8: N/A - as a CAH, we are reimbursed at 101% of cost from Medicare. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | Part III, Line 9b: Any remaining balance after charity care guidelines, falls under our general collection policy. | DebtCollectionPolicy |
| Needs Assessment | Part VI, Line 2: Several groups request health fairs. The Board and Management considered the health needs of the community. Community members have requested the program. | NeedsAssessment |
| Patient Education Assistance | Part VI, Line 3: patients are counseled on an individual basis in person or phone conversation as to the availability of state or corporate programs. At the time of registration, self-pay patients are informed of assistance available. Patient statements indicate assistance that is available. | PatientEducationAssistance |
| Community Information | Part VI, Line 4: Jersey Shore Hospital's Primary service area covers much of Clinton County and Lycoming County - an area with a population of approximately 40,000. Jersey Shore Hospital is considered to be in a Medically Underserved Area (MUA). Jersey Shore and Jersey Shore Hospital is located in Lycoming County, which has an area of 1,237 square miles. It is the largest county in Pennsylvania and occupies a hilly and heavily forested part of the state. The West Branch of the Susquehanna River flows through the southern part of the county. Jersey Shore is approximately 45 miles northeast of State College Pennsylvania and approximately 15 miles west of Williamsport, Pennsylvania.Seventy-nine point four percent (79.4%) of Jersey Shore Hospital inpatients live in the primary service area (PSA) which is in Lycoming County and Clinton County, Pennsylvania. The Primary Service Area (PSA) for Jersey Shore Hospital consists of four zip codes: 17720 - Jersey Shore, 17745 - Lock Haven, 17779 - Woolrich and 17751 - Mill Hall.Jersey Shore Hospital relies upon a relatively small geographic area to support the hospital.The SSA (secondary service area) consists of 9 additional zip codes which are important to the hospital and from which 17% of hospitalized patients originate. These zip codes are to the west and northeast of the PSA.The total Service Area for Jersey Shore Hospital has a population of 103,102 and is expected to decrease in population by 1.2% by 2012 to 101,890.A major demographic issue affecting Jersey Shore Hospital is the aging population.The percent of the population over the age of 65 in the PSA is 16% and 16.6% in the SSA. This compares to the over 65 population for the U.S. of 12%. The senior population is expected to increase by 5.8% in the PSA and by 4% in the SSA by 2012.This growing elderly segment should generate a future demand for health care services, since individuals over age 65 use healthcare and hospital services at 2.7 times the rate of the under age 65 population.A demographic reality is the low income level of area households. Currently, the Median Household Income in the Service Area is $35,956, compared to PA ($45,038) and the U.S. ($48,250). By 2012 the PSA is anticipated to have a median household income of $41,006. This is 82% of the Pennsylvania state average household income and considerably below the national average.The Service Area is not racially diversified to a significant degree, with 98.6% of the population considered white.The Educational Profile of the Service Area demonstrates that 44% of the population has a high school education and 7.1% of the population has an Associate Degree. The percentage achieving a Bachelor or Professional Degree is less than Pennsylvania or the U.S. as a whole. A higher percentage of the labor force in the area is engaged in Manufacturing / Construction when compared to the State and US as a whole.In terms of patients served, Combined Inpatient and Outpatient Payer Mix in 2010 reflected a slight decrease in Medicare, Blue Cross, HMO and Self Pay and a slight increase in Commercial. This is the first time in over five years that HMO has decreased. Our Medical Assistance business continued to have a significant impact on JSH as a Critical Access Hospital. Medical Assistance payments make up 9.35% of our payers, which is up over 6% from 2009. | CommunityInformation |
| Other Information | Part VI, Line 6: All of the persons serving on our board live in the primary communities being served by the hospital. The board consists of some physicians who are employees of a related entity, a few contractors, and several other community members.The hospital extends staff privileges to all qualified physicians in the area. As applicable, the hospital applies suplus funds to improvements in patient care through new and updated equipment purchases, major facility improvements, and community health programs.The hospital participates in Medicare, Medicaid, Champus, and Tricare. | OtherInformation |
| Affiliated Health Care System | Part VI, Line 7: The hospital is part of Jersey Shore Healthcare, Inc. This affiliation includes a non-profit physician practice with family practice physicians and surgeons.PART VI, LINE 8: N/A | AffiliatedHealthCareSystem |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | X | WrittenEmploymentContract |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CAREY PLUMMER | |||||||||||||
| 194295 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 67150 | 0 | 261445 | 0 | 0 | 0 |
| CARMEN SPINNEY MD | |||||||||||||
| 0 | 160903 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 25751 | 0 | 186654 | 0 | 0 |
| STEVEN KATZ MD | |||||||||||||
| 0 | 388476 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 37932 | 0 | 426408 | 0 | 0 |
| AARON KOLB MD | |||||||||||||
| 225112 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 34887 | 0 | 259999 | 0 | 0 | 0 |
| THOMAS FORKER MD | |||||||||||||
| 175753 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 24162 | 0 | 199915 | 0 | 0 | 0 |
| THOMAS BURGE | |||||||||||||
| 149715 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 24162 | 0 | 173877 | 0 | 0 | 0 |
| Ronald Eister | |||||||||||||
| 214604 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 31956 | 0 | 246560 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Form 990, Part VI, Section A, line 2 | Hubert Valencik and Leroy H. Keilor,III, board members, are both on the board of Jersey Shore State Bank. |
| Form 990, Part VI, Section A, line 3 | THE ORGANIZATION UTILIZES THE MANAGEMENT SERVICES OF QUORUM HEALTH SYSTEM. |
| Form 990, Part VI, Section B, line 11 | The Form 990 was reviewed in detail by management before filing with the IRS. A copy of the 990 was provided to all board members after filing with the IRS. |
| Form 990, Part VI, Section B, line 12c | ALL BOARD MEMBERS AND EMPLOYEES ARE REQUIRED TO ANNUALLY COMPLETE A CONFLICT OF INTEREST STATEMENT. THESE ARE REVIEWED BY MANAGEMENT. BOARD MEMBERS ARE REQUIRED TO RECUSE THEMSELVES FROM VOTING ON MATTERS THAT ARE RELATED TO ANY POTENTIAL CONFLICTS. THERE HAS NEVER BEEN AN ISSUE INVOLVING CONFLICTS OF INTEREST. |
| Form 990, Part VI, Section B, line 15 | The Personnel Salary committee and Quorum (management company) reviews an executive compensation study performed by Yaffee, an independent third party who is employed by HAP to conduct a compensation study. HR also provides a compensation study from ACRS which is based on the Appalachian region. These two studies are used to determine FMV. The recommendations for compensation levels and passed on to the Board for their approval. Approval is documented in the minutes. The actual amount of compensation is not included in the minutes for privacy purposes. |
| Form 990, Part VI, Section C, line 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART I, LINES 9 AND 17: | Contractual Allowances are reported in the current year as net of patient service revenue as is typically done with hospital organizations. Prior year presentation reflected Gross patient service revenue on the Statement of Revenues (line 9 of Part I) and contractual allowances on the Statement of Functional Expenses (line 17 of Part I). |
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 | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|
| JERSEY SHORE HEALTH CARE INC | ||||||||||
| 1020 THOMPSON STREET | JERSEY SHORE | PA | 17740 | 232480603 | HEALTHCARE | PA | 501(C)(3) | 3 | N/A | |
| SHORE PROPERTIES CORPORATION | ||||||||||
| 1020 THOMPSON STREET | JERSEY SHORE | PA | 17740 | 231280605 | SUPPORT JERSEY SHORE HEALTH CARE INC. THROUGH RENTAL INCOME | PA | 501(C)(3) | 11A | JERSEY SHORE HEALTH CARE INC | |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JERSEY SHORE AREA HEALTH SERVICES CORPORATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1020 THOMPSON STREET | AddressLine1 |
| City | JERSEY SHORE | City |
| State | PA | State |
| ZIP Code | 17740 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 232192826 | EIN |
| Primary Activity | LABORATORY SERVICES | PrimaryActivity |
| Legal Domicile State | PA | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JERSEY SHORE HEALTH CARE INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 1 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | 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 | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | 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 | 1 | OtherTransferFromOtherOrg |
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