MOUNTAIN VIEW NURSING HOME INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
MOUNTAIN VIEW NURSING HOME INC (EIN 23-2568288)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-05-16
IRS object ID
201141369349303454
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-05-16T11:47:38-05:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ParenteBeard LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line146 Public Square Suite 400AddressLine1
CityWilkesBarreCity
StatePAState
ZIP Code18701ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN232568288EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MOUNTAIN VIEW NURSING HOME INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMOUNNameControl
Phone5703410050Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11822 MULBERRY STREETAddressLine1
CitySCRANTONCity
StatePAState
ZIP Code18510ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJim JesikiewiczName
TitleAccounting Mngr/Assistant TreasurerTitle
Phone5709698227Phone
Date Signed2011-05-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJulius Green CPAName
Phone5708200100Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJAMES JESIKIEWICZNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11822 MULBERRY STREETAddressLine1
CitySCRANTONCity
StatePAState
ZIP Code18510ZIPCode
FieldValueIRS element (for citing)
Gross Receipts16170231GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitemountainviewcarecenter.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1989YearFormation
State Legal DomicilePAStateLegalDomicile
Activity Or Mission DescriptionTO OPERATE A LONG-TERM CARE FACILITY.ActivityOrMissionDescription
Nbr Voting Members Governing Body6NbrVotingMembersGoverningBody
Nbr Independent Voting Members5NbrIndependentVotingMembers
Total Nbr Employees270TotalNbrEmployees
Total Nbr Volunteers83TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year985ContributionsGrantsPriorYear
Contributions Grants Current Year9506ContributionsGrantsCurrentYear
Program Service Revenue Prior Year15518430ProgramServiceRevenuePriorYear
Program Service Revenue CY15776874ProgramServiceRevenueCY
Investment Income Prior Year253724InvestmentIncomePriorYear
Investment Income Current Year152548InvestmentIncomeCurrentYear
Other Revenue Prior Year222508OtherRevenuePriorYear
Other Revenue Current Year231303OtherRevenueCurrentYear
Total Revenue Prior Year15995647TotalRevenuePriorYear
Total Revenue Current Year16170231TotalRevenueCurrentYear
Grants And Similar Amnts CY2000000GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year8917586SalariesEtcPriorYear
Salaries Etc Current Year9639273SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year5648989OtherExpensePriorYear
Other Expenses Current Year5663425OtherExpensesCurrentYear
Total Expenses Prior Year14566575TotalExpensesPriorYear
Total Expenses Current Year17302698TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1429072RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1132467RevenuesLessExpensesCY
Total Assets BOY14793584TotalAssetsBOY
Total Assets EOY13894935TotalAssetsEOY
Total Liabilities BOY7147241TotalLiabilitiesBOY
Total Liabilities EOY7130455TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY7646343NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY6764480NetAssetsOrFundBalancesEOY
Mission DescriptionTO OPERATE A LONG-TERM CARE FACILITY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense15473020Expense
Grants2000000Grants
Revenue15776874Revenue
DescriptionMountain View Nursing Home, Inc. (MVCC) is a tax-exempt, Pennsylvania not for profit corporation organized under Section 501 (c) (3) of the Internal Revenue Code, which owns and operates a 180 bed long term care, skilled nursing and rehabilitation facility located in the City of Scranton, located approximately 4.5 miles from Community Medical Center (CMC). MVCC provides nursing and medical services to residents at varying levels of care, including 24 hour skilled nursing care, rehabilitative therapies, and assistance with activities of daily living.In addition to nursing and skilled nursing, services include a 24 bed unit specializing in the care of individuals with Alzheimer's Disease. The staff of this unit are specially trained to deal with dementia with emphasis on behavioral management and communication techniques. A complete range of rehabilitation therapies include physical, respiratory, occupational, and speech therapies designed to assist residents in the pursuit of health and wellness. To enhance residents' quality of life, activities are incorporated into each resident's daily routine. Activities range from an exercise program to pet therapy and are based on individual abilities and needs.Governance:Membership. The Community Medical Center Healthcare System (the System) is the sole corporate member of MVCC. The System was incorporated in 1983 as a non-stock, not for profit corporation under the laws of the Commonwealth of Pennsylvania and is a 501 (c) (3) Entity. Board of Directors. MVCC is governed by a Board of Directors (the Board), elected by the System, and consisting of six members. Subject to the powers reserved to the System, the administrative powers of MVCC are vested in the MVCC Board who have charge, control, and management of property, affairs, and funds of MVCC, and which has the power and authority to do and perform all acts and functions.Auxiliary:The MVCC Auxiliary is comprised of volunteer members who organize fundraising functions, such as flea markets, bazaars, and dinners. Proceeds are used to benefit residents through holiday parties, purchasing of activity supplies, and assistance in purchasing clothing and/or medical equipment for residents who cannot afford to purchase them.Education and ResearchMVCC has partnered with several institutions of higher learning to provide students with hands-on training in the workplace. Students from the Physician Assistant, Nursing, Dietary, Social Work, and Health Administration departments of Marywood University, The University of Scranton, Wilkes University, State University of New York, College Misericordia Georgetown University, Penn State university, Allied Medical and Technical Careers, and Career Institute of Technology obtain a rotation in a skilled care setting. MVCC is also a placement site for Scranton School Districts alternative education program.Support to the Community:MVCC participates in educating the public about skilled nursing care through participation in the Hospice Fair, which is sponsored by the VNA Hospice, is open to the public, and includes free health screenings. Annually, MVCC sponsors a health fair as a gift to the community, which offers free diagnostic testing as well as information on services available to seniors within the community. MVCC also participates in other community health fairs sponsored by organizations that provide care to seniors.Volunteer Services:In addition to the support provided by the MVCC Auxiliary, each year adult and junior volunteers provide one to one visitation with residents, and adult volunteers participate in religious services, provide entertainment, and act as chaperones to resident outings. Junior volunteers participate in an intergenerational program, through which local schools, day care centers and other junior volunteers assist in providing a more homelike environment, and assist with various activities.Description
Total Program Service Expense15473020TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109621NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees270NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Form8899 Filed0Form8899Filed
Form1098 C Filed0Form1098CFiled
Nbr Voting Governing Body Members6NbrVotingGoverningBodyMembers
Number Independent Voting Members5NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledPAStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1JAMES JESIKIEWICZBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5709698227TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11822 MULBERRY STREETAddressLine1
CitySCRANTONCity
StatePAState
ZIP Code18510ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (11 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
SIDNEY PREJEAN
DIRECTOR0.50X000
WILLIAM J BURKAVAGE
DIRECTOR0.50X000
GEORGE GINADER
DIRECTOR0.50X000
LETHA WELLS REINHEIMER
DIRECTOR0.50X000
John Nilsson
Interim President & CEO0.50X05784810X
DAVID HAWK
CHAIRMAN0.50X000X
Thomas Kelly Jr
Interim CFO0.5003803490X
BARBARA BOSSI
Assistant Secretary0.50024089613099X
Joseph Fisne
VP of Information Systems0.50019280111513X
james jesikiewicz
acct mngr/asst treasurer0.5006044713414X
William Kammerer
Administrator40.00114706010208X
FieldValueIRS element (for citing)
Total Reportable Comp From Org114706TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1452974TotalReportableCompFrmRltdOrgs
Total Other Compensation48234TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY MEDICAL CENTERBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11822 MULBERRY STREETAddressLine1
CitySCRANTONCity
StatePAState
ZIP Code18510ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesTHERAPY SERVICESDescriptionOfServices
Compensation896173Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
All Other Contributions9506AllOtherContributions
Total Contributions9506TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNET PATIENT SERVICE REDescription
Business Code623000BusinessCode
Total Revenue Column15776874TotalRevenueColumn
Related Or Exempt Function Income15776874RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue15776874TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column152548TotalRevenueColumn
Exclusion$152,548ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
Gift Shop453220139647$139,647
BEAUTY SHOP81290038894$38,894
CABLE TV & LINEN90009933515$33,515

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column19247TotalRevenueColumn
Exclusion$19,247ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue231303TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column16170231TotalRevenueColumn
Related Or Exempt Function Income15776874RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$383,851ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total2000000Total
Program Services2000000ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7783047Total
Program Services7249346ProgramServices
Management And General533701ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total229095Total
Program Services219077ProgramServices
Management And General10018ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1056027Total
Program Services1011388ProgramServices
Management And General44639ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total571104Total
Program Services531303ProgramServices
Management And General39801ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total1944Total
Management And General1944ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total13356Total
Management And General13356ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total11226Total
Management And General11226ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1237963Total
Program Services1132376ProgramServices
Management And General105587ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total28868Total
Management And General28868ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total402357Total
Program Services265403ProgramServices
Management And General136954ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total344228Total
Program Services344228ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total14594Total
Program Services7032ProgramServices
Management And General7562ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total257857Total
Management And General257857ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total598181Total
Management And General598181ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total37965Total
Management And General37965ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Patient supplies13639441363944
NURSING HOME ASSESSMENT13425901342590
bad debt expense63336333
donations12501250
licenses769769

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total17302698Total
Program Services15473020ProgramServices
Management And General1829678ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
EOY850EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY5341186BOY
EOY4397812EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1461679BOY
EOY1331178EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY125847BOY
EOY112540EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY17220BOY
EOY33063EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis12669734LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec9679201LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY3195625BOY
EOY2990533EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY3856034BOY
EOY4239566EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY795993BOY
EOY789393EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY14793584BOY
EOY13894935EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1636725BOY
EOY1989352EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY5422063BOY
EOY5041089EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY88453BOY
EOY100014EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY7147241BOY
EOY7130455EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY7646343BOY
EOY6764480EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7646343BOY
EOY6764480EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY14793584BOY
EOY13894935EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4370CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4715CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1105CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year985CurrentTaxYearMinus1Year
Current Tax Year3247CurrentTaxYear
Total14422Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years12400607CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years13858331CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years15042416CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year15518430CurrentTaxYearMinus1Year
Current Tax Year15776874CurrentTaxYear
Total72596658Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years12404977CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years13863046CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years15043521CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year15519415CurrentTaxYearMinus1Year
Current Tax Year15780121CurrentTaxYear
Total72611080Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50972611080PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years538210CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years589814CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years259495CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year253724CurrentTaxYearMinus1Year
Current Tax Year152548CurrentTaxYear
Total1793791Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years538210CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years589814CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years259495CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year253724CurrentTaxYearMinus1Year
Current Tax Year152548CurrentTaxYear
Total1793791Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years83695CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years139469CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years228510CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year222508CurrentTaxYearMinus1Year
Current Tax Year231303CurrentTaxYear
Total905485Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years13026882CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years14592329CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years15531526CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year15995647CurrentTaxYearMinus1Year
Current Tax Year16163972CurrentTaxYear
Total75310356Total
FieldValueIRS element (for citing)
Public Support Percentage5090.96420PublicSupportPercentage509
Prior Year Support Percentage0.94080PriorYearSupportPercentage
Investment Income Percentage0.02380InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.02490PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis8271147OtherCostOrOtherBasis
Depreciation6581037Depreciation
Book Value1690110BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis4398587OtherCostOrOtherBasis
Depreciation3098164Depreciation
Book Value1300423BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2990533TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
TRUST HELD FUNDS688161
DEFERRED EXPENSES47375
BOND DISCOUNT53857
FieldValueIRS element (for citing)
Total Book Value Other Assets789393TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionLONG-TERM INSURANCEDescription
Amount$100,014Amount
FieldValueIRS element (for citing)
Total Of Amounts100014TotalOfAmounts
Total Revenue16170231TotalRevenue
Total Expenses17302698TotalExpenses
Excess Or Deficit For Year-1132467ExcessOrDeficitForYear
Net Unrealized GL On Investments250604NetUnrealizedGLOnInvestments
Total Adjustments250604TotalAdjustments
Excess Or Deficit Per FS-881863ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt16409609TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments250604NetUnrealizedGainsInvestments
Revenue Not Rptd F990250604RevenueNotRptdF990
Revenue Subtotal16159005RevenueSubtotal
Other Revenues Not Included11226OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt11226RevenueNotRptdOnFinStmt
Total Revenue Per Form99016170231TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt17291472TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal17291472ExpensesSubtotal
Other Expenses Not Included11226OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt11226ExpensesNotRptdOnFinStmt
Total Expenses Per Form99017302698TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part X:Description of Uncertain Tax Positions Under FIN 48:THE SYSTEM ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES IN THE CONSOLIDATED FINANCIAL STATEMENTS 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 HAS DETERMINED THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD.
Part XII, Line 4b - Other Adjustments:INVESTMENT MANGEMENT FEES INCLUDED IN INVESTMENT INCOME : 11226.
Part XIII, Line 4b - Other Adjustments:INVESTMENT MANAGEMENT FEES INCLUDED IN INVESTMENT INCOME : 11226.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained0RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1Community Medical Center Healthcare SystemBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11822 Mulberry StreetAddressLine1
CityScrantonCity
StatePAState
ZIP Code18510ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient232279376EINOfRecipient
IRC Section501(c)(3)IRCSection
Amount Of Cash Grant2000000AmountOfCashGrant
Method Of ValuationcashMethodOfValuation
Purpose Of Grantgeneral support to affiliated entityPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsXTravelForCompanions
Housing Allowance Or ResidenceXHousingAllowanceOrResidence
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 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
John Nilsson
0552000000264810000057848100
Thomas Kelly Jr
0360000000203490000038034900
BARBARA BOSSI
0240896000001064002459025399500
Joseph Fisne
019280100000917802335020431400

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part I, Line 1aTravel for companions and housing allowances are paid directly to Quorum Health Resources on behalf of the CEO and CFO.
Part IIIJohn Nilsson, Interim President & CEO of Community Medical Center receives compensation for services rendered in capacity as an officer from Quorum Health Resources, an unrelated organization. Total compensation including benefits paid to Quorum Health Resources for the year was $578,481. Thomas Kelly Jr., Interim CFO of Community Medical Center receives compensation for services rendered in capacity as an officer from Quorum Health Resources, an unrelated organization. Total compensation including benefits paid to Quorum Health Resources for the year was $380,349.Supplemental Information

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierExplanationExplanation
Form 990, Part VI, Section A, line 3The Organization delegates responsibility to an outside management company Quorum Health Resources for their CEO and CFO job functions. The organization delineates the responsibilities in the management agreements and reports to the Board of Directors compliance with the delegated duties.
Form 990, Part VI, Section B, line 11THE FINANCE STAFF REVIEWS ALL FORMS BEFORE FILING WITH IRS. FOR THE 2009 YEAR, THE 990 WILL BE PRESENTED TO THE BOARD BEFORE FILING.
Form 990, Part VI, Section B, line 12cEach year in January, the Conflict of Interest Policy along with a Conflict of Interest Statement is sent to all Board Members for their review and completion. After all statements are received back, each one is recorded into a summary which is presented at the Board of Directors meeting in March/April.
Form 990, Part VI, Section B, line 15The Board of Directors maintains an Executive Compensation Committee for the purpose of reviewing the performance and compensation of the Executives. The Executive Compensation Committee of the Board utilizes information from external third parties to validate that the compensation for executives is appropriate or fair market value. During fiscal year 2010 Community Medical Center had engaged a company to provide the Chief Executive Officer and Chief Financial Officer. Prior to engaging this firm, proposals from other firms were evaluated. This evaluation helped to confirm the fair market value for contracting for these two senior executives.
Form 990, Part VI, Section C, line 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
Form 990, Part XI, Line 2c:THE ORGANIZATION HAS AN AUDIT COMMITTEE THAT IS RESPONSIBLE FOR OVERSIGHT DURING THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNA
COMMUNITY MEDICAL CENTER
1822 MULBERRY STREETSCRANTONPA18510240862246HOSPITAL BASED HEALTHCARE SERVICESPA501(C)(3)170(B)(1)(A)(III)N/A
COMMUNITY MEDICAL CARE INC
1822 MULBERRY STREETSCRANTONPA18510232429776PHYSICIAN PRACTICESPA501(C)(3)170(B)(1)(A)(III)N/A
COMMUNITY MEDICAL CENTER HEALTHCARE SYSTEM
1822 MULBERRY STREETSCRANTONPA18510232279376SUPPORTS ACTIVITIES OF CMC AND AFFILIATESPA501(C)(3)509(A)(3) TYPE 1N/A
MEDICAL DIMENSIONS INC
1822 MULBERRY STREETSCRANTONPA18510232369788REAL ESTATE HOLDING COMPANY FOR THE HEALTHCARE SYSTEMPA501(C)(2)N/AN/A
COMMUNITY MEDICAL CENTER HEALTHCARE SYSTEM MEDICAL PROF LIAB SELF INSURANCE
1800 MULBERRY STREETSCRANTONPA18510046990600SELF INSURANCE FOR AFFILIATESPA501(C)(3)509(A)(3) TYPE 1N/A
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1MEDICAL DIMENSIONS INCBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeJTransactionType
Amount Involved15000AmountInvolved

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