BARNES-KASSON COUNTY HOSPITAL: Form 990, tax year 2024
View the entire original 990 at ProPublica ↗
- Organization
- BARNES-KASSON COUNTY HOSPITAL (EIN 24-0798681)
- Tax period
- 2024-07-01 to 2025-06-30
- Filed
- 2026-05-15
- IRS object ID
- 202641359349309309
- Schema version
- 2024v5.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2026-05-15T12:37:51+00:00 | ReturnTs |
| Tax Period End | 2025-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 440160260 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Forvis Mazars LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 910 E St Louis 200 PO Box 1190 | AddressLine1Txt |
| City | Springfield | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 658062523 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2024-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 240798681 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BARNES-KASSON COUNTY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BARN | BusinessNameControlTxt |
| Phone | 5708533135 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2872 TURNPIKE STREET | AddressLine1Txt |
| City | SUSQUEHANNA | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 18847 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JAMES PETTINATO | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 5702538100 | PhoneNum |
| Signature | 2026-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (true) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Brian Todd | PreparerPersonNm |
| PTIN | P00422601 | PTIN |
| Phone | 4178658701 | PhoneNum |
| Preparation | 2026-05-15 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2024 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAMES PETTINATO | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 601 PARK STREET | AddressLine1Txt |
| City | HONESDALE | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 18431 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $18,013,280 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.BARNES-KASSON.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1904 | FormationYr |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | BARNES-KASSON COUNTY HOSPITAL IS A 501(C)(3) NON-PROFIT HOSPITAL. AS SUCH, OUR FACILITY'S MISSION IS TO PROVIDE ACCESS TO AFFORDABLE HIGH QUALITY HEALTH CARE SERVICES IN OUR RURAL COMMUNITY. (SEE ON SCHEDULE O) | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 265 | TotalEmployeeCnt |
| Total Volunteers | 9 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,732,598 | PYContributionsGrantsAmt |
| CY Contributions Grants | $169,827 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $17,445,329 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $17,787,582 | CYProgramServiceRevenueAmt |
| PY Investment Income | $14,809 | PYInvestmentIncomeAmt |
| CY Investment Income | $20,579 | CYInvestmentIncomeAmt |
| PY Other Revenue | $334,186 | PYOtherRevenueAmt |
| CY Other Revenue | $28,950 | CYOtherRevenueAmt |
| PY Total Revenue | $19,526,922 | PYTotalRevenueAmt |
| CY Total Revenue | $18,006,938 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,861,795 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,807,084 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,582,124 | PYOtherExpensesAmt |
| CY Other Expenses | $8,721,148 | CYOtherExpensesAmt |
| PY Total Expenses | $20,443,919 | PYTotalExpensesAmt |
| CY Total Expenses | $18,528,232 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$916,997 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$521,294 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $9,705,610 | TotalAssetsBOYAmt |
| Total Assets EOY | $10,288,190 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,889,088 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,991,536 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,816,522 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $6,296,654 | NetAssetsOrFundBalancesEOYAmt |
| Mission | BARNES-KASSON COUNTY HOSPITAL IS A 501 (C)(3) NON-PROFIT HOSPITAL. AS SUCH, OUR FACILITIES MISSION IS TO PROVIDE ACCESS TO AFFORDABLE, HIGH QUALITY HEALTH CARE SERVICES TO THE POPULATION OF RURAL SUSQUEHANNA COUNTY AND SURROUNDING AREAS. (SEE ON SCHEDULE O) | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $16,386,975 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $17,787,582 | RevenueAmt |
| Desc | BARNES-KASSON COUNTY HOSPITAL PROVIDES HEALTH CARE SERVICES TO THE POPULATION OF RURAL SUSQUEHANNA COUNTY AND SURROUNDING AREAS. OUR FACILITY PROVIDES AN ARRAY OF HEALTH CARE SERVICES, INCLUDING EMERGENCY CARE, RADIOLOGY, LABORATORY, PHYSICAL AND OCCUPATIONAL THERAPY, AND SKILLED NURSING. OUR FACILITY'S RURAL HEALTH CLINIC PROVIDES PRIMARY/SPECIALTY PHYSICIAN AND DENTAL SERVICES. THE DENTISTRY SERVICE PROVIDED IN THE RURAL HEALTH CLINIC IS THE ONLY DENTISTRY SERVICE IN THE IMMEDIATE AREA THAT PROVIDES SERVICE TO MEDICAID BENEFICIARIES. DURING THE 2025 FISCAL YEAR, WE HAD 313 INPATIENT ADMISSIONS. OF THOSE, 172 WERE MEDICARE RECIPIENTS AND 14 WERE MEDICAID RECIPIENTS. THE SKILLED NURSING FACILITY PROVIDED 12,845 DAYS OF SERVICE. | Desc |
| Total Program Service Expenses | $16,386,975 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 22 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 265 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (true) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Policies Reference Chapters | false | PoliciesReferenceChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Written Policy Or Procedure | false | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | PA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAMES PETTINATO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5702538100 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 601 PARK STREET | AddressLine1Txt |
| City | HONESDALE | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 18431 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| JOSEPH WHITE | ||||||||
| VICE PRESIDENT | 0.5 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| PATRICK AHEARN | ||||||||
| PRESIDENT | 1.0 | 0.5 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| CHARLES ALIANO ESQ | ||||||||
| TRUSTEE/ATTORNEY | 20.0 | 0 | Yes (X) | $39,998 | $0 | $0 | ||
| DONALD BUTTON | ||||||||
| TRUSTEE | 0.5 | 0 | Yes (X) | $0 | $0 | $0 | ||
| GEORGE STOVER III | ||||||||
| TRUSTEE | 0.5 | 0 | Yes (X) | $0 | $0 | $0 | ||
| LAURETTA CLOWES | ||||||||
| TRUSTEE END 02/25 | 0.5 | 0 | Yes (X) | $0 | $0 | $0 | ||
| PRAVINCHANDRA PATEL MD | ||||||||
| TRUSTEE/MEDICAL STAFF PRES | 40.0 | 0 | Yes (X) | $415,995 | $0 | $0 | ||
| ROBERT PAGE | ||||||||
| TRUSTEE | 0.5 | 0 | Yes (X) | $0 | $0 | $0 | ||
| ROSARIA ARMETTA | ||||||||
| TRUSTEE | 0.5 | 0 | Yes (X) | $0 | $0 | $0 | ||
| JAMES PETTINATO | ||||||||
| WMHS CHIEF EXECUTIVE OFFICER | 0.1 | 40.0 | Yes (X) | $0 | $353,924 | $54,007 | ||
| KELLI KANE | ||||||||
| CHIEF FINANCIAL OFFICER | 40.0 | 0 | Yes (X) | $98,281 | $0 | $25,109 | ||
| PATRICIA DUNSINGER | ||||||||
| WMHS CHIEF FINANCIAL OFFICER | 1.0 | 40.0 | Yes (X) | $0 | $211,723 | $12,763 | ||
| SARA ADORNATO | ||||||||
| EXECUTIVE DIRECTOR | 40.0 | 0 | Yes (X) | $132,633 | $0 | $25,109 | ||
| AMY VIVONA | ||||||||
| DON/RNAC | 40.0 | 0 | $148,764 | $0 | $15,401 | Yes (X) | ||
| BHUPENDRA PATEL MD | ||||||||
| PHYSICIAN | 40.0 | 0 | $599,249 | $0 | $22,004 | Yes (X) | ||
| DANIEL COSTER MD | ||||||||
| PHYSICIAN | 40.0 | 0 | $297,977 | $0 | $0 | Yes (X) | ||
| KIRK HINKLEY MD | ||||||||
| PHYSICIAN | 40.0 | 0 | $356,067 | $0 | $16,511 | Yes (X) | ||
| PATRICK MACCONNELL DPM | ||||||||
| PHYSICIAN | 40.0 | 0 | $146,779 | $0 | $9,168 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,235,743 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $565,647 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $180,072 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 13 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Computer Programs and Systems | |||||
| PO Box 850309 | Mobile | AL | 36685 | Computer Program Support | $382,100 |
| Qualivis LLC | |||||
| PO Box 674913 | Dallas | TX | 75267 | Staffing Agency | $188,191 |
| Blue Ridge Family Health LLC | |||||
| PO Box 602 | New Milford | PA | 18834 | Nurse Practioner Services | $141,800 |
| TQCS LLC | |||||
| 2533 Tingley Lake Rd | New Milford | PA | 18834 | Cleaning Services | $112,535 |
| K4MD Inc | |||||
| 880 Colwell Rd | Susquehanna | PA | 18847 | Emergency Department Physician | $103,850 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $143,000 | GovernmentGrantsAmt |
| All Other Contributions | $26,827 | AllOtherContributionsAmt |
| Total Contributions | $169,827 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 623000 | $12,843,775 | $12,843,775 |
| PA RURAL HEALTH MODEL REVENUE | 623000 | $4,783,858 | $4,783,858 |
| PHARMACY REVENUE | 446110 | $88,743 | $88,743 |
| CAFETERIA | 722514 | $46,041 | $46,041 |
| OTHER REVENUE | 900099 | $25,165 | $25,165 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $17,787,582 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $26,921 | TotalRevenueColumnAmt |
| Exclusion | $26,921 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $28,950 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $28,950 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $28,950 | TotalRevenueColumnAmt |
| Exclusion | $28,950 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $6,342 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | -$6,342 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$6,342 | TotalRevenueColumnAmt |
| Exclusion | -$6,342 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,006,938 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,787,582 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $49,529 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $737,125 | TotalAmt |
| Program Services | $415,995 | ProgramServicesAmt |
| Management And General | $321,130 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,413,297 | TotalAmt |
| Program Services | $6,825,491 | ProgramServicesAmt |
| Management And General | $587,806 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $922,365 | TotalAmt |
| Program Services | $816,969 | ProgramServicesAmt |
| Management And General | $105,396 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $734,297 | TotalAmt |
| Program Services | $616,809 | ProgramServicesAmt |
| Management And General | $117,488 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,327,046 | TotalAmt |
| Program Services | $3,877,215 | ProgramServicesAmt |
| Management And General | $449,831 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $530,188 | TotalAmt |
| Program Services | $213,679 | ProgramServicesAmt |
| Management And General | $316,509 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,154 | TotalAmt |
| Program Services | $2,649 | ProgramServicesAmt |
| Management And General | $505 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $432,689 | TotalAmt |
| Program Services | $378,908 | ProgramServicesAmt |
| Management And General | $53,781 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,516 | TotalAmt |
| Program Services | $1,443 | ProgramServicesAmt |
| Management And General | $1,073 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,279 | TotalAmt |
| Program Services | $7,983 | ProgramServicesAmt |
| Management And General | $296 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $106,986 | TotalAmt |
| Program Services | $89,868 | ProgramServicesAmt |
| Management And General | $17,118 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $588,104 | TotalAmt |
| Program Services | $494,007 | ProgramServicesAmt |
| Management And General | $94,097 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $335,406 | TotalAmt |
| Program Services | $281,741 | ProgramServicesAmt |
| Management And General | $53,665 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES & DRUGS | $2,224,823 | $2,224,823 | |
| REPAIRS & MAINTENANCE | $136,902 | $118,349 | $18,553 |
| LICENSES, DUES, SUBCRIPTIONS | $25,055 | $21,046 | $4,009 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,528,232 | TotalAmt |
| Program Services | $16,386,975 | ProgramServicesAmt |
| Management And General | $2,141,257 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,456,159 | BOYAmt |
| EOY | $94,004 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,000 | BOYAmt |
| EOY | $1,436,911 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,164,435 | BOYAmt |
| EOY | $2,173,789 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $240,800 | BOYAmt |
| EOY | $152,541 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $102,635 | BOYAmt |
| EOY | $99,892 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $5,159,320 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $588,104 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,693,412 | BOYAmt |
| EOY | $4,571,216 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $38,781 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $367,582 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $162,000 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,038,169 | BOYAmt |
| EOY | $1,191,474 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,705,610 | BOYAmt |
| EOY | $10,288,190 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,673,316 | BOYAmt |
| EOY | $1,939,498 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $668,382 | BOYAmt |
| EOY | $411,891 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $547,390 | BOYAmt |
| EOY | $1,640,147 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,889,088 | BOYAmt |
| EOY | $3,991,536 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,816,522 | BOYAmt |
| EOY | $6,296,654 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,816,522 | BOYAmt |
| EOY | $6,296,654 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,705,610 | BOYAmt |
| EOY | $10,288,190 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$521,294 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $1,001,426 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $85,000 | OtherCostOrOtherBasisAmt |
| Book Value | $85,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,725,263 | OtherCostOrOtherBasisAmt |
| Depreciation | $324,668 | DepreciationAmt |
| Book Value | $3,400,595 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,145,386 | OtherCostOrOtherBasisAmt |
| Depreciation | $222,741 | DepreciationAmt |
| Book Value | $922,645 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $203,671 | OtherCostOrOtherBasisAmt |
| Depreciation | $40,695 | DepreciationAmt |
| Book Value | $162,976 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,571,216 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE FROM THIRD PARTY | Desc |
| Book Value | $1,191,474 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,191,474 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Federal Income Taxes | |
| DUE TO THIRD PARTY | $1,130,159 |
| ROU LIABILITY | $509,988 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,640,147 | TotalLiabilityAmt |
| Other Revenue | $0 | OtherRevenueAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $0 | RevenueSubtotalAmt |
| Other Revenues Not Included | $0 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $0 | TotalRevenuePerForm990Amt |
| Other Expenses Included | $0 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $0 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $0 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $0 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule D, Part X, Line 2 UNCERTAIN TAX POSITIONS | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $44,025 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $44,025 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00238 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,734,465 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $537,773 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,196,692 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11856 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $2,778,490 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $537,773 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,240,717 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12094 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,180 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,040 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,140 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00039 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $8,180 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,040 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,140 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00039 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $2,786,670 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $538,813 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,247,857 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12132 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,232,505 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $9,452 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $2,120,016 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,087,198 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$3,967,182 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BARNES-KASSON COUNTY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2872 TURNPIKE ST | AddressLine1Txt |
| City | SUSQUEHANNA | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 18847 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.BARNES-KASSON.ORG | WebsiteAddressTxt |
| State License | 02050101 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | SKILLED NURSING FACILITY | OtherDesc |
| Facility Reporting Group | 1 | FacilityReportingGroupCd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 24 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.BARNES-KASSON.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 24 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.BARNES-KASSON.ORG | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.0 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.0 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTP://WWW.BARNES-KASSON.ORG/INDEX.PHP/RESOURCES/INSURANCE-AND-PAYMENT | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTP://WWW.BARNES-KASSON.ORG/INDEX.PHP/RESOURCES/INSURANCE-AND-PAYMENT | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTP://WWW.BARNES-KASSON.ORG/INDEX.PHP/RESOURCES/INSURANCE-AND-PAYMENT | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part V, Section B, Line 5 Facility 1, 1 | Facility 1, 1 - BARNES-KASSON COUNTY HOSPITAL. A COMMITTEE OF HEALTH PROFESSIONALS AND ADMINISTRATIVE PROFESSIONALS WAS FORMED, AT BARNES-KASSON, TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY. AFTER LOOKING AT THE DEMOGRAPHICS OF OUR SERVICE AREA, A SURVEY WAS CREATED THAT WE DETERMINED WOULD HELP ASSESS THE COMMUNITY'S HEALTH NEEDS. IN TODAY'S TECHNOLOGICALLY ADVANCED WORLD, WE DECIDED TO MAKE OUR SURVEY AVAILABLE ONLINE WITH THE USE OF AN ONLINE SURVEY BUILDING WEBSITE CALLED SURVEYMONKEY.COM. THIS WEBSITE ALLOWED US TO CREATE OUR SURVEY EXACTLY AS WE WANTED, AS WELL AS KEEPING TRACK OF THE RESPONSES AND COMPILING THE RESULTS ONCE WE REMOVED THE SURVEY. |
| Schedule H, Part V, Section B, Line 11 Facility 1, 1 | Facility 1, 1 - BARNES-KASSON COUNTY HOSPITAL. ALTHOUGH BARNES-KASSON COUNTY HOSPITAL RECOGNIZES THE IMPORTANCE OF ALL THE NEEDS IDENTIFIED BY THE COMMUNITY, CERTAIN NEEDS ARE NOT WITHIN THE PURVIEW OF BKH AND ARE THEREFORE NOT ADDRESSED. THE IMPLEMENTATION STRATEGY DESCRIBES THE NEEDS BEING MET, AS WELL AS THE ORGANIZATION RESPONSIBLE TO ADDRESS THE IDENTIFIED NEEDS AND THE STRATEGY TO ADDRESS SUCH NEEDS. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 0 | FacilityNum |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part III, Line 3 Bad Debt Expense Methodology | THIS AMOUNT IS FOR FUNDS DIRECTLY WRITTEN OFF TO BAD DEBT ONCE DEEMED UNCOLLECTABLE. |
| Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote | THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE, THAT NOTE CAN BE FOUND ON THE ATTACHED AUDITED FINANCIAL STATEMENTS. |
| Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs | A COST-TO-CHARGE RATIO CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COSTS-TO-CHARGES IS THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON PART III, LINE 6. |
| Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance | WHEN AN ACCOUNT IS REGISTERED AS A CASH ACCOUNT AND IS DEEMED THE RESPONSIBILITY OF THE PATIENT, THE ACCOUNT IS CROSS REFERENCED WITH THE HOSPITAL CHARITY CARE PROGRAM TO BE SURE THAT ANY ADJUSTMENT DUE HAS BEEN CORRECTLY TAKEN. IF THE PATIENT IS NOT INCLUDED IN THE ROSTER, A CASH LETTER IS THEN MAILED TO THE PATIENT WITH THE INITIAL BILLING. THIS LETTER ASKS THAT THE PATIENT CONTACT THE OFFICE REGARDING ANY AVAILABLE INSURANCE INFORMATION NOT GIVEN AT TIME OF SERVICE AND POSSIBLE COMPLETION OF APPLICATION FOR MEDICAL ASSISTANCE AND ANY BARNES- KASSON PROGRAMS SUCH AS CHARITY CARE |
| Schedule H, Part V, Section B, Line 16a FAP website | 1 - BARNES-KASSON COUNTY HOSPITAL: Line 16a URL: HTTP://WWW.BARNES-KASSON.ORG/INDEX.PHP/RESOURCES/INSURANCE-AND-PAYMENT; |
| Schedule H, Part V, Section B, Line 16b FAP Application website | 1 - BARNES-KASSON COUNTY HOSPITAL: Line 16b URL: HTTP://WWW.BARNES-KASSON.ORG/INDEX.PHP/RESOURCES/INSURANCE-AND-PAYMENT; |
| Schedule H, Part V, Section B, Line 16c FAP plain language summary website | 1 - BARNES-KASSON COUNTY HOSPITAL: Line 16c URL: HTTP://WWW.BARNES-KASSON.ORG/INDEX.PHP/RESOURCES/INSURANCE-AND-PAYMENT; |
| Schedule H, Part VI, Line 2 Needs assessment | THE COMMUNITY THAT THE HOSPITAL SERVES IS SUSQUEHANNA COUNTY, PA AND CONTIGUOUS AREAS OF WAYNE COUNTY, PA, AND BROOME AND DELAWARE COUNTIES, NY. A LARGE MAJORITY OF THE SERVICES PROVIDED ARE FOR GOVERNMENT MEDICALLY ASSISTED HEALTH CARE NEEDS AND ARE DISCUSSED AT MONTHLY MEDICAL STAFF AND DEPARTMENT HEAD MEETINGS. IN ATTENDANCE ARE HOSPITAL, SKILLED AND FAMILY HEALTH CLINIC ADMINISTRATORS, PHYSICIANS, NURSES, AND DEPARTMENT HEADS OF THE HOSPITAL. NEEDS ARE ASSESSED BASED UPON EXPERIENCE, EDUCATION, OBSERVATION, RESEARCH, AND KNOWLEDGE AND UNDERSTANDING OF PATIENTS' NEEDS. THE BOARD OF DIRECTORS' MEETING HELD BI-MONTHLY IS ALSO A FORUM FOR COMMUNITY NEEDS DISCUSSION. THERE IS A PUBLIC MEETING OFFERED ONCE A YEAR AND ADVERTISED INVITING COMMUNITY. |
| Schedule H, Part VI, Line 3 Patient education of eligibility for assistance | WHEN OUT-PATIENT SERVICES ARE REGISTERED, IF A PATIENT DOES NOT HAVE INSURANCE THEY ARE ASKED TO COMPLETE AN APPLICATIONS FOR BOTH MEDICAL ASSISTANCE AND CHARITY CARE. THEY ARE THEN REFERRED TO A BARNES-KASSON SOCIAL WORKER. SOCIAL SERVICES SPEAKS TO IN-PATIENTS AT DISCHARGE AND EVALUATES THE ABOVE MENTIONED CRITERIA. |
| Schedule H, Part VI, Line 4 Community information | THE COMMUNITY THAT THE HOSPITAL SERVES IS SUSQUEHANNA COUNTY, PA AND CONTIGUOUS AREAS OF WAYNE COUNTY, PA, AND BROOME AND DELAWARE COUNTIES, NY. ACCORDING TO THE 2024 PENNSYLVANIA ABSTRACT OF THE US CENSUS REPORTING, SUSQUEHANNA COUNTY'S MEDIAN FAMILY INCOME RANKED 31ST POOREST OUT OF 67 COUNTIES. IN THE 2024 CENSUS, MEDIAN HOUSEHOLD INCOME IS $39,983. THIS MAKES THE AVERAGE HOUSEHOLD INCOME APPROXIMATELY 12.1% OF POVERTY. |
| Schedule H, Part VI, Line 5 Promotion of community health | COMBINING HOMETOWN QUALITY WITH NEW TECHNOLOGY, BARNES-KASSON HOSPITAL OFFERS A WIDE RANGE OF MEDICAL, SURGICAL, DIAGNOSTIC AND REFERRAL SERVICES, AS WELL AS FAMILY-CENTERED CARE, CORONARY/INTENSIVE CARE, OUTPATIENT REHABILITATION (INCLUDING PHYSICAL AND OCCUPATIONAL THERAPY AND SPORTS MEDICINE), A 58-BED SKILLED-NURSING FACILITY, AND 24-HOUR EMERGENCY CARE. THE HOSPITAL ALSO OPERATES THREE RURAL HEALTH CLINICS. THE RURAL HEALTH CLINICS ARE PHYSICIAN OFFICES OFFERING A WIDE VARIETY OF PRIMARY AND SPECIALTY CARE SERVICES. SOME OF THE SERVICES AVAILABLE ARE INTERNAL MEDICINE, FAMILY MEDICINE, DENTAL, AND CARDIOLOGY. THE HOSPITAL MAINTAINS STRONG TIES WITH OTHER LOCAL BUSINESSES AND DEVELOPS EFFECTIVE PROGRAMS TO MEET THEIR NEEDS THOUGH ITS INDUSTRIAL HEALTH SERVICES PROGRAM. BARNES-KASSON COUNTY HOSPITAL IS AN ACTIVE HEALTH INFORMATION AND EDUCATION RESOURCE FOR THE ENTIRE COUNTY. |
| Schedule H, Part VI, Line 6 Affiliated health care system | THE HOSPITAL IS PART OF AN AFFILIATED HEALTH CARE SYSTEM UNDER COMMON GOVERNANCE AND CONTROL THAT INCLUDES THE HOSPITAL, WAYNE MEMORIAL LONG TERM CARE (WMLTC, WHICH OPERATES WAYNE WOODLANDS MANOR), AND WAYNE MEMORIAL HOSPITAL. WAYNE MEMORIAL HOSPITAL IS A NOT-FOR-PROFIT HOSPITAL THAT OPERATES A 90-BED ACUTE CARE INPAITIENT, A WIDE VARIETY OF OUTPATIENT SERVICES, AND 24 HOUR EMERGENCY CARE SERVICES. IN ADDITION, THE WAYNE MEMORIAL HOSPITAL HAS AN AFFILIATION WITH THE GEISINGER COMMONWEALTH SCHOOL OF MEDICINE (SCRANTON, PA) FOR THE PROVISION OF CLINICAL EDUCATION EXPERIENCES AT THE HOSPITAL AND WITHIN THE COMMUNITY. THE HOSPITAL CONSIDERS THIS A RESPONSIBILITY CONSISTENT WITH ITS MISSION TO BE INVOLVED IN EDUCATION. WAYNE WOODLANDS MANOR IS A 24 HOUR NURSING FACILITY THAT PROVIDES SERVICES PRIMARILY TO MEDICAID RECIPIENTS (OVER 75% OF ITS RESIDENTS). MOST COUNTIES IN PENNSYLVANIA HAVE COUNTY OWNED AND OPERATED NURSING HOMES THAT PROVIDE SERVICES TO THIS SEGMENT OF THEIR COUNTY POPULATION. WAYNE COUNTY DOES NOT HAVE A COUNTY NURSING HOME. THIS COMMUNITY NEED IS MET BY WAYNE MEMORIAL LONG TERM CARE BY ITS OPERATION OF WAYNE WOODLANDS MANOR. WMH IS ALSO A CLINICAL AFFILIATE OF WAYNE MEMORIAL COMMUNITY HEALTH CENTERS (WMCHC), WHICH IT SUPPORTS CLINICALLY AND ADMINISTRATIVELY. WMCHC SERVES A NUMBER OF MEDICALLY UNDERSERVED AREAS AND POPULATIONS. THE HOSPITAL HAS FINANCED WMCHC'S AND WMLTC'S WORKING CAPITAL NEEDS WITH LINES OF CREDIT THAT ARE NECESSARY SUBSIDIES BECAUSE OF THE TIME DELAY BETWEEN SERVICE PERFORMANCE AND REIMBURSEMENTS RECEIVED FROM GOVERNMENT AND COMMERCIAL INSURERS. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PRAVINCHANDRA PATEL MD | ||||||||||||||
| TRUSTEE/MEDICAL STAFF PRES | $415,995 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $415,995 | $0 | $0 | $0 |
| JAMES PETTINATO | ||||||||||||||
| WMHS CHIEF EXECUTIVE OFFICER | $0 | $330,924 | $0 | $0 | $0 | $23,000 | $0 | $32,096 | $0 | $21,911 | $0 | $407,931 | $0 | $0 |
| PATRICIA DUNSINGER | ||||||||||||||
| WMHS CHIEF FINANCIAL OFFICER | $0 | $211,723 | $0 | $0 | $0 | $0 | $0 | $12,763 | $0 | $0 | $0 | $224,486 | $0 | $0 |
| SARA ADORNATO | ||||||||||||||
| EXECUTIVE DIRECTOR | $132,633 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $25,109 | $0 | $157,742 | $0 | $0 | $0 |
| DANIEL COSTER MD | ||||||||||||||
| PHYSICIAN | $297,977 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $297,977 | $0 | $0 | $0 |
| KIRK HINKLEY MD | ||||||||||||||
| PHYSICIAN | $356,067 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $16,511 | $0 | $372,578 | $0 | $0 | $0 |
| PATRICK MACCONNELL DPM | ||||||||||||||
| PHYSICIAN | $146,779 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $9,168 | $0 | $155,947 | $0 | $0 | $0 |
| BHUPENDRA PATEL MD | ||||||||||||||
| PHYSICIAN | $599,249 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $22,004 | $0 | $621,253 | $0 | $0 | $0 |
| AMY VIVONA | ||||||||||||||
| DON/RNAC | $148,764 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $15,401 | $0 | $164,165 | $0 | $0 | $0 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (7 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| JOSEPH ADORNATO | |||
| SARA ADORNATO'S SPOUSE | $90,372 | EDUCATION DIRECTOR WAGES | false |
| MICHAEL IVESON | |||
| SARA ADORNATO'S BROTHER | $66,630 | FACILITY MANAGER WAGES | false |
| ROBERT IVESON | |||
| SARA ADORNATO'S BROTHER | $48,097 | RADIOLOGY TECHNICIAN WAGES | false |
| LEXIS IVESON | |||
| SARA ADORNATO'S NIECE | $1,913 | EMT WAGES | false |
| MATTHEW KANE | |||
| KELLI KANE'S SON | $22,291 | RADIOLOGY ASSISTANT WAGES | false |
| BENEDICT KANE | |||
| KELLI KANE'S SON | $46,660 | QUALITY ASSURANCE ASSISTANT WAGES | false |
| AMANDA IVESON | |||
| SARA ADORNATO'S NIECE | $3,771 | NURSING ASSISTANT WAGES | false |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part I, Line 1 BRIEF MISSION | OUR FACILITY PROVIDES AN ARRAY OF HEALTH CARE SERVICES, INCLUDING EMERGENCY CARE, RADIOLOGY, LABORATORY, PHYSICAL AND OCCUPATIONAL THERAPY, AND SKILLED NURSING. OUR FACILITY'S RURAL HEALTH CLINIC PROVIDES PRIMARY/SPECIALTY PHYSICIAN AND DENTAL SERVICES. THE DENTISTRY SERVICE PROVIDED IN THE RURAL HEALTH CLINIC IS THE ONLY DENTISTRY SERVICE IN THE IMMEDIATE AREA THAT PROVIDES SERVICE TO MEDICAID BENEFICIARIES. |
| Form 990, Part III, Line 1 ORGANIZATION'S MISSION | OUR FACILITY PROVIDES AN ARRAY OF HEALTH CARE SERVICES, INCLUDING EMERGENCY CARE, RADIOLOGY, LABORATORY, PHYSICAL AND OCCUPATIONAL THERAPY, AND SKILLED NURSING. OUR FACILITY'S RURAL HEALTH CLINIC PROVIDES PRIMARY/SPECIALTY PHYSICIAN AND DENTAL SERVICES. THE DENTISTRY SERVICE PROVIDED IN THE RURAL HEALTH CLINIC IS THE ONLY DENTISTRY SERVICE IN THE IMMEDIATE AREA THAT PROVIDES SERVICE TO MEDICAID BENEFICIARIES. |
| Form 990, Part VI, Line 6 7A & 7B - MEMBERS OR STOCKHOLDERS | WAYNE MEMORIAL HEALTH SYSTEM INC. (THE SYSTEM), A RELATED ORGANIZATION AND A PENNSYLVANIA NONPROFIT CORPORATION, IS THE SOLE MEMBER OF BARNES-KASSN COUNTY HOSPITAL. WAYNE MEMORIAL HEALTH SYSTEM, INC. IS ENTITLED TO APPROVE THE ELECTION OF THE BOARD MEMBERS AND OFFICERS OF WAYNE MEMORIAL HOSPITAL, INC. ALL OF WHOM SHALL BE APPROVED BY WAYNE MEMORIAL HEALTH SYSTEM, INC, A RELATED ORGANIZATION. THE FOLLOWING DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY WAYNE MEMORIAL HEALTH SYSTEM, INC.: (A) AMENDMENT OF THE BYLAWS OR THE ARTICLES OF CORPORATION (B) MERGER OR CONSOLIDATION WITH ANY OTHER ENTITY (C) DISSOLUTION AND DISTRIBUTION OF ASSETS IN CONNECTION THEREWITH (D) ELECTION OF OFFICERS OF THIS CORPORATION (E) ADOPTION OF INVESTMENT POLICIES AND SELECTION OF INVESTMENT ADVISORS (F) INVESTMENT OF RESTRICTED GIFTS (G) SELECTION OF AUDITORS AND ATTORNEYS (H) ADOPTION OF OPERATING AND CAPITAL BUDGETS (I) APPROVAL OF FUND-RAISING PROGRAMS (J) DONATION OR TRANSFER OF ANY ASSET WITH AN AGGREGATE VALUE IN EXCESS OF SUCH AMOUNT AS MAY BE DETERMINED BY THE BOARD OF WAYNE MEMORIAL HEALTH SYSTEM FROM TIME TO TIME (K) CREATION OF ANY LIEN OR SECURITY INTEREST IN ASSETS OF THE CORPORATION (L) DESIGNATION OR RESTRICTION OF GIFTS WITH A MARKET VALUE IN EXCESS OF SUCH AMOUNT AS MAY BE DETERMINED BY THE BOARD OF WAYNE MEMORIAL HEALTH SYSTEM FROM TIME TO TIME, AND (M) ANY OTHER MATTER THAT WOULD REQUIRE THE APPROVAL OF THE MEMBERS OF A PENNSYLVANIA NONPROFIT CORPORATION. |
| Form 990, Part VI, Line 3 Delegation of management duties | WAYNE MEMORIAL HEALTH SYSTEM, INC., PROVIDES MANAGEMENT OVER THE ORGANIZATION THROUGH DIRECT EMPLOYMENT OF THE DIRECTORS AND OFFICERS OF THE ORGANIZATION. |
| Form 990, Part VI, Line 4 Significant changes to organizational documents | BARNES-KASSON COUNTY HOSPITAL'S GOVERNING DOCUMENTS WERE UPDATED TO REFLECT THEIR ACQUISITION BY WAYNE MEMORIAL HEALTH SYSTEM, THE SOLE MEMBER. WAYNE MEMORIAL HEALTH SYSTEM'S RESPONSIBILITIES INCLUDE ELECTING ONE-FOURTH OF THE NON-EX-OFFICIO TRUSTEES, APPROVING THE BOARD OF TRUSTEES, ETC. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | THE 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. A COPY OF THE FORM 990 WILL BE REVIEWED WITH THE FINANCE COMMITTEE WHICH IS RESPONSIBLE FOR THE FINANCIAL OVERSIGHT OF ALL ENTITIES OF THE WAYNE MEMORIAL HEALTH SYSTEM. A COPY OF THE 990 WILL BE DISTRIBUTED VIA E-MAIL TO EACH BOARD MEMBER BEFORE THE RETURN IS SUBMITTED TO THE IRS. MANAGEMENT WILL DISCUSS ANY QUESTIONS THAT ANY BOARD MEMBER MAY HAVE AT THE NEXT FULL BOARD MEETING. |
| Form 990, Part VI, Line 12c Conflict of interest policy | CONFLICT OF INTEREST STATEMENTS ARE COMPLETED BY EVERY BOARD MEMBER AND MANAGER ANNUALLY. EACH INDIVIDUAL IS REQUIRED TO SIGN AND RETURN THE STATEMENTS TO THE ADMINISTRATION OFFICE. THE AUDIT COMMITTEE IS RESPONSIBLE FOR MONITORING COMPLIANCE WITH ANY CONFLICT OF INTEREST THROUGHOUT THE YEAR. IF A CONFLICT ARISES, THE PERSON WITH THE CONFLICT WILL RECUSE THEMSELVES FROM VOTING AND/OR DISCUSSING THE MATTER. |
| Form 990, Part VI, Line 19 Required documents available to the public | THESE FORMS ARE ON OUR WEBSITE AND ARE PRESENTED UPON REQUEST. |
| Form 990, Part IX, Line 11g Other Fees | PROFESSIONAL FEES - Total Expense: 2985551, Program Service Expense: 2868551, Management and General Expenses: 117000, Fundraising Expenses: ; CONTRACT SERVICES - Total Expense: 1116907, Program Service Expense: 803486, Management and General Expenses: 313421, Fundraising Expenses: ; PURCHASE FEES - Total Expense: 99795, Program Service Expense: 95255, Management and General Expenses: 4540, Fundraising Expenses: ; PROCESSING FEES - Total Expense: 80423, Program Service Expense: 67555, Management and General Expenses: 12868, Fundraising Expenses: ; OTHER SERVICES - Total Expense: 44370, Program Service Expense: 42368, Management and General Expenses: 2002, Fundraising Expenses: ; |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | ASSET ADJUSTMENT FOR WAYNE MEMORIAL HEALTH SYSTEM ACQUISITION - 1001426; Total - 1001426; |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| WAYNE MEMORIAL HEALTH SYSTEM INC | ||||||||||
| 601 PARK STREET | HONESDALE | PA | 18431 | 232221292 | OVERSIGHT | PA | 501(c)(3) | Type II | NA | false |
| WAYNE MEMORIAL HEALTH FOUNDATION INC | ||||||||||
| 601 PARK STREET | HONESDALE | PA | 18431 | 232208596 | FUNDRAISING | PA | 501(c)(3) | Type I | WMHS | false |
| WAYNE MEMORIAL LONG TERM CARE | ||||||||||
| 37 WOODLANDS DRIVE | WAYMART | PA | 18472 | 232719336 | NURSING HOME | PA | 501(c)(3) | 10 | WMHS | false |
| WAYNE MEMORIAL HOSPITAL | ||||||||||
| 601 PARK STREET | HONESDALE | PA | 18431 | 240798839 | HOSPITAL | PA | 501(c)(3) | 3 | WMHS | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |