MADISON VALLEY HOSPITAL INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- MADISON VALLEY HOSPITAL INC (EIN 81-0236460)
- Tax period
- 2021-10-01 to 2022-09-30
- Filed
- 2023-08-15
- IRS object ID
- 202322279349304042
- Schema version
- 2021v4.2
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-08-15T16:24:25-05:00 | ReturnTs |
| Tax Period End | 2022-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 105 E PINE ST | AddressLine1Txt |
| City | MISSOULA | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59802 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810236460 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADISON VALLEY HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MADI | BusinessNameControlTxt |
| Phone | 4066826862 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 305 NORTH MAIN STREET | AddressLine1Txt |
| City | ENNIS | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59729 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ALLEN ROHRBACK | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 4066826862 | PhoneNum |
| Signature | 2023-08-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | ALLEN | PersonFirstNm |
| Person Last | ROHRBACK | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | SAM BRUNSON CPA | PreparerPersonNm |
| PTIN | P01696998 | PTIN |
| Phone | 4067281800 | PhoneNum |
| Preparation | 2023-08-10 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADISON VALLEY MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ALLEN ROHRBACK | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 305 NORTH MAIN STREET | AddressLine1Txt |
| City | ENNIS | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59729 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $14,942,005 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | MVMEDCENTER.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1948 | FormationYr |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Activity Or Mission | THE MISSION OF MADISON VALLEY MEDICAL CENTER IS TO INSPIRE AND PROMOTE HEALTH AND WELLNESS FOR EACH PATIENT THROUGH EXCELLENCE IN HEALTHCARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 149 | TotalEmployeeCnt |
| Total Volunteers | 40 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,356,224 | PYContributionsGrantsAmt |
| CY Contributions Grants | $884,060 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $10,238,511 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $11,849,758 | CYProgramServiceRevenueAmt |
| PY Investment Income | $227,235 | PYInvestmentIncomeAmt |
| CY Investment Income | $210,871 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,610,141 | PYOtherRevenueAmt |
| CY Other Revenue | $1,990,312 | CYOtherRevenueAmt |
| PY Total Revenue | $14,432,111 | PYTotalRevenueAmt |
| CY Total Revenue | $14,935,001 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,642,617 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,656,343 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,270,567 | PYOtherExpensesAmt |
| CY Other Expenses | $6,025,830 | CYOtherExpensesAmt |
| PY Total Expenses | $10,913,184 | PYTotalExpensesAmt |
| CY Total Expenses | $13,682,173 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,518,927 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,252,828 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $21,002,888 | TotalAssetsBOYAmt |
| Total Assets EOY | $18,792,434 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,453,674 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,396,471 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $12,549,214 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $12,395,963 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF MADISON VALLEY MEDICAL CENTER IS TO INSPIRE AND PROMOTE HEALTH AND WELLNESS FOR EACH PATIENT THROUGH EXCELLENCE IN HEALTHCARE. | MissionDesc |
| Significant New Program Srvc | Yes (1) | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $11,630,669 | ExpenseAmt |
| Revenue | $13,836,440 | RevenueAmt |
| Desc | THE MADISON VALLEY MEDICAL CENTER PROVIDES HEALTHCARE AND HOSPITAL SERVICES TO THE LOCAL COMMUNITY AND SURROUNDING AREA. THE PROVIDERS IN THE CLINIC HAD 8,098 VISITS. THE OBSERVATION, INPATIENT, AND SWING BED DAYS FOR THE HOSPITAL TOTAL 959 FOR FY2022.ON MAY 1, 2021, THE CITY COMMISSION OF ENNIS, MONTANA CONVEYED ITS AMBULANCE RELATED ASSETS TO THE HOSPITAL IN RETURN FOR THE HOSPITAL'S COMMITMENT TO CONTINUE TO PROVIDE EMERGENCY AMBULANCE TRANSPORTATION SERVICES IN THE ENNIS COMMUNITY. IN FY2022, THE AMBULANCE SERVICE RESPONDED TO 373 CALLS, WITH 140 OF THOSE CALLS BEING NON-BILLABLE.ON FEBRUARY 16, 2022, MADISON VALLEY MEDICAL CENTER OPENED A RETAIL PHARMACY TO BETTER SERVE THE ENNIS COMMUNITY. IN FY2022, THE RETAIL PHARMACY FILLED OVER 9,500 PRESCRIPTIONS. | Desc |
| Total Program Service Expenses | $11,630,669 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | Yes (1) | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 40 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 149 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALICIA NICHOLSON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4066826862 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 305 NORTH MAIN STREET | AddressLine1Txt |
| City | ENNIS | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59729 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| DOTTIE FOSSEL | |||||||
| CHAIR | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JEFF MONTAG | |||||||
| VICE CHAIR | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MARY OLIVER | |||||||
| SECRETARY | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| BRYANT HARP | |||||||
| TRUSTEE | 1.25 | Yes (X) | $0 | $0 | $0 | ||
| JIM HAGEMAN | |||||||
| TRUSTEE | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| ALLEN ROHRBACK | |||||||
| CEO | 40.00 | Yes (X) | $209,276 | $0 | $11,709 | ||
| ALICIA NICHOLSON | |||||||
| CFO | 40.00 | Yes (X) | $91,753 | $0 | $8,825 | ||
| MAURA DAVENPORT | |||||||
| MD | 40.00 | $300,962 | $0 | $11,187 | Yes (X) | ||
| RD MARKS | |||||||
| MD | 40.00 | $201,302 | $0 | $12,022 | Yes (X) | ||
| MARTIN DEGROOT | |||||||
| NP | 40.00 | $139,134 | $0 | $7,679 | Yes (X) | ||
| MARTIN HENSEL | |||||||
| PA | 40.00 | $140,442 | $0 | $3,447 | Yes (X) | ||
| KRYSTIN NUTT | |||||||
| FNP | 40.00 | $108,258 | $0 | $9,164 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,191,127 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $64,033 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARDINAL HEALTH | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 13651 DUBLIN CT | AddressLine1Txt |
| City | STAFFORD | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 77477 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | RETAIL PHARMACY CONSULTING | ServicesDesc |
| Compensation | $102,500 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $211,652 | RelatedOrganizationsAmt |
| Government Grants | $611,978 | GovernmentGrantsAmt |
| All Other Contributions | $60,430 | AllOtherContributionsAmt |
| Total Contributions | $884,060 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621110 | $9,563,229 | $9,563,229 |
| CLINIC | 621110 | $1,704,958 | $1,704,958 |
| 340B REVENUE | 621110 | $479,681 | $479,681 |
| OTHER PROGRAM SERVICE REVENUE | 900099 | $101,890 | $101,890 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $11,849,758 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $217,875 | TotalRevenueColumnAmt |
| Exclusion | $217,875 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $3,630 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $3,630 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,630 | TotalRevenueColumnAmt |
| Exclusion | $3,630 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $7,004 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$7,004 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$7,004 | TotalRevenueColumnAmt |
| Exclusion | -$7,004 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | TAX LEVY REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $1,986,682 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,986,682 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,986,682 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,935,001 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $13,836,440 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $214,501 | 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 | $365,240 | TotalAmt |
| Program Services | $300,149 | ProgramServicesAmt |
| Management And General | $65,091 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,240,121 | TotalAmt |
| Program Services | $5,128,031 | ProgramServicesAmt |
| Management And General | $1,112,090 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,422 | TotalAmt |
| Program Services | $52,119 | ProgramServicesAmt |
| Management And General | $11,303 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $505,746 | TotalAmt |
| Program Services | $415,614 | ProgramServicesAmt |
| Management And General | $90,132 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $481,814 | TotalAmt |
| Program Services | $395,947 | ProgramServicesAmt |
| Management And General | $85,867 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,840 | TotalAmt |
| Management And General | $25,840 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,083,819 | TotalAmt |
| Program Services | $1,866,943 | ProgramServicesAmt |
| Management And General | $216,876 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $90,545 | TotalAmt |
| Program Services | $21,497 | ProgramServicesAmt |
| Management And General | $69,048 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $176,476 | TotalAmt |
| Program Services | $44,283 | ProgramServicesAmt |
| Management And General | $132,193 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $131,410 | TotalAmt |
| Program Services | $74,304 | ProgramServicesAmt |
| Management And General | $57,106 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,171 | TotalAmt |
| Program Services | $24,132 | ProgramServicesAmt |
| Management And General | $4,039 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,245 | TotalAmt |
| Program Services | $25,781 | ProgramServicesAmt |
| Management And General | $3,464 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $168,821 | TotalAmt |
| Program Services | $167,133 | ProgramServicesAmt |
| Management And General | $1,688 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $780,721 | TotalAmt |
| Program Services | $772,914 | ProgramServicesAmt |
| Management And General | $7,807 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $204,897 | TotalAmt |
| Program Services | $202,848 | ProgramServicesAmt |
| Management And General | $2,049 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,152,129 | $1,152,129 | |
| BAD DEBT EXPENSE | $486,422 | $486,422 | |
| 340B EXPENSE | $185,792 | $185,792 | |
| DUES & SUBSCRIPTIONS | $100,707 | $56,169 | $44,538 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $380,835 | TotalAmt |
| Program Services | $258,462 | ProgramServicesAmt |
| Management And General | $122,373 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,682,173 | TotalAmt |
| Program Services | $11,630,669 | ProgramServicesAmt |
| Management And General | $2,051,504 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $123,845 | BOYAmt |
| EOY | $671,197 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,906,681 | BOYAmt |
| EOY | $1,368,701 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,606,936 | BOYAmt |
| EOY | $2,598,455 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $328,825 | BOYAmt |
| EOY | $488,812 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,693 | BOYAmt |
| EOY | $153,357 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $15,899,879 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $8,802,444 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,538,745 | BOYAmt |
| EOY | $7,097,435 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,204,418 | BOYAmt |
| EOY | $6,096,932 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $251,745 | BOYAmt |
| EOY | $317,545 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,002,888 | BOYAmt |
| EOY | $18,792,434 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,128,216 | BOYAmt |
| EOY | $1,136,324 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,845,171 | BOYAmt |
| EOY | $217,752 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,480,287 | BOYAmt |
| EOY | $5,042,395 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,453,674 | BOYAmt |
| EOY | $6,396,471 | 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 | $12,549,214 | BOYAmt |
| EOY | $12,395,963 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,549,214 | BOYAmt |
| EOY | $12,395,963 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,002,888 | BOYAmt |
| EOY | $18,792,434 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,252,828 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$1,406,079 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Collection Used Pub Exhibition | Yes (X) | CollectionUsedPubExhibitionInd |
| Solicited Assets Sale | 0 | SolicitedAssetsSaleInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $376,209 | OtherCostOrOtherBasisAmt |
| Book Value | $376,209 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,384,310 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,241,207 | DepreciationAmt |
| Book Value | $5,143,103 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,139,360 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,561,237 | DepreciationAmt |
| Book Value | $1,578,123 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,097,435 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $12,856,708 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$1,406,079 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$1,406,079 | RevenueNotReportedAmt |
| Revenue Subtotal | $14,262,787 | RevenueSubtotalAmt |
| Other Revenues Not Included | $672,214 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $672,214 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $14,935,001 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $13,009,959 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $13,009,959 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $672,214 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $672,214 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $13,682,173 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART III, LINE 1A: | THE HOSPITAL DOES NOT RECOGNIZE CONTRIBUTIONS OF WORKS OF ART, HISTORICAL TREASURES, AND SIMILAR ASSETS WHEN THE COLLECTION ITEMS ARE HELD FOR PUBLIC EXHIBITION AND ARE PROTECTED, KEPT UNENCUMBERED, CARED FOR, AND PRESERVED. CURRENT COLLECTIONS INCLUDE A SCULPTURE AND ARTWORK DONATED FOR DISPLAY IN THE HOSPITAL BUILDING. |
| PART X, LINE 2: | THE HOSPITAL IS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL IS ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME. THE HOSPITAL HAS NO TAXABLE BUSINESS INCOME UNRELATED TO ITS EXEMPT ACTIVITIES AND, THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN RECORDED. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 486,422. 340B EXPENSES 185,792. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 486,422. 340B EXPENSES 185,792. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $102,019 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $102,019 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00750 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,222,474 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $821,336 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $401,138 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02930 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $30,812 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $17,032 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $13,780 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,355,305 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $838,368 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $516,937 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03780 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $200,965 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,252 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $186,713 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01360 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $241,320 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $241,320 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01760 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,164,642 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,748,944 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,415,698 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10350 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,778 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $20,778 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,627,705 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,763,196 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,864,509 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13620 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,983,010 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,601,564 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,381,446 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.17400 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $77,970 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,237 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $65,733 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00480 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $77,970 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,237 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $65,733 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00480 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $437,305 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $236,121 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $5,413,046 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,431,762 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$18,716 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | Yes (X) | CostAccountingSystemInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | 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 | MADISON VALLEY MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 305 NORTH MAIN STREET | AddressLine1Txt |
| City | ENNIS | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59729 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.MVMEDCENTER.ORG | WebsiteAddressTxt |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | RURAL HEALTH CLINIC | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADISON VALLEY MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | 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 | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | MVMEDCENTER.ORG/COMMUNITY/HEALTH-RESOURCES | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.MVMEDCENTER.ORG | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 250.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | MVMEDCENTER.ORG/PATIENT-INFORMATION/BILLING-FINANCIAL-SERVICES | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | MVMEDCENTER.ORG/PATIENT-INFORMATION/BILLING-FINANCIAL-SERVICES | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | MVMEDCENTER.ORG/PATIENT-INFORMATION/BILLING-FINANCIAL-SERVICES | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| MADISON VALLEY MEDICAL CENTER | PART V, SECTION B, LINE 5: A STEERING COMMITTEE WAS CONVENED TO ASSIST MADISON VALLEY MEDICAL CENTER IN CONDUCTING CHSD. A DIVERSE GROUP OF COMMUNITY MEMBERS REPRESENTING VARIOUS ORGANIZATIONS AND POPULATIONS WITHIN THE COMMUNITY (EX. PUBLIC HEALTH, ELDERLY, UNINSURED) CAME TOGETHER IN MARCH 2020. IN JUNE 2020, SURVEYS WERE MAILED OUT TO THE RESIDENTS IN THE MADISON VALLEY MEDICAL CENTER HOSPITAL DISTRICT. SURVEY RESPONDENTS HAD THE ABILITY TO COMPLETE THE SURVEY MAILED TO THEM, OR VIA AN ONLINE SURVEY HOSTED AT MONTANA STATE UNIVERSITY'S HELPS LAB WEB PORTAL. IN ADDITION, KEY INFORMANT INTERVIEWS WERE CONDUCTED TO IDENTIFY IMPORTANT LOCAL HEALTHCARE ISSUES, HOW TO IMPROVE THE HEALTH OF THE COMMUNITY, AND GAPS IN HEALTH SERVICES. |
| MADISON VALLEY MEDICAL CENTER | PART V, SECTION B, LINE 6A: LIVINGSTON HEALTHCARE |
| MADISON VALLEY MEDICAL CENTER | PART V, SECTION B, LINE 6B: BOZEMAN HEALTHCOMMUNITY HEALTH PARTNERSGALLATIN COUNTY HEALTH DEPARTMENTPARK COUNTY HEALTH DEPARTMENT |
| MADISON VALLEY MEDICAL CENTER | PART V, SECTION B, LINE 11: BASED ON THE RESULTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE MADISON VALLEY MEDICAL CENTER BOARD OF DIRECTORS, LEADERSHIP TEAM AND MEDICAL PROVIDERS IDENTIFIED THE MOST IMPORTANT HEALTH NEEDS. THE GROUPS DETERMINED WHICH NEEDS COULD BE ADDRESSED WHILE CONSIDERING MADISON VALLEY MEDICAL CENTER'S RESOURCES AND LIMITATIONS. THE NEEDS WERE PRIORITIZED USING THE ORGANIZATION'S MISSION, VISION AND VALUES. THESE STRATEGIC INITIATIVES ARE PUBLISHED IN OUR CURRENT IMPLEMENTATION PLAN. GOAL 1: IMPROVE ACCESS TO MENTAL AND BEHAVIORAL HEALTH SERVICES IN MADISON CO. STRATEGY 1.1: ENGAGE WITH COMMUNITY PARTNERS TO IMPROVE ACCESS TO MENTAL AND BEHAVIORAL HEALTH SERVICES. CONVENE PRIVATE PRACTICE MENTAL/BEHAVIORAL HEALTH PROVIDERS IN AREA TO EXPLORE OPPORTUNITIES TO SUPPORT LOCAL SERVICES (ED SUPPORT, REFERRALS, EDUCATIONAL SUPPORT, ETC.)CONTINUE TO PARTICIPATE IN LOCAL MENTAL HEALTH ADVISORY COMMITTEE.WORK WITH COMMUNITY PARTNERS AND AREA PROVIDERS TO HELP REDUCE BARRIERS AND STIGMA ASSOCIATED WITH MENTAL HEALTH CREATE WELLNESS PROGRAMMING/EDUCATION TO SUPPORT BEHAVIORAL HEALTH (PHYSICAL HEALTH, MINDFULNESS ETC.) CATALOGUE AVAILABLE MENTAL/BEHAVIORAL HEALTH SERVICES IN MADISON CO./SURROUNDING AREA AND DEVELOP OUTREACH/EDUCATION STRATEGY WITH COMMUNITY PARTNERS. STRATEGY 1.2: ENHANCE AVAILABILITY OF MENTAL AND BEHAVIORAL HEALTH SERVICES.EXPLORE OPPORTUNITIES TO EXPAND BEHAVIORAL HEALTH COVERAGE (EXPAND WORKFORCE, PROVIDER TYPE) AT MVMC.DETERMINE FEASIBILITY OF OFFERING ADDITIONAL TELE-MENTAL HEALTH SERVICES (EXPLORE ON-DEMAND MODELS).CONTINUE TO PROVIDE TELEHEALTH CONSULTS/VISITS AND CRISIS RESPONSE AT MVMC.CONTINUE TO PARTICIPATE IN INTEGRATED BEHAVIORAL HEALTH GRANT AND WORK TOWARDS SUSTAINABILITY/EXPANSION.ESTABLISH PARTNERSHIP WITH BOZEMAN HEALTH AND BIG SKY MEDICAL CENTER TO PROVIDE BEHAVIORAL HEALTH SERVICES IN THE BIG SKY AREA.GOAL 2: IMPROVE ACCESS TO HEALTHCARE SERVICES IN MADISON CO.STRATEGY 2.1: IMPROVE COMMUNITY ACCESS TO SPECIALTY SERVICES.EXPLORE OPPORTUNITIES TO BRING ON MORE SPECIALTY SERVICES SUCH AS CHIROPRACTIC AND ORTHOPEDIC, FOOT CARE ETC. INCREASE ACCESS TO ONSITE ONCOLOGY SERVICES AND DETERMINE FEASIBILITY OF BRINGING CHEMOTHERAPY INFUSION SERVICES TO MVMC. EXPAND CARDIOLOGY SERVICES (ONSITE CARDIAC STRESS TESTING AND ECHO STRESS TESTING)STRATEGY 2.2: ENHANCE ACCESS TO PRIMARY CARE AND SUPPORTIVE HEALTHCARE SERVICES.EXPLORE MODELS FOR AFTER-HOURS OR EXPANDED HOURS CLINIC (EXPANDED WALK-IN CLINIC HOURS, ON-DEMAND TELEMEDICINE VISITS).ESTABLISH AMBULANCE SERVICES WITHIN MADISON VALLEY MEDICAL CENTER.PROVIDE EXPANDED OUTPATIENT AND RETAIL PHARMACY SERVICES WITHIN THE HOSPITAL.REESTABLISH 340B PHARMACY PROGRAM TO EXPAND ACCESS TO AFFORDABLE PHARMACY RESOURCES.PARTNER WITH SENIOR CENTER TO ENHANCE AND EXPAND TRANSPORTATION SERVICES IN MADISON CO.STRATEGY 2.3: PROVIDE RESOURCES AND PROGRAMS THAT IMPROVE ACCESS TO WELLNESS AND PREVENTATIVE HEALTH SERVICES IN MADISON COUNTY.EXPAND NEW SOCIAL MEDIA STRATEGY TO EXPAND OUTREACH AND COMMUNITY KNOWLEDGE OF HEALTH TOPICS AND SERVICES.CONTINUE TO OFFER PRESENTATIONS AND OUTREACH MATERIALS TO VARIOUS LOCAL PARTNERS (EX. SENIOR CENTER, LIONS CLUB, CHAMBER OF COMMERCE, LOCAL CHURCHES).IMPLEMENT MONTHLY/QUARTERLY NEWSLETTER (VIRTUAL AND PRINT) TO SHARE HEALTH TOPICS AND IMPROVE AWARENESS OF AVAILABLE HEALTH SERVICES.THE FOLLOWING HEALTH CONCERNS AND SPECIALTY MEDICINE SERVICES WERE NOT ABLE TO BE ADDRESSED AT THIS TIME. 1. SENIOR NEEDS: A. TOP ADDITIONAL SENIOR SERVICES THAT SURVEY RESPONDENTS WOULD LIKE TO SEE LOCALLY WERE: "SENIOR RETIREMENT HOUSING/COMMUNITY", "HOME HEALTH AND "ASSISTED LIVING FACILITY."B. KEY INFORMANT INTERVIEW PARTICIPANTS EXPRESSED CONCERNS ABOUT LOCAL SENIOR SERVICES. SEVERAL FELT THE LOCAL NURSING HOME/ASSISTED LIVING CENTERS ARE AT CAPACITY AND OFTEN UNDERSTAFFED.C. KEY INFORMANT PARTICIPANTS MENTIONED THAT SENIORS FREQUENTLY SEEK HELP NAVIGATING MEDICARE AND OTHER PROGRAMS.RATIONALE: MVMC'S MISSION IS NOT RELATED TO RETIREMENT HOUSING OR ASSISTED LIVING SERVICES. HOME HEALTH REQUIRES A CERTIFICATE OF NEED WHICH IS NOT CURRENTLY POSSIBLE IN MADISON COUNTY. WE CURRENTLY ASSIST PATIENTS WITH MEDICARE ELIGIBILITY AND ANSWER QUESTIONS REGARDING BENEFIT STRUCTURE. |
| MADISON VALLEY MEDICAL CENTER | PART V, SECTION B, LINE 24: PATIENTS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE MAY BE BILLED AT AN AMOUNT EQUAL TO GROSS CHARGES FOR PROCEDURES AND SUPPLIES THAT ARE DETERMINED TO BE ELECTIVE OR NON-MEDICALLY NECESSARY. |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 6A: | MADISON VALLEY MEDICAL CENTER FOUNDATION |
| PART I, LINE 7: | THE HOSPITAL USED WORKSHEET 2 TO DETERMINE A COST-TO-CHARGE RATIO OF 1.05 USED IN THE CALCULATION OF PART I, LINE 7A AND LINE 7C. |
| PART I, LINE 7G: | THE RURAL HEALTH CLINIC AND EMERGENCY DEPARTMENT OPERATE AT A LOSS CALCULATED BY TAKING THE ALLOWABLE COSTS TO OPERATE FROM THE MEDICARE COST REPORT AND OFFSETTING REVENUES. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | THE HOSPITAL OFFERS ANNUAL HEALTH FAIR LABS THROUGHOUT THE YEAR WHICH PROMOTES THE HEALTH OF THE COMMUNITY BY ENCOURAGING CITIZENS TO RECEIVE LAB TESTS AT A NOMINAL FEE, AND AT A DATE THAT'S CONVENIENT FOR THEM. |
| PART III, LINE 2: | CALCULATED BASED ON THE TOTAL BAD DEBT OF THE FACILITY FOR FISCAL YEAR 2022 (FOUND IN THE FACILITY'S 2022 AUDITED FINANCIAL STATEMENTS) MULTIPLIED BY THE COST-TO-CHARGE RATIO CALCULATED ON WORKSHEET 2 OF THE 2021 SCHEDULE H. |
| PART III, LINE 3: | CALCULATED BASED ON THE ASSUMPTION THAT A LARGE PORTION OF PRIVATE PAY PATIENTS SENT TO BAD DEBT WOULD HAVE QUALIFIED FOR FINANCIAL ASSISTANCE HAD THEY APPLIED. MADISON VALLEY MEDICAL CENTER ESTIMATES THAT 54% OF PRIVATE PAY ACCOUNTS WOULD QUALIFY FOR FINANCIAL ASSISTANCE OR EXPANDED MEDICAID HAD THEY BEEN WILLING TO APPLY. THE ESTIMATED BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR CHARITY CARE IS CALCULATED AS THE FACILITY'S TOTAL BAD DEBT EXPENSE MULTIPLIED BY THE COST-TO-CHARGE RATIO CALCULATED ON WORKSHEET 2 OF THE 2021 SCHEDULE H AND THE ESTIMATED PORTION OF BAD DEBT ACCOUNTS ELIGIBLE FOR FINANCIAL ASSISTANCE. |
| PART III, LINE 4: | THE FOOTNOTE THAT DESCRIBES BAD DEBT CAN BE FOUND ON PAGE 8 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | THIS AMOUNT REFLECTS THE ACTUAL AMOUNT RECEIVED FROM MEDICARE RELATED TO MEDICARE SERVICES BILLED. THE COSTING METHODOLOGY USED WAS THE STANDARD ALLOWABLE COST FROM THE MEDICARE COST REPORT 2552-10. |
| PART III, LINE 9B: | TO RECEIVE ASSISTANCE, PATIENTS MUST COMPLETE AN APPLICATION ACCOMPANIED BY PROOF OF INCOME AND A WRITTEN STATEMENT OF NON-QUALIFICATION FOR GOVERNMENT ASSISTANCE. THE APPLICATION IS REVIEWED AND A WRITTEN DETERMINATION IS PROVIDED TO THE PATIENT. THE PATIENT MAY QUALIFY FOR A DISCOUNT OF UP TO 100% ON THEIR BILL BASED ON CURRENT FEDERAL POVERTY GUIDELINES. IF THE PATIENT HAS A BALANCE REMAINING, A PAYMENT PLAN MAY BE SET UP AT THIS TIME, USING GUIDELINES FOR PRIVATE PAY PATIENTS. |
| PART VI, LINE 2: | THE ORGANIZATION UTILIZES OR RELIES UPON THE INFORMATION CONTAINED WITHIN THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED. IN ADDITION, IPADS ARE LOCATED OUTSIDE OF THE LAB AND CLINIC TO ALLOW FOR QUICK SURVEY RESPONSES. INFORMATION FROM THE SURVEYS ARE REVIEWED ON A MONTHLY BASIS AS PART OF THE QUALITY IMPROVEMENT PROGRAM WITHIN THE ORGANIZATION. COMMENTS SPECIFIC TO DEPARTMENTS RECEIVED FROM THE SURVEYS ARE DISTRIBUTED TO THE APPROPRIATE DEPARTMENT MANAGER FOR RESPONSE AND CORRECTIVE ACTION WHERE NECESSARY. |
| PART VI, LINE 3: | PATIENTS ARE NOTIFIED OF OUR FINANCIAL ASSISTANCE PROGRAM BY VERBAL AND WRITTEN EFFORTS AT THE TIME OF SERVICE, BY TELEPHONE, AS WELL AS BY WRITTEN NOTICE ON STATEMENTS ON EACH ACCOUNT. THE FINANCIAL ASSISTANCE PROGRAM IS ALSO AVAILABLE ON THE WEBSITE. |
| PART VI, LINE 4: | THE GEOGRAPHIC AREA THAT THE CENTER SERVICES IS APPROXIMATELY 650 SQUARE MILES CONSISTING OF 80 MILES NORTH TO SOUTH AND 10 MILES EAST TO WEST. THE GEOGRAPHIC AREA IS IN SOUTHWESTERN MONTANA AND IS COMPRISED OF THE ENNIS AND HARRISON TAX DISTRICTS, WHICH ARE NO. 53 AND NO. 23, RESPECTIVELY. THE POPULATION OF THIS AREA IS APPROXIMATELY 3,000 BUT INCREASES TO 5-6,000 FROM MAY TO SEPTEMBER. MEDICARE AGE POPULATION IS SLIGHTLY ABOVE STATE AND NATIONAL AVERAGES. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MAURA DAVENPORT | ||||||||||||||
| MD | $300,962 | $0 | $0 | $0 | $0 | $0 | $4,750 | $0 | $6,437 | $0 | $312,149 | $0 | $0 | $0 |
| ALLEN ROHRBACK | ||||||||||||||
| CEO | $192,276 | $0 | $17,000 | $0 | $0 | $0 | $5,347 | $0 | $6,362 | $0 | $220,985 | $0 | $0 | $0 |
| RD MARKS | ||||||||||||||
| MD | $201,302 | $0 | $0 | $0 | $0 | $0 | $6,000 | $0 | $6,022 | $0 | $213,324 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 2 | ON FEBRUARY 16, 2022 MADISON VALLEY MEDICAL CENTER OPENED A RETAIL PHARMACY TO BETTER SERVE THE ENNIS COMMUNITY. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS MEMBERS WHO CONSIST OF ALL REGISTERED VOTERS OF THE TAX DISTRICT. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE RETURN IS REVIEWED BY THE FINANCE COMMITTEE BEFORE FILING ON BEHALF OF THE BOARD. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION REQUIRES BOARD MEMBERS AND MANAGEMENT STAFF TO SIGN A CONFLICT OF INTEREST STATEMENT. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE PROCESS INCLUDES THE USE OF SURVEY INFORMATION FROM COMPARABLE ORGANIZATIONS. KEY EMPLOYEE COMPENSATION IS ALSO REVIEWED AND APPROVED BY THE BOARD. |
| FORM 990, PART VI, SECTION C, LINE 19 | DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | MEDICAL CONTRACTUAL SERVICES: PROGRAM SERVICE EXPENSES 1,329,696. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,329,696. OTHER CONTRACTUAL SERVICES: PROGRAM SERVICE EXPENSES 537,247. MANAGEMENT AND GENERAL EXPENSES 216,876. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 754,123. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADISON VALLEY MEDICAL CENTER FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 993 | AddressLine1Txt |
| City | ENNIS | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59729 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810453395 | EIN |
| Primary Activities | RAISES FUNDS TO SUPPORT THE CENTER AND ITS RELATED PROGRAMS | PrimaryActivitiesTxt |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | 509(A)(3) II | PublicCharityStatusTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MADISON VALLEY MEDICAL CENTER FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $211,652 | InvolvedAmt |