POMERENE HOSPITAL: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- POMERENE HOSPITAL (EIN 31-1518658)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-14
- IRS object ID
- 202213189349320166
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-14T21:13:09-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 351178661 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUE & CO LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 9200 WORTHINGTON RD STE 200 | AddressLine1Txt |
| City | WESTERVILLE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43082 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311518658 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POMERENE HOSPITAL | BusinessNameLine1Txt |
| Business Name Line2 | FKA JOEL POMERENE FOUNDATION | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | POME | BusinessNameControlTxt |
| Phone | 3306741015 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 981 WOOSTER RD | AddressLine1Txt |
| City | MILLERSBURG | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 446541094 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TIA CERNAVA | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 3306741015 | PhoneNum |
| Signature | 2022-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | TIA | PersonFirstNm |
| Person Last | CERNAVA | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | NATHAN A RODGERS CPA | PreparerPersonNm |
| PTIN | P01568275 | PTIN |
| Phone | 6148852583 | PhoneNum |
| Preparation | 2022-11-14 | 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 | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TIA CERNAVA | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 981 WOOSTER RD | AddressLine1Txt |
| City | MILLERSBURG | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 446541094 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $49,807,807 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.POMERENEHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1937 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | WE WILL BE A LEADER AND PARTNER IN PROVIDING HIGH QUALITY, COST EFFECTIVE HEALTH CARE FOR ALL RESIDENTS OF GREATER HOLMES COUNTY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 443 | TotalEmployeeCnt |
| Total Volunteers | 45 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $5,091,378 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,786,086 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $38,133,904 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $43,556,684 | CYProgramServiceRevenueAmt |
| PY Investment Income | $33,343 | PYInvestmentIncomeAmt |
| CY Investment Income | $43,341 | CYInvestmentIncomeAmt |
| PY Other Revenue | $381,288 | PYOtherRevenueAmt |
| CY Other Revenue | $421,696 | CYOtherRevenueAmt |
| PY Total Revenue | $43,639,913 | PYTotalRevenueAmt |
| CY Total Revenue | $49,807,807 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $28,035 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $45,740 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $19,367,787 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $21,259,490 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $18,092,048 | PYOtherExpensesAmt |
| CY Other Expenses | $19,795,227 | CYOtherExpensesAmt |
| PY Total Expenses | $37,487,870 | PYTotalExpensesAmt |
| CY Total Expenses | $41,100,457 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $6,152,043 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $8,707,350 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $38,025,678 | TotalAssetsBOYAmt |
| Total Assets EOY | $43,116,892 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $7,756,075 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,121,128 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $30,269,603 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $38,995,764 | NetAssetsOrFundBalancesEOYAmt |
| Mission | HOLMES COUNTY'S COMMUNITY HOSPITAL. WE PROVIDE HIGH-QUALITY, COST EFFECTIVE HEALTHCARE SERVICES TO OUR COMMUNITY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $30,503,789 | ExpenseAmt |
| Grant | $45,740 | GrantAmt |
| Revenue | $43,574,206 | RevenueAmt |
| Desc | NOT-FOR-PROFIT HOSPITAL THAT PROVIDES ACUTE CARE INPATIENT AND OUTPATIENT SERVICES TO THE HOLMES COUNTY AREA. WE PROVIDED THIS THROUGH MEDICAL, SURGICAL, MATERNAL, AND NURSERY INPATIENT SERVICES. OUTPATIENT SERVICES INCLUDE LABORATORY, RADIOLOGY, REHABILITATION, AND RESPIRATORY SERVICES. POMERENE HOSPITAL PROVIDED 10,829 ED VISITS, 2,171 DISCHARGES, AND 51,438 OUTPATIENT REGISTRATIONS IN 2021. | Desc |
| Total Program Service Expenses | $30,503,789 | 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 | 0 | 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 | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | 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 | Yes (1) | 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 | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 72 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 443 | 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 | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | 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 | 0 | 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 | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | 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 |
| States Where Copy Of Return Is Fld | OH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JASON JUSTUS | PersonNm |
| Phone | 3306741015 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 981 WOOSTER RD | AddressLine1Txt |
| City | MILLERSBURG | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44654 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 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 |
|---|---|---|---|---|---|---|---|---|
| DAN MATHIE | ||||||||
| CHAIRMAN | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ERNEST HERSHBERGER | ||||||||
| VICE CHAIRMAN | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ELLIE RAMSEYER | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JANE GRAVEN | ||||||||
| SECRETARY | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DAVE FINLEY | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SHEILA KNAPP | ||||||||
| TREASURER | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| CRAIG MULLET | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| TODD SOMMER | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JAMIE TIPPETT | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JOHN HENRY TROYER | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LEROY YODER | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MELVIN YODER | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JASON JUSTUS | ||||||||
| CEO | 40.00 | 2.00 | Yes (X) | Yes (X) | $330,172 | $0 | $0 | |
| TIA CERNAVA | ||||||||
| CFO | 40.00 | 2.00 | Yes (X) | $165,605 | $0 | $0 | ||
| DR MICHAEL T SCHELL | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $456,561 | $0 | $0 | Yes (X) | ||
| EUGENE KOSER | ||||||||
| ANESTHESIOLOGIST | 40.00 | 0.00 | $349,774 | $0 | $0 | Yes (X) | ||
| DR LEON MILLER | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $353,267 | $0 | $0 | Yes (X) | ||
| DR IBRAHIM SOZEN | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $362,863 | $0 | $0 | Yes (X) | ||
| DR YASSER OMRAN | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $274,514 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,292,756 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 9 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| POMERENE EMERGENCY PHYSICIANS | |||||
| 2625 MACNAUGHTEN RD | NORTH CANTON | OH | 44720 | ED PHYSICIANS | $2,073,280 |
| KOMBIAN GBARUK MD DBA PRISM MEDICAL LLC | |||||
| 5480 GORDON WAY | DUBLIN | OH | 43017 | HOSPITALIST PHYSICIAN COVERAGE | $323,880 |
| OHIO PHYSICIANS PROFESSIONAL CORP | |||||
| 2600 SIXTH ST SW | CANTON | OH | 44710 | CARDIOLOGY PHYSICIAN COVERAGE | $143,861 |
| PROFESSIONAL MEDICAL RECORDS | |||||
| PO BOX 67 | CLINTON | OH | 44216 | TRANSCRIPTION SERVICES | $113,501 |
| ROZUK RADIOLOGY | |||||
| PO BOX 392 | MILLERSBURG | OH | 44654 | RADIOLOGY SERVICES | $112,693 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $5,721,052 | GovernmentGrantsAmt |
| All Other Contributions | $65,034 | AllOtherContributionsAmt |
| Total Contributions | $5,786,086 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $43,556,684 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $43,556,684 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $43,556,684 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $43,235 | TotalRevenueColumnAmt |
| Exclusion | $43,235 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $278,887 | 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 | $278,887 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $278,887 | TotalRevenueColumnAmt |
| Exclusion | $278,887 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $106 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $106 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $106 | TotalRevenueColumnAmt |
| Exclusion | $106 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MEALS | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $107,500 | TotalRevenueColumnAmt |
| Exclusion | $107,500 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $35,309 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,522 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $17,787 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $142,809 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $49,807,807 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $43,574,206 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $447,515 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,740 | TotalAmt |
| Program Services | $45,740 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,577,683 | TotalAmt |
| Program Services | $13,486,756 | ProgramServicesAmt |
| Management And General | $4,090,927 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $578,748 | TotalAmt |
| Program Services | $436,952 | ProgramServicesAmt |
| Management And General | $141,796 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,145,859 | TotalAmt |
| Program Services | $1,620,115 | ProgramServicesAmt |
| Management And General | $525,744 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $957,200 | TotalAmt |
| Program Services | $831,402 | ProgramServicesAmt |
| Management And General | $125,798 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,162 | TotalAmt |
| Program Services | $12,163 | ProgramServicesAmt |
| Management And General | $6,999 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $102,997 | TotalAmt |
| Program Services | $65,378 | ProgramServicesAmt |
| Management And General | $37,619 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,173,513 | TotalAmt |
| Program Services | $5,762,548 | ProgramServicesAmt |
| Management And General | $2,410,965 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $179,265 | TotalAmt |
| Program Services | $113,790 | ProgramServicesAmt |
| Management And General | $65,475 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,236,843 | TotalAmt |
| Program Services | $1,419,851 | ProgramServicesAmt |
| Management And General | $816,992 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $416,866 | TotalAmt |
| Program Services | $264,609 | ProgramServicesAmt |
| Management And General | $152,257 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,686,694 | TotalAmt |
| Program Services | $1,070,641 | ProgramServicesAmt |
| Management And General | $616,053 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $223,761 | TotalAmt |
| Program Services | $142,034 | ProgramServicesAmt |
| Management And General | $81,727 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,981 | TotalAmt |
| Program Services | $5,066 | ProgramServicesAmt |
| Management And General | $2,915 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,888 | TotalAmt |
| Program Services | $6,911 | ProgramServicesAmt |
| Management And General | $3,977 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,286,544 | TotalAmt |
| Program Services | $551,095 | ProgramServicesAmt |
| Management And General | $735,449 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $311,336 | TotalAmt |
| Program Services | $197,623 | ProgramServicesAmt |
| Management And General | $113,713 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL AND OTHER SUPPL | $4,017,715 | $3,759,132 | $258,583 |
| FRANCHISE FEE | $792,494 | $503,041 | $289,453 |
| DUES, PUBS, AND SUBSCRI | $148,815 | $94,461 | $54,354 |
| DIETARY | $96,112 | $61,008 | $35,104 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $84,241 | TotalAmt |
| Program Services | $53,473 | ProgramServicesAmt |
| Management And General | $30,768 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,100,457 | TotalAmt |
| Program Services | $30,503,789 | ProgramServicesAmt |
| Management And General | $10,596,668 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,708 | BOYAmt |
| EOY | $1,708 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,643,977 | BOYAmt |
| EOY | $15,190,674 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,320,978 | BOYAmt |
| EOY | $6,002,432 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $578,985 | BOYAmt |
| EOY | $619,071 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $446,354 | BOYAmt |
| EOY | $702,177 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $41,178,663 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $32,374,078 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,552,193 | BOYAmt |
| EOY | $8,804,585 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,481,483 | BOYAmt |
| EOY | $11,796,245 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,025,678 | BOYAmt |
| EOY | $43,116,892 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,023,442 | BOYAmt |
| EOY | $2,299,082 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,855 | BOYAmt |
| EOY | $55,590 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,679,778 | BOYAmt |
| EOY | $1,471,736 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $294,720 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,756,075 | BOYAmt |
| EOY | $4,121,128 | 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 | $30,269,603 | BOYAmt |
| EOY | $38,995,764 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,269,603 | BOYAmt |
| EOY | $38,995,764 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,025,678 | BOYAmt |
| EOY | $43,116,892 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $8,707,350 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $18,811 | 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| 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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $631,987 | OtherCostOrOtherBasisAmt |
| Book Value | $631,987 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,817,065 | OtherCostOrOtherBasisAmt |
| Depreciation | $12,691,999 | DepreciationAmt |
| Book Value | $5,125,066 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $214,573 | OtherCostOrOtherBasisAmt |
| Depreciation | $80,899 | DepreciationAmt |
| Book Value | $133,674 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $22,234,047 | OtherCostOrOtherBasisAmt |
| Depreciation | $19,601,180 | DepreciationAmt |
| Book Value | $2,632,867 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $280,991 | OtherCostOrOtherBasisAmt |
| Book Value | $280,991 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,804,585 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| OTHER RECEIVABLES | $440,709 |
| INVESTMENT IN JOINT VENTURES | $5,144 |
| ASSETS WHOSE USE IS LIMITED | $11,350,392 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $11,796,245 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | THIRD PARTY SETTLEMENT | Desc |
| Amt | $294,720 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $294,720 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY IF AN UNCERTAIN POSITION HAS BEEN TAKEN THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THESE ENTITIES AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2021 AND 2020, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION IS REQUIRED TO FILE FEDERAL FORM 990 RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, WHICH IS AN INFORMATION RETURN ONLY. THE ORGANIZATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS. HOWEVER, AS OF THE DATE THE CONSOLIDATED FINANCIAL STATEMENTS WERE AVAILABLE TO BE ISSUED, THERE WERE NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THESE INCOME TAX RETURNS ARE GENERALLY OPEN TO EXAMINATION BY THE RELEVANT TAXING AUTHORITIES FOR A PERIOD OF THREE YEARS FROM THE LATER OF THE DATE THE RETURN WAS FILED OR ITS DUE DATE (INCLUDING APPROVED EXTENSIONS). | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 175.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | $173,827 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $208,785 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,253,679 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,894,684 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,358,995 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03310 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,427,506 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,103,469 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,358,995 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03310 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $153,136 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $153,136 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00370 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $45,740 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $45,740 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $198,876 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $198,876 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00480 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,626,382 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,103,469 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,557,871 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03790 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,430,517 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $4,591,155 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,613,269 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $977,886 | 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 (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 | POMERENE HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 981 WOOSTER | AddressLine1Txt |
| City | MILLERSBURG | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44654 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.POMERENE.ORG | WebsiteAddressTxt |
| State License | 1202 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POMERENE HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Licensed CY Or PY | Yes (1) | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | Yes (1) | 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 | 20 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | 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 | SEE PART V, PAGE 8 | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | HTTPS://HOLMESHEALTH.ORG/ | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 20 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, PAGE 8 | 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 | 175.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| 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 | HTTPS://WWW.POMERENEHOSPITAL.ORG/FINANCIAL-ASSISTANCE-PROGRAMS | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.POMERENEHOSPITAL.ORG/FINANCIAL-ASSISTANCE-PROGRAMS | FAPAppAvailableOnWebsiteURLTxt |
| 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 |
| 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 Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| POMERENE HOSPITAL | PART V, SECTION B, LINE 5: THE 2020 HOLMES COUNTY COMMUNITY HEALTH ASSESSMENT PRESENTS THE RESULTS OF THE HEALTH ASSESSMENT SURVEY GIVEN TO A RANDOM SAMPLE OF HOLMES COUNTY RESIDENTS AND ALSO A GROUP OF COMMUNITY LEADERS FOR SPECIFIC INPUT. THE RESIDENT SURVEY CONSISTED OF 149-QUESTIONS, IN BOTH PAPER MAIL AND ELECTRONIC FORMATS. THE COMMUNITY LEADER SURVEY CONSISTED OF 9 QUESTIONS TO 27 LEADERS WITHIN HOLMES COUNTY. THE INFORMATION PRESENTED CONSISTS OF DATA COLLECTED FROM THE SURVEYS AS WELL AS HEALTH INFORMATION OBTAINED FROM THE OHIO DEPARTMENT OF HEALTH AND REVELVANT NATIONAL, STATE, AND LOCAL DATA SOURCES THAT IS PUBLICALLY AVAILABLE. THE REPORT WAS COORDINATED, REVIEWED, AND ANALYZED BY THE PARTNERS FOR A HEALTHIER HOLMES COUNTY COMMITTEE (THE "PARTNERS), WHICH WAS COMPROMISED OF A TOTAL OF 13 HOLMES COUNTY AGENCIES AND FUNDED BY POMERENE HOSPITAL, HOLMES COUNTY GENERAL HEALTH DISTRICT, MENTAL HEALTH AND RECOVERY BOARD OF WAYNE AND HOLMES COUNTIES, HOLMES COUNTY BOARD OF DEVELOPMENT DISABILITIES, HOLMES COUNTY EMERGENCY MANAGEMENT AGENCY, FAMILY AND CHILDREN FIRST COUNCIL OF HOLMES COUNTY, ANAZAO COMMUNITY PARTNERS, OHIO UNIVERSITY, ONEEIGHTY FOUNDATION, THE COUNSELING CENTER OF WAYNE AND HOLMES COUNITIES, VIOLA STARTZMAN CLINIC, AND THE EAST HOLMES AND WEST HOLMES SCHOOL DISTRICTS. THE PARTNERS COMMITTEE WERE ORGANIZED AND GOVERNED BY THE EXECUTIVE COMMITTEE CONSISTING OF THE HOLMES COUNTY GENERAL HEALTH DISTRICT ("HEALTH DEPARTMENT") AND POMERENE HOSPITAL. THE PARTNERS SOLICITED INPUT AND RESPONSES FROM MEMBERS OF THE COMMUNITY BY CONDUCTING FOCUS GROUPS AND MEETINGS TO DISCUSS THE SURVEY RESULTS IN ORDER TO DEVELOP STRATEGIES TO ADDRESS THE HEALTH AND WELLNESS ISSUES FACING THE HOLMES COUNTY COMMUNITY. COLLECTIVELY, THE PARTNERS CONDUCTED ONGOING AND FREQUENT MEETINGS TO ANALYZE, DISCUSS AND DEVELOP EACH UNDERLYING COMMUNITY HEALTH ASSESSMENT INITIATIVE. AS EACH COMMUNITY INITIATIVE WAS ENACTED, FOLLOW-UP MEETINGS BY THE PARTNERS WERE CONDUCTED TO RECORD AND TRACK RESULTS AND PROGRESS ON EACH PROJECT. |
| POMERENE HOSPITAL | PART V, SECTION B, LINE 6B: HOLMES COUNTY HEALTH DISTRICT |
| POMERENE HOSPITAL | PART V, SECTION B, LINE 11: THE 2020 HOLMES COUNTY HEALTH ASSESSMENT IDENTIFIED NINE PRIMARY NEEDS CONSISTING OF HEALTHCARE ACCESS, HEALTH BEHAVIORS RELATED TO CANCER, CHRONIC DISEASE, COMMUNICATION, EDUCATION, HEALTH INSURANCE, INFECTIOUS DISEASE, MENTAL HEALTH AND SUBSTANCE ABUSE, AND NUTRITION AND PHYSICAL ACTIVITY. POMERENE HOSPITAL IS ADDRESSING SIX OUT OF THE NINE HEALTHCARE ASSESSMENT PRIMARY NEED CATEGORIES BY UNDERTAKING A LEAD ROLE ON SEVERAL PROJECTS/INITIATIVES WITHIN EACH CATEGORY. POMERENE HOSPITAL DEDICED NOT TO PURSUE THE PRIMARY NEED OF SOCIAL CONDITIONS. THE SOCIAL CONDITIONS NEED (SOCIAL DETERMINANTS OF HEALTH) INCLUDES COMMUNICATION, EDUCATION, AND HEALTH INSURANCE. POMERENE DID NOT DEVELOP AN INITIATIVE WITHIN THE SOCIAL DETERMINANTS OF HEALTH CATEGORIES BECAUSE COMMUNICATION 53% OF HOLMES COUNTY RESIDENTS HAVE A BROADBAND INTERNEST SUBSCRIPTION AND CULTURALLY, [FIFTY PERCENT (50%) OF THE ENTIRE HOLMES COUNTY POPULATION (ANABASPTIST/AMISH) MAINTAIN AN EFFORT TO BE SELF-SUFFICIENT EDUCATION 57% OF HOLMES COUNTY ADULTS 25 YEARS AND OLDER HAVE AT LEAST A HIGH SCHOOL DIPLOMA AND CULTURALLY, [FIFTY PERCENT (50%) OF THE ENTIRE HOLMES COUNTY POPULATION (ANABASPTIST/AMISH) ONLY ATTEND SCHOOL UNITL THE COMPLETION OF 8TH GRADE POMERENE ALREADY PROVIDES TRANSPORTATION FOR PATIENTS WHO RECEIVE HEALTHCARE SERVICES AT ONE OF OUR FACILITIES HEALTH INSURANCE SEVENTEEN (17%) OF HOLMES COUNTY RESIDENTS WERE CLASSIFIED AS UNINSURED, BUT FOURTY-ONE PERCENT (41%) OF THE TOTAL POPULATION PARTICIPATE IN COMMUNITY-BASED FINANCIAL SUPPORT PROGRAMS UNDERTAKEN BY THE ANABAPTIST/AMISH COMMUNITY. THE AMISH COMMUNITY COLLECTIVELY CONTRIBUTES TOWARDS THE COST OF HEALTHCARE SERVICES UTILIZED BY ITS COMMUNITY MEMBERS. POMERENE HOSPITAL DID UNDERTAKE THE FOLLOWING INITIATIVES AIMED TOWARDS IMPROVING THE OVERALL HEALTH OF THE RESIDENTS OF HOLMES COUNTY HEALTHCARE ACCESS RECRUIT AND EMPLOY PROVIDERS TO ADDRESS THE KEY HEALTH CONDITIONS OR PROVISION OF CARE "GAPS" IDENTIFIED WITHIN THE ADULT MEDICINE, WOMEN'S HEALTH, FAMILY MEDICINE, CARDIOLOGY, AND OCCUPATIONAL MEDICINE EXPAND SERVICES CANCER, CHRONIC CARE MANAGEMENT, INFECTIOUS DISEASE, OUTPATIENT UTILIZATION AND CASE MANAGEMENT, EXTENDED CARE SERVICES, DIABETIC EDUCATION, CORPORATE WELLNESS/PREVENTION, OUTPATIENT PRIMARY CARE PROVIDER OFFICES AND INPATIENT-HOSPITAL BASED CARDIOLOGY SERVICES COMMUNITY BASED SUPPORT FOR NUTRITION AND PHYSICAL ACTIVITY DEVELOPED NUTRITIONAL EDUCATION, ADULT MOVEMENT AND EXERCISE CLASSES WITHIN POMERENE'S KINETICS FITNESS FACILITY ORGANIZED AND CONDUCTED TRAINING AND EDUCATION FOR ER AND PRIMARY CARE PROVIDERS AND STAFF ON MENTAL HEALTH AND SUBSTANCE ABUSE ISSUES AND AVAILABLE RESOURCES CONDUCTED RESEARCH AND EVALUATION OF POTENTIAL TELEMEDICINE PROVIDERS FOR POMERENE HOSPITAL OUTBUILDINGS AND SERVICES IN ORDER TO IMPROVE ACCESS AND CONTINUITY OF CARE PARTICIPATED IN MULTIPLE COMMUNITY-BASED EVENTS (FAIRS) FOCUSING UPON HEALTH CONDITIONS WITHIN HOLMES COUNTY, AVAILABLE RESOURCES AND PROVIDERS AS WELL AS PROVIDING EDUCATION MATERIALS. |
| POMERENE HOSPITAL: | SCHEDULE H, PART V, LINE 7A:HTTPS://WWW.POMERENEHOSPITAL.ORG/COMMUNITY-CARE9CC3B603 |
| POMERENE HOSPITAL: | SCHEDULE H, PART V, LINE 10:HTTPS://WWW.POMERENEHOSPITAL.ORG/COMMUNITY-CARE9CC3B603 |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | IN ADDITION TO FPG, POMERENE HOSPITAL USES THE FOLLOWING METHODS TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY: ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, UNDERINSURANCE STATUS, AND RESIDENCY. |
| PART I, LINE 7: | POMERENE HOSPITAL CALCULATED THE COST OF FINANCIAL ASSISTANCE AND MEANS-TESTED GOVERNMENT PROGRAMS USING THE COST-TO-CHARGE RATIO DERIVED FROM SCHEDULE H, WORKSHEET 2 AND A COST ACCOUNTING SYSTEM (MEDLINK). THE ORGANIZATION'S SYSTEM CALCULATES COST BASED ON PATIENT TYPE AND FINANCIAL CLASS. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | THESE ACTIVITIES PROVIDE FREE TRANSPORTATION TO THE HOSPITAL FOR HEALTH SERVICES. THESE ACTIVITIES ALSO PROVIDE EDUCATION TO IMPROVE OUR COMMUNITY'S HEALTH DECISIONS. |
| PART III, LINE 2: | ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON THE ORGANIZATION'S EVALUATION OF ITS MAJOR PAYOR SOURCES OF REVENUE, THE AGING OF THE ACCOUNTS, HISTORICAL LOSSES, CURRENT ECONOMIC CONDITIONS, AND OTHER FACTORS UNIQUE TO THEIR SERVICE AREA AND THE HEALTHCARE INDUSTRY. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRDPARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTY THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PAYMENTS, WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL, THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.THE DECEMBER 31, 2021 AND 2020 ALLOWANCE FOR DOUBTFUL ACCOUNTS OF APPROXIMATELY $1,892,000 AND $1,492,000, RESPECTIVELY, RELATES TO RESERVES FOR SELF-PAY BALANCES. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS BASED ON A PERCENTAGE OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2021 AND 2020. THE ORGANIZATION'S SELF-PAY WRITE-OFFS INCREASED $143,012 FROM $2,287,505 FOR 2020 TO $2,430,517 FOR 2021. THE ORGANIZATION HAS NOT CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING 2021 OR 2020. THE ORGANIZATION DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR DOUBTFUL ACCOUNTS FROM THIRD-PARTY PAYORS, NOR DID IT HAVE SIGNIFICANT WRITE-OFFS FROM THIRD-PARTY PAYORS. |
| PART III, LINE 3: | THE HOSPITAL HAS A DETAILED FINANCIAL ASSISTANCE POLICY WHICH STATES THAT TO PARTICIPATE IN CHARITY CARE CANDIDATES MUST COOPERATE FULLY. IN ADDITION THE HOSPITAL EDUCATES PATIENTS WITH LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THIS REASON THE ORGANIZATION BELIEVES THAT IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE. |
| PART III, LINE 4: | THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE CAN BE FOUND UNDER THE HEADING 'PATIENT CARE SERVICE REVENUE' STARTING ON PAGE 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED 12/31/21 REPORT: HOSPITAL STATEMENT OF REIMBURSABLE COST. THE ORGANIZATION DOES NOT CONSIDER MEDICARE SHORTFALL AS A COMMUNITY BENEFIT. |
| PART III, LINE 9B: | WHEN A PATIENT IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FAP BASED UPON A PRIOR FAP ELIGIBILITY DETERMINATION OR DUE TO INFORMATION ACQUIRED FROM A THIRD-PARTY (I.E. SOMEONE OTHER THAN THE PATIENT OR HIS/HER REPRESENTATIVE) AND THE ELIGIBILITY DETERMINATION IS FOR LESS THAN THE MOST GENEROUS ASSISTANCE AVAILABLE UNDER THE FAP, POMERENE WILL DO THE FOLLOWING BEFORE INSTITUTING ANY ECA:- NOTIFY THE PATIENT (VIA A BILLING STATEMENT) OF THE BASIS FOR THE PRESUMPTIVE ELIGIBILITY DETERMINATION AND HOW TO APPLY FOR MORE GENEROUS ASSISTANCE;- PROVIDE THE PATIENT A REASONABLE PERIOD OF TIME (NOT LESS THAN 90 DAYS FROM THE FIRST BILLING STATEMENT) TO APPLY FOR MORE GENEROUS ASSISTANCE BEFORE INSTITUTING AN ECA TO OBTAIN PAYMENT OF THE DISCOUNTED AMOUNT OWED; AND- IF THE PATIENT SUBMITS A COMPLETE APPLICATION FOR FINANCIAL ASSISTANCE, MEET THE REQUIREMENTS FOR NOTICE OF ELIGIBILITY DETERMINATIONS OF COMPLETE APPLICATIONS SET FORTH BELOW. |
| PART VI, LINE 2: | POMERENE HOSPITAL CONDUCTS ONGOING, INTERMITTENT AND ANNUAL RESEARCH, DATA GATHERING, ANALYZING OF LARGE QUANTITIES OF DATA AND METRICS REGARDING LOCAL HOLMES COUNTY AND SURROUNDING COMMUNITIES AS WELL AS EXTERNAL COMPARISON DATA FROM STATE, REGION AND FEDERAL SOURCES. POMERENE ATTEMPTS TO BUILD A COMPREHENSIVE PERSPECTIVE AND VIEW TOWARDS LOCAL, STATE AND NATIONAL ECONOMIC, SOCIAL, ENVIRONMENTAL, HEALTHCARE AND FINANCIAL CONDITIONS AND TRENDS IN ORDER TO POSITIVELY IMPROVE DECISION MAKING AND STRATEGIC PLANNING. EXAMPLES OF INTERNAL AND EXTERNAL DATA SOURCES POMERENE MAY USE ARE: CENTERS FOR MEDICARE AND MEDICAID (CMS), OHIO HOSPITAL ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION, TRUVEN, MOODY'S AND STANDARD AND POOR'S, HOLMES COUNTY HEALTH DISTRICT, OHIO DEPARTMENT OF HEALTH AS WELL AS HEALTHCARE INDUSTRY RESEARCH. AS MEMBERS OF AN ACO AND OTHER COLLECTIVE HEALTHCARE ORGANIZATIONS, POMERENE ALSO RECEIVES POPULATION-BASED DATA AND ACTIVITY. LAST, POMERENE COLLECTS INTERNAL COMMUNITY AND PATIENT DATA FROM SERVICES PROVIDED TO THE COMMUNITY, CONDUCTING COMMUNITY HEALTH TALKS AND EDUCATION, CONDUCTING COMMUNITY-BASED FOCUS GROUPS, REFERRAL-BASED DATA, COLLABORATING WITH LOCAL INDEPENDENT PROVIDERS AND COMMUNITY AGENCIES AS WELL AS THE POMERENE CARE TEAM WHICH IS A MULTI-DISCIPLINE TEAM OF HEALTHCARE PROVIDERS, STAFF AND ORGANIZATION LEADERS WHO ANALYZE DATA TO HELP IMPROVE THE QUALITY, SAFETY AND EFFICIENCY OF PATIENT CARE WITHIN POMERENE. |
| PART VI, LINE 3: | OUR ORGANIZATION VISITS PATIENTS WHO ARE IN THE ED, UNDER OBSERVATION, OR INPATIENT TO DISTRIBUTE PACKETS CONTAINING FINANCIAL ASSISTANCE ELIGIBILITY INFORMATION. ADMISSIONS IS TRAINED TO HAND OUT THESE PACKETS. THE FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE ON THE ORGANIZATION'S WEBSITE FOR EASY ACCESS. ADDITIONALLY, SIGNS ARE POSTED IN ALL PATIENT AREAS AND BUSINESS OFFICES THAT DETAIL WHO TO CONTACT FOR FINANCIAL ASSISTANCE. |
| PART VI, LINE 4: | HOLMES COUNTY IS ONE OF 88 COUNTIES LOCATED WITHIN THE STATE OF OHIO. THE GEOGRAPHIC FOOTPRINT CONSISTS OF 423 SQ MILES OF RURAL LAND WHICH PRIMARILY SUPPORTS AGRICULTURE, MANUFACTURING, TRADE AND PUBLIC ADMINISTRATION INDUSTRIES. ACCORDING TO THE U.S. CENSUS BUREAU (2018) THE POPULATION OF HOLMES COUNTY IS APPROXIMATELY 43,892. POPULATION AND DEMOGRAPHIC CHARACTERISTICS OF HOLMES COUNTY ARE: FEMALE (49%)/MALE (51%); MEDIAN AGE OF 30.8 (UNDER 18 (33%), 18-64 (55%) AND 65+ (13%)) WHICH IS LESS THAN THE OHIO AVERAGE OF 39.3; CULTURAL DIVERSITY NEARLY 50/50 BETWEEN ENGLISH AND ANABAPTIST/AMISH; RACE AND ETHNICITY PRIMARILY WHITE (98.6%) FOLLOWED BY BLACK/AFRICAN AMERICAN (0.4%), AMERICAN INDIAN (0.1%), ASIAN (0.2%), HISPANIC (1.0%) AND TWO OR MORE RACES (0.6%); EDUCATION DISTRIBUTION OF NO DEGREE (42%), HIGH SCHOOL (35%), SOME COLLEGE (15%), BACHELORS (6%), POST GRADUATE (2%) UP TO MIDDLE SCHOOL LEVEL (53%); MEDIAN HOUSEHOLD INCOME OF $58,728 (PER CAPITA INCOME $21,143) WITH 12-13% OF THE POPULATION LIVING IN POVERTY; PERSONS WITHOUT HEALTH INSURANCE 24% AND PERSONS WITH MEDICAID 14%; AND, MORE THAN 52% OF HOUSEHOLDS ARE WITHOUT A BROADBAND INTERNET SUBSCRIPTION.HOLMES COUNTY, OHIO CONTAINS ONE HOSPITAL, POMERENE HOSPITAL, THAT IS LOCATED IN THE TOWN OF MILLERSBURG AND SERVES THE ENTIRE COUNTY INCLUDING SURROUNDING CONTIGUOUS COMMUNITIES. HOLMES COUNTY IS DESIGNATED BY CMS AS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) AS WELL AS A MEDICARE LOW VOLUME COMMUNITY. POMERENE IS CURRENTLY WORKING TO OBTAIN A RURAL HEALTHCARE CLINIC (RHC) FOR ITS POMERENE FAMILY CARE OFFICE LOCATED IN MILLERSBURG, OHIO. |
| PART VI, LINE 5: | POMERENE HOSPITAL'S MISSION IS "CARING FOR OUR COMMUNITIES HEALTH." THE POMERENE BOARD UNDERTAKES AN ACTIVE ROLE IN ITS RESPONSIBILITY TO PROVIDE OVERSIGHT AND APPROVAL OF THE ORGANIZATIONS MISSION AND ITS STRATEGIC DIRECTION AND PLAN. POMERENE ADHERES TO MAINTAINING SEVENTY-FIVE PERCENT (75%) OF ITS GOVERNING BOARD OF DIRECTORS SHOULD RESIDE WITHIN THE BORDERS OF HOLMES COUNTY, OHIO. DURING 2019 ALL 11 MEMBERS OF THE BOARD CONSISTED OF INDIVIDUALS WHO RESIDED WITHIN HOLMES COUNTY. MEMBERSHIP OF THE POMERENE BOARD INCLUDES REPRESENTATION FROM BOTH PRIMARY CULTURAL DEMOGRAPHIC SEGMENTS OF HOLMES COUNTY, ANABAPTIST/AMISH (25%) AND NON-ANABAPTIST/ENGLISH (75%). BOARD MEMBERSHIP CONSISTED OF A DIVERSE LIST OF PERSONAL AND PROFESSIONAL BACKGROUNDS SUCH AS AN ATTORNEY, FORMER EDUCATOR, DIRECTOR OF A POST-ACUTE HEALTHCARE FACILITY, LOCAL BUSINESS OWNERS, NON-PROFIT DIRECTOR, PREVIOUS NURSE, LOCAL COMMUNITY TOURISM DIRECTOR, HUMAN RESOURCES, CORPORATE AND EMPLOYEE SAFETY MANAGER, ETC.ONE OF POMERENE'S SIX STRATEGIC INITIATIVES WAS "DEVELOP POPULATION HEALTH MODEL FOR POMERENE HOSPITAL AND HOLMES COUNTY." KEY OBJECTIVES WERE TO DEFINE AN INTERNAL/EXTERNAL HEALTH RISK PROFILE FOR EMPLOYEES AND DISTINCT POPULATION OF HOLMES COUNTY; DELIVER POPULATION HEALTH CARE MANAGEMENT TO POMERENE EMPLOYEES; EXPAND POPULATION HEALTH INITIATIVES TO COMMUNITY POPULATIONS. INDIVIDUAL PROJECTS CONSISTED OF DEVELOPING AN ANNUAL PLAN FOR EMPLOYEE WELLNESS ACTIVITIES AND SERVICES (SUCH AS DIABETIC EDUCATION) BASED UPON THE EMPLOYEE RISK PROFILE, BIOMETRIC RESULTS AND HEALTH PLAN CLAIM ACTIVITY. PROVIDE CORPORATE WELLNESS/PREVENTION SERVICES TO LOCAL HOLMES COUNTY EMPLOYERS. INTEGRATE AND OPERATE CARDIAC REHABILITATION AND PHYSICAL THERAPY SERVICES WITHIN KINETICS, WHICH IS POMERENE'S MEDICAL FITNESS FACILITY. DEVELOP AND OPERATE OCCUPATIONAL MEDICINE SERVICES TO MEET THE NEEDS OF HOLMES COUNTY EMPLOYERS. PARTICIPATE IN ACO-LIKE ORGANIZATIONS TO COORDINATE PRIMARY AND POST-ACUTE PATIENT CARE DELIVERY. CONDUCT UTILIZATION REVIEW AND CASE MANAGEMENT WITHIN POMERENE FAMILY CARE OFFICE SETTING.THE PROVISION OF PATIENT CARE ASSOCIATED WITH POMERENE HOSPITAL WAS DELIVERED BY MORE THAN NINETY-SIX (96) PROVIDERS CONSISTING OF HOSPITAL AND NON-HOSPITAL-BASED, EMPLOYED AND INDEPENDENT, PHYSICIANS AND ADVANCED PRACTICE PROVIDERS, AS WELL AS PRIMARY CARE AND SPECIALISTS. THE HOSPITAL REINVESTED NEARLY 25% OF ITS ANNUAL EBITDA OF $4.2 MILLION ($900,000) IN CAPITAL IMPROVEMENTS SUCH AS PATIENT CARE (53%), INFORMATION TECHNOLOGY (27%), FACILITY (6%), POPULATION HEALTH/MEDICAL GROUP (5%) AND ADMINISTRATIVE (9%). POMERENE PROVIDED APPROXIMATELY $2.4 MILLION IN UNCOMPENSATED CARE FOR HOLMES COUNTY AND THE SURROUNDING COMMUNITIES IT SERVES. POMERENE DONATED IN EXCESS OF $34,000 TO LOCAL COMMUNITY AGENCIES AND CHARITABLE ORGANIZATIONS. AS WELL AS INTRODUCED NEW SERVICE PROGRAMS AIMED AT COMMUNITY HEALTH NEEDS SUCH AS CHRONIC CARE MANAGEMENT, DIABETIC EDUCATION, EXTENDED CARE SERVICES AND NUTRITIONAL COUNSELING. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOLMES CO ECONOMIC DEVELOPMENT COUNCIL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 112 | AddressLine1Txt |
| City | MILLERSBURG | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44654 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 352257820 | RecipientEIN |
| IRC Section | 501C3 | IRCSectionDesc |
| Cash Grant | $5,000 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Purpose Of Grant | CONTRIBUTION FOR ECONOMIC DEVELOPMENT IN HOLMES COUNTY | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR MICHAEL T SCHELL | ||||||||||||||
| PHYSICIAN | $456,561 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $456,561 | $0 | $0 | $0 |
| DR IBRAHIM SOZEN | ||||||||||||||
| PHYSICIAN | $362,863 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $362,863 | $0 | $0 | $0 |
| DR LEON MILLER | ||||||||||||||
| PHYSICIAN | $353,267 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $353,267 | $0 | $0 | $0 |
| EUGENE KOSER | ||||||||||||||
| ANESTHESIOLOGIST | $349,774 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $349,774 | $0 | $0 | $0 |
| JASON JUSTUS | ||||||||||||||
| CEO | $330,172 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $330,172 | $0 | $0 | $0 |
| DR YASSER OMRAN | ||||||||||||||
| PHYSICIAN | $274,514 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $274,514 | $0 | $0 | $0 |
| TIA CERNAVA | ||||||||||||||
| CFO | $165,605 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $165,605 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE PROCESS OF REVIEWING THE FORM 990 ENTAILS A DETAILED REVIEW BY THE ORGANIZATION'S ACCOUNTING DEPARTMENT. THE GOVERNING BODY RECEIVES AN ELECTRONIC COPY OF THE FORM 990 INCLUDING REQUESTED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, FOR REVIEW AND APPROVAL PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | UPON APPOINTMENT, AND THEREAFTER ANNUALLY, THROUGH SIGNED ACKNOWLEDGEMENT OF THE CONFLICT OF INTEREST AGREEMENT, OR AT THE TIME WHEN AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST MAY ARISE, THE COVERED PERSON MUST IDENTIFY AND DISCLOSE AT ANY MEETING ALL MATERIAL FACTS AND DETAILS RELATING TO THE ACTUAL OR POTENTIAL CONFLICT OF INTEREST SO THAT THE DISINTERESTED POMERENE DECISION MAKERS ARE ABLE TO MAKE AN OBJECTIVE BUSINESS DETERMINATION CONSISTENT WITH POMERENE'S MISSION AND PURPOSE. ANY COVERED PERSON WITH AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST MUST NOT VOTE OR USE HIS/HER PERSONAL INFLUENCE WITH RESPECT TO ANY VOTE OR ACTION TAKEN BY POMERENE DECISION MAKERS VOTING ON THE PROPOSED MATTER, CONTRACT, TRANSACTION OR BUSINESS ARRANGEMENT. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE BOARD OF TRUSTEES CONDUCTS A PERIODIC REVIEW OF THE CHIEF EXECUTIVE OFFICER'S PERFORMANCE AND COMPENSATION DURING AN EXECUTIVE SESSION OF THE BOARD. THE CEO CONDUCTS AN ANNUAL REVIEW OF THE PERFORMANCE AND COMPENSATION FOR EACH OTHER KEY EMPLOYEE (CFO, CNO, OTHER KEY LEADERSHIP PERSONNEL). THE CEO'S SALARY RECOMMENDATIONS ARE PRESENTED INFORMATIONALLY TO THE EXECUTIVE COMMITTEE OF THE BOARD. |
| FORM 990, PART VI, SECTION C, LINE 19 | DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 4,971,345. MANAGEMENT AND GENERAL EXPENSES 814,303. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,785,648. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 791,203. MANAGEMENT AND GENERAL EXPENSES 1,596,662. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,387,865. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| POMERENE HEALTH FOUNDATION | ||||||||||
| 981 WOOSTER RD | MILLERSBURG | OH | 44654 | 475317369 | FUNDRAISING FOR HOSPITAL | OH | 501(C)(3) | LINE 12B, II | POMERENE HOSPITAL | Yes (1) |
| HEALTH PROFESSIONALS OF HOLMES COUNTY | ||||||||||
| 981 WOOSTER RD | MILLERSBURG | OH | 44654 | 300329769 | LEASING OF PROFESSIONAL SERVICES | OH | 501(C)(3) | LINE 10 | POMERENE HOSPITAL | Yes (1) |
| 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 | 0 | 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 | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |