BARNESVILLE HOSPITAL ASSOCIATION INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- BARNESVILLE HOSPITAL ASSOCIATION INC (EIN 34-0719172)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-10-29
- IRS object ID
- 202143029349302004
- Schema version
- 2020v4.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-10-29T15:17:45-05:00 | ReturnTs |
| Tax Period End | 2020-12-31 | 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 | 500 N MERIDIAN ST SUITE 200 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46204 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 340719172 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BARNESVILLE HOSPITAL ASSOCIATION INC | BusinessNameLine1Txt |
| Business Name Line2 | DBA BARNESVILLE HOSPITAL | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BARN | BusinessNameControlTxt |
| Phone | 7404253941 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 639 W MAIN STREEET | AddressLine1Txt |
| City | BARNESVILLE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43713 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | WILLIE COOPER-LOHR | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 7404253941 | PhoneNum |
| Signature | 2021-10-29 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | WILLIE | PersonFirstNm |
| Person Last | COOPER-LOHR | 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 | 3176334705 | PhoneNum |
| Preparation | 2021-10-26 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | WILLIE COOPER-LOHR | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 639 W MAIN STREEET | AddressLine1Txt |
| City | BARNESVILLE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43713 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $22,655,280 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.BARNESVILLEHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1940 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | WE SERVICE THE HEALTH NEEDS OF THE COMMUNITY AND SURROUNDING COUNTIES. OUR COUNTY TO THE SOUTH OF US DOES NOT HAVE A HOSPITAL. THE COMMUNITY IS SERVICED WITH A 24 HOUR EMERGENCY DEPARTMENT, ACUTE INPATIENT SERVICES ALONG WITH SWING BED TO HELP THEM REMAIN CLOSE TO THEIR FAMILIES. WE ALSO HAVE A FULL SERVICE OUTPATIENT SERVICE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 263 | TotalEmployeeCnt |
| Total Volunteers | 139 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $840,585 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,314,331 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $17,173,528 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $17,043,670 | CYProgramServiceRevenueAmt |
| PY Investment Income | $119,791 | PYInvestmentIncomeAmt |
| CY Investment Income | $59,622 | CYInvestmentIncomeAmt |
| PY Other Revenue | $207,480 | PYOtherRevenueAmt |
| CY Other Revenue | $146,917 | CYOtherRevenueAmt |
| PY Total Revenue | $18,341,384 | PYTotalRevenueAmt |
| CY Total Revenue | $22,564,540 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,028,741 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $897,151 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $11,476,127 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,673,899 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,157,972 | PYOtherExpensesAmt |
| CY Other Expenses | $8,861,846 | CYOtherExpensesAmt |
| PY Total Expenses | $20,662,840 | PYTotalExpensesAmt |
| CY Total Expenses | $19,432,896 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$2,321,456 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,131,644 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $11,839,224 | TotalAssetsBOYAmt |
| Total Assets EOY | $15,220,078 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $9,057,705 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $9,645,812 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,781,519 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,574,266 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | BARNESVILLE HOSPITAL ASSOCIATION, INC. OPERATES IN A MANNER CONSISTENT WITH THE REQUIREMENTS OF REV RUL 69-545, THROUGH IT'S PROVISION OF HEALTH CARE SERVICES TO THE COMMUNITY, REGARDLESS OF ABILITY TO PAY. OUR MISSION IS TO IMPROVE THE COMMUNITY'S HEALTH THROUGH THE EFFICIENT PROVISION, COORDINATION AND INTEGRATION OF QUALITY HEALTH SERVICES, HEALTH EDUCATION AND RESEARCH. WE ALSO PROVIDE COMPASSIONATE, QUALITY HEALTH SERVICES ACCORDING TO THE PHYSICAL, SPIRITUAL, PHYCHOLOGICAL, SOCIAL, RELIGIOUS, ENVIRONMENTAL AND ECONOMIC NEEDS OF OUR COMMUNITIES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $17,284,874 | ExpenseAmt |
| Grant | $897,151 | GrantAmt |
| Revenue | $17,043,670 | RevenueAmt |
| Desc | IN 2020 BARNESVILLE HOSPITAL PROVIDED CARE FOR 244 INPATIENT ADMISSIONS RESULTING IN 1,139 PATIENT DAYS. WE ALSO PROVIDED 23,351 OUTPATIENT VISITS PLUS 6,751 EMERGENCY ROOM VISITS. BARNESVILLE HOSPITAL IS A CRITICAL ACCESS HOSPITAL AND PROVIDES EXTENSIVE INPATIENT AND OUTPATIENT CARE FOR MEMBERS OF THE COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY. | Desc |
| Total Program Service Expenses | $17,284,874 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | 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 | Yes (1) | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | 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 | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 48 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 263 | 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
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILLIE COOPER-LOHR | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7404253941 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 639 W MAIN STREEET | AddressLine1Txt |
| City | BARNESVILLE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43713 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 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 |
|---|---|---|---|---|---|---|---|---|
| R MELVIN MILBURN | ||||||||
| PRESIDENT | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| KENT GALLAGHER | ||||||||
| VICE PRESIDENT | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| C J BRADFIELD | ||||||||
| TREASURER | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| AARON BRUGGEMAN | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| WILLIAM E FRANK JR | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| ANGELA HANNAHS | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DAVID HILLIARD DO | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MINDY JOHNSON | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| TOM JOHNSON | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| KENNETH PHILLIPS | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DR SHAUN ROE | ||||||||
| BOARD MEMBER | 1.00 | 39.00 | Yes (X) | $0 | $281,709 | $40,829 | ||
| P K SOURI MD | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DELORES WELLS | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MELISSA HARTSHORN | ||||||||
| SECRETARY | 40.00 | 0.00 | Yes (X) | $48,348 | $0 | $36,628 | ||
| DAVID PHILLIPS | ||||||||
| CEO | 38.00 | 2.00 | Yes (X) | $287,970 | $0 | $0 | ||
| WILLIE COOPER - LOHR | ||||||||
| CFO | 38.00 | 2.00 | Yes (X) | $109,950 | $0 | $30,733 | ||
| CYNTHIA TOUVELLE | ||||||||
| CNO | 40.00 | 0.00 | Yes (X) | $116,464 | $0 | $28,185 | ||
| TODD TUCKER JR | ||||||||
| PHARMACIST | 40.00 | 0.00 | $105,657 | $0 | $35,935 | Yes (X) | ||
| AMY PERRY | ||||||||
| PHARMACIST | 40.00 | 0.00 | $124,282 | $0 | $25,197 | Yes (X) | ||
| JANET LALLATHIN | ||||||||
| PHARMACIST | 40.00 | 0.00 | $117,245 | $0 | $16,620 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $909,916 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $281,709 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $214,127 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| REYNOLDS MEMORIAL HOSPITAL INC | |||||
| 800 WHEELING AVENUE | GLEN DALE | WV | 26038 | CONTRACTED PHYSICIANS | $1,072,732 |
| ALLSCRIPTS HEALTHCARE LLC | |||||
| 24630 NETWORK PLACE | CHICAGO | IL | 60673 | COMPUTER SYSTEM SERVICES | $900,343 |
| ACUTE CARE INC | |||||
| 1609 N ANKENY BLVD SUITE 200 | ANKENY | IA | 43718 | ER PHYSICIANS | $895,207 |
| MEDSTAFF SERVICES LLC | |||||
| PO BOX 1895 | POWELL | OH | 43065 | HOSPITALIST SERVICES | $475,300 |
| LAB CORP | |||||
| PO BOX 12140 | BURLINGTON | NC | 27216 | LAB SERVICES | $471,613 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 11 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $169,967 | RelatedOrganizationsAmt |
| Government Grants | $5,060,529 | GovernmentGrantsAmt |
| All Other Contributions | $83,835 | AllOtherContributionsAmt |
| Total Contributions | $5,314,331 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $17,043,670 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,043,670 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $17,043,670 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $43,624 | TotalRevenueColumnAmt |
| Exclusion | $43,624 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $62,370 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $90,738 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$28,368 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$28,368 | TotalRevenueColumnAmt |
| Exclusion | -$28,368 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $16,000 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $2 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $15,998 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,998 | TotalRevenueColumnAmt |
| Exclusion | $15,998 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA | 722210 | $66,677 | $66,677 |
| AUXILIARY INCOME | 900099 | $24,248 | $24,248 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $84,360 | TotalRevenueColumnAmt |
| Exclusion | $84,360 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $175,285 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $22,564,540 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,043,670 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $206,539 | 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 | $897,151 | TotalAmt |
| Program Services | $897,151 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $370,307 | TotalAmt |
| Program Services | $329,042 | ProgramServicesAmt |
| Management And General | $41,265 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,820,208 | TotalAmt |
| Program Services | $6,060,202 | ProgramServicesAmt |
| Management And General | $760,006 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $254,391 | TotalAmt |
| Program Services | $219,537 | ProgramServicesAmt |
| Management And General | $34,854 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,727,557 | TotalAmt |
| Program Services | $1,490,866 | ProgramServicesAmt |
| Management And General | $236,691 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $501,436 | TotalAmt |
| Program Services | $432,735 | ProgramServicesAmt |
| Management And General | $68,701 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,000 | TotalAmt |
| Program Services | $45,688 | ProgramServicesAmt |
| Management And General | $9,312 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,005,552 | TotalAmt |
| Program Services | $3,327,348 | ProgramServicesAmt |
| Management And General | $678,204 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,792 | TotalAmt |
| Program Services | $1,546 | ProgramServicesAmt |
| Management And General | $246 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $406,844 | TotalAmt |
| Program Services | $404,569 | ProgramServicesAmt |
| Management And General | $2,275 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,852,021 | TotalAmt |
| Program Services | $1,645,293 | ProgramServicesAmt |
| Management And General | $206,728 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,964 | TotalAmt |
| Program Services | $11,184 | ProgramServicesAmt |
| Management And General | $1,780 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,234 | TotalAmt |
| Program Services | $3,653 | ProgramServicesAmt |
| Management And General | $581 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $79,314 | TotalAmt |
| Program Services | $70,028 | ProgramServicesAmt |
| Management And General | $9,286 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $452,725 | TotalAmt |
| Program Services | $397,929 | ProgramServicesAmt |
| Management And General | $54,796 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $165,291 | TotalAmt |
| Program Services | $148,126 | ProgramServicesAmt |
| Management And General | $17,165 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| DRUGS AND MEDICAL SUPPL | $1,756,271 | $1,756,271 | |
| DUES & SUB. | $43,820 | $37,805 | $6,015 |
| AUXILIARY EXPENSES | $19,178 | $19,178 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,840 | TotalAmt |
| Program Services | $5,901 | ProgramServicesAmt |
| Management And General | $939 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,432,896 | TotalAmt |
| Program Services | $17,284,874 | ProgramServicesAmt |
| Management And General | $2,148,022 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $571 | BOYAmt |
| EOY | $571 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $229,475 | BOYAmt |
| EOY | $3,584,202 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,891,993 | BOYAmt |
| EOY | $1,484,775 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $403,879 | BOYAmt |
| EOY | $417,905 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $223,815 | BOYAmt |
| EOY | $203,349 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $19,196,723 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $14,514,144 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,269,335 | BOYAmt |
| EOY | $4,682,579 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,816,339 | BOYAmt |
| EOY | $2,969,033 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $835,069 | BOYAmt |
| EOY | $1,154,257 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,168,748 | BOYAmt |
| EOY | $723,407 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,839,224 | BOYAmt |
| EOY | $15,220,078 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,700,269 | BOYAmt |
| EOY | $1,841,003 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,832,296 | BOYAmt |
| EOY | $1,498,228 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,525,140 | BOYAmt |
| EOY | $6,306,581 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,057,705 | BOYAmt |
| EOY | $9,645,812 | 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 | $2,781,519 | BOYAmt |
| EOY | $5,574,266 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,781,519 | BOYAmt |
| EOY | $5,574,266 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,839,224 | BOYAmt |
| EOY | $15,220,078 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $3,131,644 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $60,216 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$399,113 | 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $4,015 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $4,015 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | A PORTION OF ANNUAL MEMBERSHIP DUES PAID TO TRADE ASSOCIATIONS IS ALLOCATED TO LOBBYING EXPENDITURES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $66,199 | OtherCostOrOtherBasisAmt |
| Book Value | $66,199 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,631,580 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,503,845 | DepreciationAmt |
| Book Value | $3,127,735 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $400,235 | OtherCostOrOtherBasisAmt |
| Depreciation | $272,530 | DepreciationAmt |
| Book Value | $127,705 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,098,709 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,737,769 | DepreciationAmt |
| Book Value | $1,360,940 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,682,579 | TotalBookValueLandBuildingsAmt |
Invst Program Related Org InvstProgramRelatedOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | EQUITY IN BELMONT COUNTY HEALTH SERVICES | Desc |
| Book Value | $1,154,257 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Program Rltd | $1,154,257 | TotalBookValueProgramRltdAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| ACCRUED PENSION COSTS | $3,580,101 |
| ESTIMATED THIRD PARTY SETTLEMENTS | $150,000 |
| REFUNDABLE ADVANCES | $2,576,480 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $6,306,581 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN 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, 2020 AND 2019, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE ENTITIES ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. |
| SCHEDULE D, PART X, LINE 1 | THE HOSPITAL HAS A NON-CONTRIBUTORY DEFINED BENEFIT PENSION PLAN FOR EMPLOYEES WHO MEET CERTAIN REQUIREMENTS AS TO AGE AND LENGTH OF SERVICE. THE PLAN PROVIDES PENSION BENEFITS THAT ARE BASED ON THE EMPLOYEE'S COMPENSATION DURING THEIR PERIOD OF CREDITED SERVICE. |
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 |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| 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 | $412,013 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $412,013 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02120 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,679,254 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,416,083 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,263,171 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06500 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,091,267 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,416,083 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,675,184 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08620 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $47,246 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $47,246 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00240 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $897,151 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $897,151 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04620 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $944,397 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $944,397 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04860 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,035,664 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,416,083 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,619,581 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13480 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,001,243 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $5,085,895 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,107,004 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$21,109 | 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 | BARNESVILLE HOSPITAL ASSOCIATION INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 639 W MAIN ST | AddressLine1Txt |
| City | BARNESVILLE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43713 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.BARNESVILLEHOSPITAL.COM | WebsiteAddressTxt |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BARNESVILLE HOSPITAL ASSOCIATION | 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 | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | 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 |
| 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 | 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 | 250.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| 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 |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V, PAGE 8 | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, PAGE 8 | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, PAGE 8 | 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 Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| 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 Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| BARNESVILLE HOSPITAL ASSOCIATION | PART V, SECTION B, LINE 5: MET WITH FOCUS GROUPS FROM DIFFERENT COMMUNITIES (BARNESVILLE, BETHESDA, AND WOODSFIELD). IN ADDITION TO THE COMMUNITY FOCUS GROUPS, AN ADDITIONAL MEETING WAS HELD WITH INDIVIDUALS HAVING A SPECIAL KNOWLEDGE IN PUBLIC HEALTH, COMMUNITY ORGANIZATIONS, AND RESOURCES TO UTILIZE THEIR EXPERTISE AND TO SOLICIT THEIR FEEDBACK. COLLABORATING PARTNERS WITHIN THE COMMUNITY INCLUDED:- ADDICTION SERVICES OF EASTERN OHIO- ASTORIA PLACE NURSING FACILITY- BARNESVILLE CHIEF OF POLICE- BARNESVILLE EMS/FIRE DEPARTMENT- BARNESVILLE EXEMPTED VILLAGE SCHOOLS- BARNESVILLE HOSPITAL CHIEF OF STAFF- BARNESVILLE HOSPITAL MARKETING SPECIALIST- BARNESVILLE HOSPITAL PRESIDENT & CEO- BARNESVILLE HOSPITAL SOCIAL WORKER- BELMONT COUNTY 911- BELMONT COUNTY COMMISSIONER- BELMONT COUNTY EMERGENCY MANAGEMENT AGENCY- BELMONT COUNTY HEALTH DEPARTMENT- BELMONT COUNTY JOB AND FAMILY SERVICES- BELMONT PROFESSIONAL ASSOCIATES- COMMUNITY ACTION COMMISSION OF BELMONT COUNTY- EMERALD POINTE NURSING FACILITY- MENTAL HEALTH AND RECOVERY BOARD- MONROE COUNTY HEALTH DEPARTMENT- OHIO HILLS HEALTH SERVICES- PUBLIC RELATIONS & CORPORATE COMMUNICATIONS, WVUHS DIRECTOR- UNION LOCAL SCHOOLSA COMMUNITY MEETING WAS HELD IN BARNESVILLE TO GET MORE INPUT FROM THE PUBLIC, ESPECIALLY FROM ORGANIZATIONS WHO PROVIDE SOCIAL SERVICES TO INDIVIDUALS WITHIN THE SERVICE AREA OF THE HOSPITAL. REPRESENTATIVES FROM FIFTEEN DIFFERENT ORGANIZATIONS HELD DISCUSSIONS IN SMALL GROUPS TO COMPILE A WORKING LIST OF EXISTING RESOURCES, PROGRAMS, POLICIES, AND IDEAS TO ADDRESS EACH AREA OF CONCERN, IN ADDITION TO RAISING QUESTIONS AND PROVIDING INFORMATION AND PERSPECTIVE DURING OVERALL DISCUSSION OF THE SURVEY DATA RESULTS. THEY ALSO WORKED IN THEIR SMALL GROUPS AND AS PART OF A LARGER DISCUSSION TO FORMULATE SOME NEW SUGGESTIONS TO ADDRESS EACH HEALTH CONCERN. |
| BARNESVILLE HOSPITAL ASSOCIATION | PART V, SECTION B, LINE 11: THE HOSPITAL FACILITY IDENTIFIED THREE SIGNIFICANT NEEDS IN ITS MOST RECENTLY CONDUCTED CHNA. THE NEEDS & THE ACTION TAKEN BY THE HOSPITAL FACILITY TO ADDRESS THE NEEDS DURING 2019 ARE AS FOLLOWS:SUBSTANCE USE AND ABUSE: -BARNESVILLE HOSPITAL PARTNERS WITH CROSSROADS COUNSELING TO OPERATE AN ADDICTION CLINIC. -PROVIDES A DROP BOX IN THE HOSPITAL LOBBY TO ALLOW COMMUNITY MEMBERS A VEHICLE TO DISPOSE OF UNWANTED MEDICATIONS AND SYRINGES ON AN AS NEEDED BASIS. -PROVIDED SPACE FOR ALCOHOLIC ANONYMOUS TO MEET AT THE HOSPITAL. -COLLABORATED THROUGH COMMUNITY AND EMS MEETINGS TO PROVIDE EDUCATION REGARDING NARCAN FOR COMMUNITY MEMBERS AND HEALTH CARE PROFESSIONALS AND TO PROVIDE NARCAN FREE OF CHARGE THROUGH THE PROJECT DAWN PROGRAM.OBESITY AND DIABETES: -CONDUCTED FITNESS SCREENINGS IN THE COMMUNITY (BODY COMPOSITION ANALYSIS, FLEXIBILITY TESTING, GRIP STRENGTH AND BLOOD PRESSURE). -HOSPITAL DIETICIAN OFFERED A HEALTH PROGRAM EMPHASIZING PROPER NUTRITION, THE IMPORTANCE OF EXERCISE AND THE BENEFITS OF SMOKING CESSATION. -OFFERED COMMUNITY WELLNESS PROGRAM ON TOPICS PERTINENT TO COMMUNITY MEMBERS.-FREE PICKLEBALL IN ST. CLAIRSVILLE AND BELMONT.MENTAL HEALTH: -DEVELOPED REFERRAL BROCHURE INCLUDING MENTAL HEALTH RESOURCES IN SERVICE AREA WHICH CAN BE PROVIDED TO PATIENTS AND FAMILY MEMBERS. ADDITIONALLY, REFERRED TO CROSSROADS COUNSELING WHEN A DRUG OR MENTAL HEALTH ISSUE AROSE IN ER.-EDUCATED CLINICAL STAFF AS TO THE ROLE A HOSPITAL'S MEDICAL SOCIAL WORKER CAN PLAY IN ASSISTING WITH APPROPRIATE REFERRALS FOR COUNSELING AND IN ASSISTING IN PSYCHIATRIC PLACEMENTS WHEN WARRANTED. -EDUCATED COMMUNITY ON SERVICES AVAILABLE AT BARNESVILLE HOSPITAL VIA NEW BROCHURES AND ACTIVE PROMOTION FROM OUR CLINICAL LEADERSHIP.OTHER:PROVIDED A HEART SCREENING AND BLOOD WORK FOR COMMUNITY MEMBERSPROVIDED EDUCATION TO THE COMMUNITY AND SCHOOLS ABOUT COVID-19HELPED WITH COMMUNITY VACCINATION CLINIC |
| BARNESVILLE HOSPITAL ASSOCIATION | PART V, SECTION B, LINE 13B: EVERY SELF PAY PATIENT RECEIVES 20% OFF THEIR INVOICE WHETHER THEY ARE ELIGIBLE FOR THE FINANCIAL ASSISTANCE OR NOT. |
| BARNESVILLE HOSPITAL ASSOCIATION | PART V, SECTION B, LINE 15E: PATIENTS CAN FILL OUT THE FORM PROVIDED IN THE REGISTRATION PACKET, ONLINE, OR CALL THE FINANCIAL COUNSELOR FOR ASSISTANCE. |
| BARNESVILLE HOSPITAL ASSOCIATION | PART V, SECTION B, LINE 16J: FINANCIAL COUNSELOR PERSONALLY CALLS SELF PAY PATIENTS AND OFFERS THEM AN APPLICATION TO APPLY FOR FAP. |
| BARNESVILLE HOSPITAL ASSOCIATION | PART V, SECTION B, LINE 24: THE GROSS CHARGES FOR ANY INDIVIDUAL SERVICE ARE ALL THE SAME. SELF PAY PATIENTS RECEIVE A 20% DISCOUNT AND PATIENTS WITH ANY TYPE OF INSURANCE ARE GIVEN THE DISCOUNT NEGOTIATED IN THE CONTRACT. MEDICARE AND MEDICAID RECEIVE THE MEDICARE AND MEDICAID CONTRACTUALS. |
| BARNESVILLE HOSPITAL ASSOCIATION, INC.: | SCHEDULE H, PART V, LINE 7A:HTTP://WWW.BARNESVILLEHOSPITAL.COM/WP-CONTENT/UPLOADS/2020/03/CHNA-2020.PDF |
| BARNESVILLE HOSPITAL ASSOCIATION, INC.: | SCHEDULE H, PART V, LINE 10A:HTTPS://WWW.WVUMEDICINE.ORG/BARNESVILLE/WP-CONTENT/UPLOADS/2021/03/BARNESVILLE-HOSPITAL-COMMUNITY-HEALTH-NEEDS-ASSESSMENT-2020.PDF |
| BARNESVILLE HOSPITAL ASSOCIATION, INC.: | SCHEDULE H, PART V, LINE 16A, FAP WEBSITE:HTTPS://WWW.WVUMEDICINE.ORG/BARNESVILLE/WP-CONTENT/UPLOADS/SITES/60/2021/03/FINANCIAL-ASSISTANCE-PROGRAM-POLICY-1.PDFSCHEDULE H, PART V, LINE 16B, FAP APPLICATION WEBSITE: HTTPS://WWW.WVUMEDICINE.ORG/BARNESVILLE/WP-CONTENT/UPLOADS/SITES/60/2021/06/BARNESVILLE-HCAP-APPLICATION-6112021.PDFSCHEDULE H, PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE: HTTPS://WWW.WVUMEDICINE.ORG/BARNESVILLE/WP-CONTENT/UPLOADS/SITES/60/2021/03/FINANCIAL-ASSISTANCE-PROGRAM-POLICY-1.PDF |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | IN ADDITION TO FPG, THE ORGANIZATION USES THE FOLLOWING CRITERIA TO DETERMINE ELIGIBILITY: MEDICAL INDIGENCY, INSURANCE STATUS, UNDERINSURANCE STATUS, AND RESIDENCY. ADDITIONALLY, EVERY SELF PAY PATIENT RECEIVES 20% OFF THEIR INVOICE WHETHER THEY ARE ELIGIBLE FOR THE FINANCIAL ASSISTANCE OR NOT. |
| PART I, LINE 7: | BARNESVILLE HOSPITAL ASSOCIATION CALCULATED THE COST OF FINANCIAL ASSISTANCE AND MEANS-TESTED GOVERNMENT PROGRAMS USING THE COST-TO-CHARGE RATIO DERIVED FROM SCHEDULE H, WORKSHEET 2, RATIO OF PATIENT CARE COST-TO CHARGES. |
| PART I, LINE 7G: | BARNESVILLE HOSPITAL ASSOCIATION INCLUDED COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC (BELMONT PROFESSIONAL ASSOCIATES) AS SUBSIDIZED HEALTH SERVICES ON LINE 7G. FOR 2020, THE AMOUNT WAS $703,447. |
| PART I, LN 7 COL(F): | 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 2: | THE ORGANIZATION PROVIDES CARE WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY. BECAUSE THE ORGANIZATION DOES NOT COLLECT AMOUNTS DEEMED TO BE CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE.OF THE ORGANIZATION'S TOTAL REPORTED EXPENSES APPROXIMATELY $22,974,000 AND $24,177,000 DURING 2020 AND 2019 RESPECTIVELY, AN ESTIMATED $154,000 AND $253,000 AROSE FROM PROVIDING SERVICES TO CHARITY PATIENTS. THE ESTIMATED COSTS OF PROVIDING CHARITY SERVICES ARE BASED ON A CALCULATION WHICH APPLIES A RATIO OF COSTS TO CHARGES TO THE GROSS UNCOMPENSATED CHARGES ASSOCIATED WITH PROVIDING CARE TO CHARITY PATIENTS. THE RATIO OF COST TO CHARGES IS CALCULATED BASED ON THE ORGANIZATION'S TOTAL EXPENSES DIVIDED BY GROSS PATIENT SERVICE REVENUE. THE ORGANIZATION PARTICIPATES IN THE HOSPITAL CARE ASSURANCE PROGRAM (HCAP) WHICH PROVIDES FOR ADDITIONAL PAYMENTS TO HOSPITALS THAT PROVIDE A DISPROPORTIONATE SHARE OF UNCOMPENSATED SERVICES TO THE INDIGENT AND UNINSURED. HCAP REVENUE IS RECORDED IN NET PATIENT SERVICE REVENUE ON THE CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS. NET AMOUNTS RECEIVED THROUGH THIS PROGRAM TOTALED APPROXIMATELY $982,000 AND $727,000 FOR 2020 AND 2019, RESPECTIVELY.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 WILL 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 3: | BARNESVILLE HOSPITAL ASSOCIATION DOES NOT ATTRIBUTE ANY BAD DEBT EXPENSE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY (FAP), THEREFORE NO PORTION OF BAD DEBT ATTRIBUTABLE TO FAP-ELIGIBLE INDIVIDUALS IS CONSIDERED A COMMUNITY BENEFIT. |
| PART III, LINE 4: | THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS DESCRIBING BAD DEBT EXPENSE IS LOCATED ON PAGE 9 OF THE ATTACHED FINANCIAL STATEMENTS UNDER NOTE "ACCOUNT RECEIVABLES AND CONTINUES ON PAGE 10 UNDER NOTE "PATIENT CARE SERVICE REVENUE." |
| PART III, LINE 8: | SURPLUS/ (SHORTFALL): THE COST WAS DETERMINED BY COST TO CHARGE RATIO ON THE COST REPORT. THIS IS AN AGING COMMUNITY AND THEY DESERVE THE BEST CARE AVAILABLE EVEN THOUGH WE HAVE TO SUPPLEMENT THE COST.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 DECEMBER 31, 2020 HOSPITAL STATEMENT OF REIMBURSABLE COST. |
| PART III, LINE 9B: | EVERY SELF PAY PATIENT RECEIVES A FINANCIAL AID PACKET WITH PAYMENT OPTIONS AND AN APPLICATION FOR FINANCIAL ASSISTANCE. AS A FOLLOW-UP THE FINANCIAL COUNSELOR PERSONALLY CONTACTS ANY SELF-PAY PATIENT PRESENTING DURING THE WEEK DAYS. PATIENTS ARE BILLED MONTHLY FOR BALANCES NOT COVERED BY INSURANCE, ELIGIBLE FOR FREE CARE OR ELIGIBLE FOR CHARITY DISCOUNTS. AFTER THREE MONTHLY STATEMENTS, IF NO PAYMENTS ARE RECEIVED OR THE PATIENT HAS NOT CONTACTED THE FINANCIAL COUNSELOR, A FINAL NOTICE IS SENT SAYING THEY ARE BEING SENT TO A SECONDARY BILLING COMPANY. THEY WILL TRY TO COLLECT FOR ANOTHER 90 DAYS. |
| PART VI, LINE 2: | WE GO INTO THE COMMUNITY AND PERFORM SURVEYS FOR NEEDS ASSESSMENT. WE ALSO GET INPUT FROM AREA PHYSICIANS, PATIENTS, STAFF AND OTHER BUSINESS FACILITIES. |
| PART VI, LINE 3: | THE PATIENT FINANCIAL COUNSELOR MEETS WITH ANYONE THAT PRESENTS IF THEY DO NOT HAVE INSURANCE. WE ALSO HAVE IT ON OUR WEBSITE AND POSTED IN THE HOSPITAL. OUR STAFF GOES INTO THE COMMUNITY AND SPEAKS TO DIFFERENT ORGANIZATIONS ABOUT OUR CHARITY AND FREE CARE POLICIES; TELLING THEM WHAT IS AVAILABLE. A FINANCIAL FORM IS GIVEN TO EACH SELF PAY PATIENT THAT REGISTERS AND THE FINANCIAL COUNSELOR'S TELEPHONE NUMBER IS ON ALL INVOICES TO THE PATIENTS. |
| PART VI, LINE 4: | BARNESVILLE HOSPITAL IS LOCATED IN AN ECONOMICALLY DEPRESSED APPALACHIAN AREA IN SOUTHEASTERN OHIO. WE SERVE SEVERAL COUNTIES AND THE COUNTY TO THE SOUTH OF US HAS NO HOSPITAL. IT IS AN AGING COMMUNITY WITH A LOT OF RESIDENTS UNDER THE FEDERAL POVERTY LEVEL. WE HAVE LITTLE INDUSTRY WITH THE HOSPITAL BEING THE LARGEST EMPLOYER IN THE COMMUNITY AND THE SCHOOLS ARE SECOND LARGEST. |
| PART VI, LINE 5: | OUR BOARD CONSISTS OF COMMUNITY MEMBERS AND THE MAJORITY OF OUR MEDICAL STAFF ARE FROM THE COMMUNITY. IT IS VERY IMPORTANT TO BARNESVILLE HOSPITAL TO PROMOTE THE HEALTH OF THE COMMUNITY BY ORGANIZING COMMUNITY HEALTH SCREENINGS AND EDUCATION FOR OUR COMMUNITY. WE HAVE AN AGING COMMUNITY AND EVERY EFFORT IS MADE TO ASSIST THEM WITH THEIR HEALTHCARE NEEDS. |
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 | BELMONT PROFESSIONAL ASSOCIATES | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 639 WEST MAIN STREET | AddressLine1Txt |
| City | BARNESVILLE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43713 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 311352493 | RecipientEIN |
| IRC Section | 501C3 | IRCSectionDesc |
| Cash Grant | $897,151 | CashGrantAmt |
| Purpose Of Grant | DEBT FORGIVENESS | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (2 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 SHAUN ROE | ||||||||||||||
| BOARD MEMBER | $0 | $281,709 | $0 | $0 | $0 | $0 | $0 | $2,287 | $0 | $38,542 | $0 | $322,538 | $0 | $0 |
| DAVID PHILLIPS | ||||||||||||||
| CEO | $287,970 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $287,970 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | THE CEO'S COMPENSATION IS PAID BY AN UNRELATED ORGANIZATION, WEST VIRGINIA UNIVERSITY HOSPITALS, INC. |
| FORM 990, PART VII, LINE 5: | NAME OF UNRELATED ORGANIZATION: WEST VIRGINIA UNIVERSITY HOSPITALS, INC. THE CEO OF BARNESVILLE HOSPITAL ASSOCATION WAS PAID BY THE UNRELATED ORGANIZATION IN 2020. NAME: DAVID PHILLIPS AMOUNT OF COMPENSATION: TOTAL COMPENSATION: $287,970 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | AFTER THE INITIAL REVIEW IT IS REVIEWED BY THE FINANCE COMMITTEE OF THE BARNESVILLE HOSPITAL BOARD OF TRUSTEES FOR REVIEW AND COMMENT. THEN IT IS APPROVED BY THE HOSPITAL BOARD. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE WRITTEN CONFLICT OF INTEREST POLICY IS REGULARLY AND CONSISTENTLY MONITORED AND COMPLIANCE ENFORCED BY THE CORPORATE COMPLIANCE OFFICER WHO REPORTS TO THE BOARD. THE SCOPE OF THIS POLICY INCLUDES ALL EMPLOYEES PLUS CONTRACTED EMPLOYEES AND BOARD MEMBERS. THE POLICY IS IN PLACE TO DEFINE SITUATIONS THAT MIGHT OCCUR AND COULD RESULT IN A CONFLICT OF INTEREST BETWEEN AN EMPLOYEE OR BOARD MEMBER AND THE HOSPITAL. THE COVERED PERSONS ARE TO REFRAIN FROM SOLICITING HOSPITAL PATIENTS, PHYSICIANS, STAFF, ETC.; OR ANYTHING THAT COULD RESULT IN A PERSONAL GAIN FOR THE EMPLOYEE OR BOARD MEMBER OR THEIR IMMEDIATE FAMILIES. A SELF DISCLOSURE FROM COVERED PERSONS TO THE CORPORATE COMPLIANCE OFFICER IS REQUIRED ON ANY POTENTIAL CONFLICTS OF INTEREST. THE COVERED PERSONS ARE TO RECUSE THEMSELVES FROM PARTICIPATING IN ANY DELIBERATION OR DECISIONS ON SUCH TRANSACTIONS. THE CORPORATE COMPLIANCE OFFICER WILL REVIEW/RESEARCH THE CONFLICTS DISCLOSED. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION OF THE ORGANIZATION'S CEO IS PAID BY AN UNRELATED ORGANIZATION, WEST VIRGINIA UNIVERSITY HOSPITALS, INC. BARNESVILLE HOSPITAL BOARD OF DIRECTORS HAS A COMPENSATION COMMITTEE THAT REVIEWS ALL PAY CHANGES FOR EMPLOYEES WHETHER IT IS A SEPARATE INCREASE OR AN ALL EMPLOYEE INCREASE. THE BOARD USES A MANUAL PUBLISHED BY AN INDEPENDENT THIRD-PARTY AS A SOURCE TO DETERMINE REASONABLE COMPENSATION AMOUNTS FOR THE EXECUTIVE COMMITTEE AND ALL OTHER EMPLOYEES. PAY CHANGES ARE APPROVED OR REJECTED BY THE FULL BOARD AND IS DOCUMENTED IN THE BOARD OF DIRECTOR MINUTES. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE 990 IS THE ONLY DOCUMENT MADE AVAILABLE TO THE PUBLIC. IF ANYONE WANTS TO REVIEW THE 990 THEY MAY CONTACT THE ADMINISTRATIVE OFFICE IN PERSON, BY TELEPHONE OR MAIL. WE WILL MAKE THE DOCUMENTS AVAILABLE AT THAT TIME. IF THE PERSON PRESENTS IN PERSON WE WILL TRY TO ACCOMODATE THEM THAT DAY. |
| FORM 990, PART IX, LINE 11G | OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,240,986. MANAGEMENT AND GENERAL EXPENSES 456,774. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,697,760. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 1,086,362. MANAGEMENT AND GENERAL EXPENSES 221,430. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,307,792. |
| FORM 990, PART XI, LINE 9: | PENSION RELATED CHANGES -468,368. NET ASSET TRANSFER - FOUNDATION DISSOLUTION 69,255. |
| 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 | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| BELMONT PROFESSIONAL ASSOCIATES INC | |||||||||||
| 639 W MAIN ST | BARNESVILLE | OH | 43713 | 311352493 | PHYSICIAN PRACTICE | OH | 501(C)(3) | LINE 3 | BARNESVILLE HOSPITAL | Yes (1) | |
| BARNESVILLE HOSPITAL FOUNDATION | |||||||||||
| 639 W MAIN ST | BARNESVILLE | OH | 43713 | 113804786 | SUPPORT FOR HOSPITAL | OH | 501(C)(3) | LINE 12A, I | 0 | N/A | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELMONT CO HEALTH SERVICES INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 639 W MAIN ST | AddressLine1Txt |
| City | BARNESVILLE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43713 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 341566526 | EIN |
| Primary Activities | RETAIL PHARMACY | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BARNESVILLE HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | $2,928,717 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $1,393,327 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | 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 | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | 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 | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| BARNESVILLE HOSPITAL FOUNDATION | ||
| C | $169,967 | CASH VALUE |
| BELMONT PROFESSIONAL ASSOCIATES | ||
| B | $897,151 | CASH VALUE |
| BARNESVILLE HOSPITAL FOUNDATION | ||
| S | $69,255 | CASH VALUE |