SHERIDAN MEMORIAL HOSPITAL ASSOCIATION: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- SHERIDAN MEMORIAL HOSPITAL ASSOCIATION (EIN 81-0243720)
- Tax period
- 2017-07-01 to 2018-06-30
- Filed
- 2019-05-15
- IRS object ID
- 201901359349306945
- Schema version
- 2017v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-05-15T13:00:19-05:00 | ReturnTs |
| Tax Period End | 2018-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 EAST FRONT STREET 301 | AddressLine1Txt |
| City | MISSOULA | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59802 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810243720 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHERIDAN MEMORIAL HOSPITAL ASSOCIATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SHER | BusinessNameControlTxt |
| Phone | 4067653700 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 440 W LAUREL AVENUE | AddressLine1Txt |
| City | PLENTYWOOD | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59254 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GREG MAURER | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 4067653700 | PhoneNum |
| Signature | 2019-05-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | PHILIP L YASENAK CPA | PreparerPersonNm |
| PTIN | P01248379 | PTIN |
| Phone | 4067281800 | PhoneNum |
| Preparation | 2019-05-14 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 65.158.74.97 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-05-14 | IPDt |
| IP Tm | 11:22:18 | IPTm |
| IP Timezone | MD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | BE7A92E7B0152C1C6812F3C99C620D56F411D8FD | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | GREG MAURER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 440 W LAUREL AVENUE | AddressLine1Txt |
| City | PLENTYWOOD | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $11,959,015 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SHERIDANMEMORIAL.NET | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1920 | FormationYr |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE QUALITY CARE TO IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITY WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 204 | TotalEmployeeCnt |
| Total Volunteers | 68 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $306,016 | PYContributionsGrantsAmt |
| CY Contributions Grants | $351,503 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $11,440,978 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $11,528,758 | CYProgramServiceRevenueAmt |
| PY Investment Income | $4,853 | PYInvestmentIncomeAmt |
| CY Investment Income | $670 | CYInvestmentIncomeAmt |
| PY Other Revenue | $88,832 | PYOtherRevenueAmt |
| CY Other Revenue | $78,084 | CYOtherRevenueAmt |
| PY Total Revenue | $11,840,679 | PYTotalRevenueAmt |
| CY Total Revenue | $11,959,015 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,735,048 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,776,900 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $45,845 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,984,587 | PYOtherExpensesAmt |
| CY Other Expenses | $5,368,151 | CYOtherExpensesAmt |
| PY Total Expenses | $11,719,635 | PYTotalExpensesAmt |
| CY Total Expenses | $12,145,051 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $121,044 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$186,036 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $6,165,298 | TotalAssetsBOYAmt |
| Total Assets EOY | $6,168,743 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,215,120 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,404,601 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,950,178 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,764,142 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | PROVIDING QUALITY CARE TO IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITY WE SERVE, REGARDLESS OF THEIR ABILITY TO PAY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $8,943,047 | ExpenseAmt |
| Revenue | $11,583,231 | RevenueAmt |
| Desc | SHERIDAN MEMORIAL HOSPITAL ASSOCIATION OPERATES A 19-BED CRITICAL ACCESS HOSPITAL, A 45-BED LONG-TERM CARE FACILITY, AND A RURAL HEALTH CLINIC THAT BENEFIT THE PEOPLE IN THE SURROUNDING AREA. SMHA IS THE ONLY MEDICAL FACILITY IN SHERIDAN COUNTY, WHICH HAS A POPULATION OF APPROXIMATELY 3,400 RESIDENTS. HIGHLIGHTS OF THE ORGANIZATION'S ACCOMPLISHMENTS DURING FY18 ARE INCLUDED BELOW:THE CRITICAL ACCESS HOSPITAL RECEIVED ACHC SLEEP STUDY ACCREDITATION AND IS NOW ABLE TO PERFORM AND BILL SLEEP STUDIES TO MEDICARE PATIENTS. THE CRITICAL ACCESS HOSPITAL ALSO PURCHASED AND RECEIVED A PHILIPS RESPIRONICS V60 VENTILATOR AND STAFF WILL RECEIVE TRAINING FOR USE OF THE EQUIPMENT EARLY IN FY19.THE EMERGENCY MEDICAL SERVICES DEPARTMENT PROVIDED COMMUNITY CPR CLASSES TO SEVERAL LOCAL BUSINESSES, FIRST RESPONDERS, AND GOVERNMENT OFFICIALS. THE DEPARTMENT CONTINUED OFFERING 1ST AID CLASSES TO LOCAL YOUTH BABY SITTERS. THE DEPARTMENT MADE SEVERAL PURCHASES DURING THE YEAR TO IMPROVE PATIENT CARE AND/OR PROCESSES. PURCHASES INCLUDE A NEW AMBULANCE, A NEW STRYKER STAIR CHAIR, IV SUPPLIES, AND 2 NEW ZOLL AED TRAINERS. THE DEPARTMENT IS ALSO WORKING TO OBTAIN REPLACEMENT VEHICLES. THE NURSING HOME PURCHASED A NEW VITALS MACHINE AND WHEELCHAIR SCALE AND CONTINUED TO INCREASE THE NUMBER OF AIR OVERLAY MATTRESS DEVICES AND GEL WHEELCHAIR CUSHIONS TO PROVIDE PRESSURE RELIEF TO PATIENTS. THE IMMUNIZATION CLINIC HAD 221 APPOINTMENTS DURING THE YEAR. ALSO, 100% OF THE IMMUNIZATIONS GIVEN WERE RECORDED IN IMMTRAX, THE MONTANA IMMUNIZATION RECORDING SYSTEM. | Desc |
| Total Program Service Expenses | $8,943,047 | 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 |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| 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 | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 7 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 204 | 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GREG MAURER | PersonNm |
| Phone | 4067653702 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 440 WEST LAUREL AVENUE | AddressLine1Txt |
| City | PLENTYWOOD | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| JAKE FLADAGER | ||||||||
| CHAIRPERSON | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MYRNETTE MILLER | ||||||||
| VICE CHAIRPERSON | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JESSICA SCHACKELFORD | ||||||||
| SECRETARY/TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| NANCY JENSEN | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DON BENSON | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JED WALLER | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JOAN TOMMERUP | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| GREG MAURER | ||||||||
| CEO | 40.00 | Yes (X) | $0 | $0 | $0 | 1.00 | ||
| KYLE GEE | ||||||||
| CFO | 10.00 | Yes (X) | $0 | $0 | $0 | |||
| CARLOS TREVINO | ||||||||
| MD | 36.00 | $221,997 | $0 | $6,048 | Yes (X) | |||
| ADAM GRAHAM | ||||||||
| PA | 36.00 | $159,481 | $0 | $11,949 | Yes (X) | |||
| LYNNE GRAHAM | ||||||||
| PA | 36.00 | $124,902 | $0 | $7,487 | Yes (X) | |||
| KRISTIN MCCOLLY | ||||||||
| FNP | 36.00 | $104,506 | $0 | $6,520 | Yes (X) | |||
| JENNA THOMAS | ||||||||
| FNP | 36.00 | $113,942 | $0 | $3,804 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $724,828 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $35,808 | 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 | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| BILLINGS CLINIC | |||||
| PO BOX 30357 | BILLINGS | MT | 59107 | MANAGEMENT COMPANY | $392,840 |
| DAKOTA DRUG | |||||
| PO BOX 5009 | MINOT | ND | 58702 | PHARMACEUTICALS | $249,401 |
| MONTANA HEALTH NETWORK | |||||
| 519 PLEASANT ST | MILES CITY | MT | 59301 | STAFFING | $179,125 |
| CERNER CORPORATION | |||||
| PO BOX 959156 | ST LOUIS | MO | 63195 | EHR/REVENUE CYCLE | $174,606 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 12 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $126,585 | RelatedOrganizationsAmt |
| Government Grants | $206,599 | GovernmentGrantsAmt |
| All Other Contributions | $18,319 | AllOtherContributionsAmt |
| Total Contributions | $351,503 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621990 | $10,753,299 | $10,753,299 |
| OTHER OPERATING REVENUE | 900099 | $345,244 | $345,244 |
| 340B REVENUE | 621990 | $221,557 | $221,557 |
| CONTRACT REVENUE | 621990 | $208,658 | $208,658 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $11,528,758 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $670 | TotalRevenueColumnAmt |
| Exclusion | $670 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $23,611 | 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 | $23,611 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $23,611 | TotalRevenueColumnAmt |
| Exclusion | $23,611 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| BAD DEBT RECOVERY | 621990 | $48,392 | $48,392 |
| GIFT SHOP REVENUE | 900099 | $6,081 | $6,081 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $54,473 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,959,015 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,583,231 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $24,281 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,682,003 | TotalAmt |
| Program Services | $4,765,760 | ProgramServicesAmt |
| Management And General | $899,340 | ManagementAndGeneralAmt |
| Fundraising | $16,903 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $680,703 | TotalAmt |
| Program Services | $440,379 | ProgramServicesAmt |
| Management And General | $238,452 | ManagementAndGeneralAmt |
| Fundraising | $1,872 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $414,194 | TotalAmt |
| Program Services | $350,176 | ProgramServicesAmt |
| Management And General | $62,745 | ManagementAndGeneralAmt |
| Fundraising | $1,273 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $337,973 | TotalAmt |
| Management And General | $337,973 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,647 | TotalAmt |
| Management And General | $3,647 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,358 | TotalAmt |
| Management And General | $23,458 | ManagementAndGeneralAmt |
| Fundraising | $900 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,806,244 | TotalAmt |
| Program Services | $1,291,372 | ProgramServicesAmt |
| Management And General | $512,977 | ManagementAndGeneralAmt |
| Fundraising | $1,895 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,079 | TotalAmt |
| Program Services | $261 | ProgramServicesAmt |
| Management And General | $25,790 | ManagementAndGeneralAmt |
| Fundraising | $6,028 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $289,464 | TotalAmt |
| Program Services | $10,216 | ProgramServicesAmt |
| Management And General | $279,248 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,877 | TotalAmt |
| Program Services | $6,471 | ProgramServicesAmt |
| Management And General | $7,371 | ManagementAndGeneralAmt |
| Fundraising | $35 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,265 | TotalAmt |
| Program Services | $31,920 | ProgramServicesAmt |
| Management And General | $17,345 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,647 | TotalAmt |
| Management And General | $1,597 | ManagementAndGeneralAmt |
| Fundraising | $1,050 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $776,768 | TotalAmt |
| Program Services | $378,802 | ProgramServicesAmt |
| Management And General | $397,966 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $136,511 | TotalAmt |
| Program Services | $249 | ProgramServicesAmt |
| Management And General | $134,900 | ManagementAndGeneralAmt |
| Fundraising | $1,362 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| SUPPLIES | $994,897 | $926,030 | $67,330 | $1,537 |
| REPAIRS AND MAINTENANCE | $282,290 | $232,932 | $49,358 | |
| BAD DEBT | $246,795 | $246,795 | ||
| BED TAX | $188,681 | $165,962 | $22,719 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $182,655 | TotalAmt |
| Program Services | $95,722 | ProgramServicesAmt |
| Management And General | $73,943 | ManagementAndGeneralAmt |
| Fundraising | $12,990 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,145,051 | TotalAmt |
| Program Services | $8,943,047 | ProgramServicesAmt |
| Management And General | $3,156,159 | ManagementAndGeneralAmt |
| Fundraising | $45,845 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $851,603 | BOYAmt |
| EOY | $1,006,448 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $174,852 | BOYAmt |
| EOY | $241,417 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,000 | BOYAmt |
| EOY | $5,390 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,210,575 | BOYAmt |
| EOY | $1,302,003 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $223,594 | BOYAmt |
| EOY | $230,318 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $78,823 | BOYAmt |
| EOY | $168,313 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $17,303,045 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $14,518,635 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,243,686 | BOYAmt |
| EOY | $2,784,410 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,884 | BOYAmt |
| EOY | $59,914 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $317,281 | BOYAmt |
| EOY | $370,530 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,165,298 | BOYAmt |
| EOY | $6,168,743 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $884,677 | BOYAmt |
| EOY | $1,111,504 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $137,606 | BOYAmt |
| EOY | $70,687 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $192,837 | BOYAmt |
| EOY | $222,410 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,215,120 | BOYAmt |
| EOY | $1,404,601 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,941,687 | BOYAmt |
| EOY | $4,752,315 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,491 | BOYAmt |
| EOY | $11,827 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,950,178 | BOYAmt |
| EOY | $4,764,142 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,165,298 | BOYAmt |
| EOY | $6,168,743 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$186,036 | ReconcilationRevenueExpnssAmt |
| 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
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $103,996 | BeginningYearBalanceAmt |
| Contributions | $143 | ContributionsAmt |
| Investment Earnings Or Losses | $147 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $104,286 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $113,984 | BeginningYearBalanceAmt |
| Contributions | $237 | ContributionsAmt |
| Administrative Expenses | $10,225 | AdministrativeExpensesAmt |
| End Year Balance | $103,996 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $113,916 | BeginningYearBalanceAmt |
| Contributions | $68 | ContributionsAmt |
| Investment Earnings Or Losses | $145 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $145 | OtherExpendituresAmt |
| End Year Balance | $113,984 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $113,916 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $64 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $64 | OtherExpendituresAmt |
| End Year Balance | $113,916 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $113,916 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $72 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $72 | OtherExpendituresAmt |
| End Year Balance | $113,916 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $384,756 | OtherCostOrOtherBasisAmt |
| Book Value | $384,756 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,459,299 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,562,225 | DepreciationAmt |
| Book Value | $897,074 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,458,990 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,956,410 | DepreciationAmt |
| Book Value | $1,502,580 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,784,410 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| COST REPORT RECEIVABLE | $85,968 |
| GUARANTEE OF PATIENT LOAN | $174,838 |
| BED TAX RECEIVABLE | $109,724 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $370,530 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| GUARANTEE OF PATIENT LOAN | $174,838 |
| BED TAXES PAYABLE | $47,418 |
| OTHER PAYABLES | $154 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $222,410 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE ENDOWMENT, HELD BY THE SHERIDAN HEALTH CARE FOUNDATION, INC., CONSISTS OF INDIVIDUAL FUNDS ESTABLISHED BY DONORS TO PROVIDE ANNUAL FUNDING FOR SPECIFIC ACTIVITIES AND GENERAL OPERATIONS OF THE HOSPITAL. GIFTS GIVEN TO THE ENDOWMENT FUND AT SHERIDAN HEALTH CARE FOUNDATION ARE INVESTED AND CAREFULLY MANAGED TO PROTECT THE PRINCIPAL; THEY ARE INTENDED TO BE A PART OF THE PERMANENT INVESTMENT RESERVE WHICH WILL REMAIN FOR PERPETUITY. INTEREST FROM ENDOWMENTS WILL GO TOWARDS SHERIDAN HEALTH CARE FOUNDATION'S UNRESTRICTED FUND TO ALLOW FOR ADDITONAL REVENUE TO ENSURE THE FUTURE OF THE FOUNDATION AND SHERIDAN MEMORIAL HOSPITAL ASSOCIATION UNLESS OTHERWISE STIPULATED BY THE DONOR. |
| PART X, LINE 2: | THE HOSPITAL AND FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL AND FOUNDATION ARE ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME. FEDERAL AND STATE INCOME TAXES ARE PAID ON NONEXEMPT UNRELATED BUSINESS INCOME IN ACCORDANCE WITH THE CODE. CURRENT ACCOUNTING GUIDELINES REQUIRE AN ORGANIZATION TO DETERMINE WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED ON THE FINANCIAL STATEMENTS. THE ORGANIZATION RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS. FEDERAL RETURNS FOR TAX YEARS 2014 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE 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 |
| Percent400 | Yes (X) | Percent400Ind |
| 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 | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $211,127 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $211,127 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01740 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,760,611 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,760,611 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.14500 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,971,738 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,971,738 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.16240 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $340,391 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $340,391 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02800 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $465,650 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $204,716 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $260,934 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02150 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $806,041 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $204,716 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $601,325 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04950 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,777,779 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $204,716 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,573,063 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.21190 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $196,449 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $5,689,489 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,167,170 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$477,681 | 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 | SHERIDAN MEMORIAL HOSPITAL ASSOCIATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 440 W LAUREL AVE | AddressLine1Txt |
| City | PLENTYWOOD | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.SHERIDANMEMORIAL.NET | WebsiteAddressTxt |
| State License | 13547 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | RURAL HEALTH CLINIC, LONG-TERM CARE FACILITY | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHERIDAN MEMORIAL 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 | 15 | 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 | WWW.SHERIDANMEMORIAL.NET | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.SHERIDANMEMORIAL.NET | 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 | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| 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 |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.SHERIDANMEMORIAL.NET | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.SHERIDANMEMORIAL.NET | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.SHERIDANMEMORIAL.NET | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SHERIDAN MEMORIAL HOSPITAL ASSOCIATION | PART V, SECTION B, LINE 5: THREE FOCUS GROUPS WERE HELD IN MAY 2016. THE MEETINGS WERE HELD IN PLENTYWOOD, WESTBY AND MEDICINE LAKE, MONTANA. FOCUS GROUP PARTICIPANTS WERE IDENTIFIED AS PEOPLE LIVING IN SHERIDAN MEMORIAL HOSPITAL'S SERVICE AREA. ADDITIONALLY, FOUR KEY INFORMANT INTERVIEWS WERE CONDUCTED WITH THE ASSISTANCE FROM THE MONTANA OFFICE OF RURAL HEALTH. |
| SHERIDAN MEMORIAL HOSPITAL ASSOCIATION | PART V, SECTION B, LINE 6B: SHERIDAN COUNTY SHERIFF'S OFFICESHERIDAN COUNTY OFFICE OF PUBLIC HEALTHSHERIDAN COUNTY MENTAL HEALTH COUNSELORPIONEER MANOR RETIREMENT HOMESHERIDAN COUNTY CHILD AND FAMILY SERVICES |
| SHERIDAN MEMORIAL HOSPITAL ASSOCIATION | PART V, SECTION B, LINE 7D: THE FULL CHNA IS AVAILABLE UPON REQUEST. IT IS ALSO POSTED IN A COUPLE PLACES IN THE HOSPITAL. |
| SHERIDAN MEMORIAL HOSPITAL ASSOCIATION | PART V, SECTION B, LINE 11: THE FOLLOWING NEEDS WERE IDENTIFIED IN THE MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT:1. IMPROVING LOCAL ACCESS TO WELLNESS OPPORTUNITIES AND HEALTH CARE SERVICES BY OPTIMIZING FACILITY SPACE AND RECRUITING/RETAINING STAFF TO SUPPORT COMMUNITY HEALTH NEEDS.2. IMPROVING LOCAL ACCESS TO WELLNESS OPPORTUNITIES BY PROVIDING HEALTH EDUCATION AND COMMUNITY OUTREACH ACTIVITIES.A COMMUNITY HEALTH OUTREACH PROGRAM IS TENTATIVELY PLANNED FOR THE TOWN OF WESTBY. ADMINISTRATION HAS MET WITH RESIDENTS OF WESTBY TO ASSESS HEALTH NEEDS AND DEVELOP A PLAN. WESTBY WILL BE OUR "PILOT PROGRAM" FOR STARTING A COMMUNITY HEALTH NEEDS PROGRAM. CURRENTLY, THE FACILITY IS WORKING ON A PLAN AND WILL BE SEEKING GRANT FUNDING TO BRING THE PLAN TO FRUITION. A WESTBY HEALTH STEERING COMMITTEE HAS MET A NUMBER OF TIMES AND IS RECOMMENDING THE DEVELOPMENT OF A COMMUNITY HEALTH WORKER PROGRAM. FUNDING AND TRAINING OPTIONS ARE BEING EXPLORED. RECENTLY, THE PROGRAM COORDINATOR RETIRED AND A REPLACEMENT IS BEING RECRUITED. |
| SHERIDAN MEMORIAL HOSPITAL ASSOCIATION | PART V, SECTION B, LINE 13H: IN ADDITION TO FAMILY SIZE AND FEDERAL POVERTY GUIDELINES, THE HOSPITAL FACILITY WILL CONSIDER SPECIAL HARDSHIPS OR UNUSUAL CIRCUMSTANCES IN DETERMINING FINANCIAL ASSISTANCE. |
| SHERIDAN MEMORIAL HOSPITAL ASSOCIATION | PART V, SECTION B, LINE 20E: THE PATIENT RECEIVES UP TO 240 DAYS TO PROPERLY SUBMIT A FINANCIAL ASSISTANCE APPLICATION. |
| SHERIDAN MEMORIAL HOSPITAL ASSOCIATION | PART V, SECTION B, LINE 24: ALL INDIVIDUALS ELIGIBLE UNDER THE HOSPITAL FINANCIAL ASSISTANCE POLICY ARE PROVIDED A DISCOUNT FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE. THE FINANCIAL ASSISTANCE POLICY DOES NOT APPLY TO ELECTIVE PROCEDURES. THEREFORE, FAP-ELIGIBLE PATIENTS WITHOUT INSURANCE MAY BE CHARGED GROSS CHARGES ON ELECTIVE PROCEDURES. |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | IN ADDITION TO FAMILY SIZE AND FEDERAL POVERTY GUIDELINES, THE HOSPITAL FACILITY WILL CONSIDER SPECIAL HARDSHIPS OR UNUSUAL CIRCUMSTANCES IN DETERMINING FINANCIAL ASSISTANCE. |
| PART I, LINE 7: | LINE 7A: CHARITY CARE WAS CALCULATED BY MULTIPLYING THE RATIO OF COST TO GROSS CHARGES BY THE GROSS UNCOMPENSATED CHARGES ASSOCIATED WITH PROVIDING CHARITY CARE TO PATIENTS.LINE 7B: THE MEDICAID CALCULATION IS BASED ON THE RATIO OF PATIENT CARE COST TO CHARGES.LINE 7E: ACTUAL COSTS WERE USED TO REPORT COMMUNITY HEALTH IMPROVEMENT SERVICES. |
| PART I, LINE 7G: | A COMBINATION OF ACTUAL COSTS AND COSTS BASED ON THE COST REPORT WERE USED TO REPORT SUBSIDIZED HEALTH SERVICES. |
| PART III, LINE 2: | ACCOUNTS ARE WRITTEN OFF AS DETERMINED. THE ALLOWANCE IS ADJUSTED UP OR DOWN BASED ON THE CHANGE IN SELF PAY AGED OUTSTANDING BALANCE. |
| PART III, LINE 4: | THE FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE IS FOUND ON PAGE 11 OF THE ATTACHED AUDIT REPORT. |
| PART III, LINE 8: | THE COST TO CHARGE RATIO IS USED TO DETERMINE COMMUNITY BENEFIT. THIS IS DONE BY APPLYING THE RATIO TO THE TOTAL MEDICARE REVENUE. A SHORTFALL OR OVERAGE IN ANY GIVEN YEAR IS A RESULT OF THE TIMING OF PAYMENTS FROM MEDICARE ON AN INTERIM BASIS AND WHEN FINAL SETTLEMENT IS MADE. MANAGEMENT USES ESTIMATES TO CALCULATE SUCH SETTLEMENTS BUT ACTUAL RESULTS VARY FROM THOSE ESTIMATES. ADDITIONALLY, SHORTFALLS CAN RESULT FROM VARIOUS EXPENSES THAT ARE INCURRED BY THE FACILITY WHICH ARE CONSIDERED NON-REIMBURSABLE BY MEDICARE. SINCE PART OF THE COSTS ARE NOT REIMBURSED IT IS ONLY PRUDENT TO CONSIDER THIS SHORTFALL TO BE A BENEFIT TO THE COMMUNITY. ALSO MEDICARE RECIPIENTS ARE PART OF A CHARITABLE CLASS AND SO THE PROVISION OF MEDICAL CARE FURTHERS THIS CHARITABLE CLASS. |
| PART III, LINE 9B: | SHERIDAN MEMORIAL FOLLOWS THE COLLECTION AND FINANCIAL ASSISTANCE PRACTICES MANDATED IN 501R. ONCE A FINANCIAL ASSISTANCE APPLICATION IS RECEIVED IT IS REVIEWED TO ENSURE ALL AREAS ARE COMPLETED AND ALL REQUESTED DOCUMENTS ARE PROVIDED. AT THIS TIME ALL COLLECTION ACTION IS SUSPENDED UNTIL A DECISION CAN BE MADE ON THE APPLICANT'S FINANCIAL ASSISTANCE REQUEST. IF THE PATIENT QUALIFIES FOR ASSISTANCE IN ACCORDANCE TO THE SLIDING FEE SCHEDULE AND THE FEDERAL POVERTY GUIDELINES, A PATIENT FINANCIAL REPRESENTATIVE THEN LOOKS BACK 240 DAYS FROM THE DATE THE APPLICATION WAS RECEIVED AND APPLIES THAT PERCENTAGE OF DISCOUNT TO ALL ACCOUNTS. SOME ACCOUNTS AT THIS POINT MAY HAVE ALREADY BEEN TURNED OVER TO A COLLECTION AGENCY. THOSE ACCOUNTS ARE PULLED BACK FROM THE COLLECTION AGENCY AND THE SAME DISCOUNT IS APPLIED. ONCE ALL DISCOUNTS ARE APPLIED, COLLECTION ACTION IS PROCEEDED AS NORMAL. |
| PART VI, LINE 2: | SHERIDAN MEMORIAL HOSPITAL CONDUCTED A THOROUGH SECONDARY DATA ANALYSIS TO IDENTIFY HEALTH CONCERNS IN PLENTYWOOD AND SHERIDAN COUNTY. ADDITIONALLY, A DIVERSE GROUP OF COMMUNITY MEMEBERS REPRESENTING VARIOUS ORGANIZATIONS AND POPULATIONS WITHIN THE COMMUNITY (EX. PUBLIC HEALTH, ELDERLY, UNINSURED) CAME TOGETHER FOR KEY INFORMANT INTERVIEWS AND FOCUS GROUPS TO BETTER UNDERSTAND THE COMMUNITY'S PERCEPTION OF HEALTH AND HEALTH CONCERNS IN THE AREA. THE INTERVIEWS AND FOCUS GROUPS WERE CONDUCTED IN MAY 2016. |
| PART VI, LINE 3: | SHERIDAN MEMORIAL ENSURES ALL PATIENTS ARE NOTIFIED OF THE AVAILABILITY OF FINANCIAL ASSISTANCE AT EVERY ADMISSION. AT ADMISSION, THE PATIENT SIGNS A CONDITION OF ADMISSION WHICH STATES THAT ASSISTANCE IS AVAILABLE. IN ADDITION, FINANCIAL ASSISTANCE PACKETS ARE HANDED OUT BY THE ADMISSION'S CLERK TO THOSE WHO ARE UNDERINSURED/UNINSURED OR EXPRESS NEED FOR ASSISTANCE. THIS PACKET INCLUDES ALL PAYMENT OPTIONS, MEDICAID INFORMATION AND FINANCIAL ASSISTANCE APPLICATION. IN ADDITION THE FINANCIAL ASSISTANCE POLICY AND APPLICATION ARE POSTED ON THE SHERIDAN MEMORIAL WEBSITE WWW.SHERIDANMEMORIAL.NET AND POSTERS ARE PLACED AROUND THE FACILITY EXPLAINING PAYMENT OPTIONS. EACH STATEMENT SENT OUT TO THE PATIENT STATES THAT FINANCIAL ASSISTANCE IS AVAILABLE. THE BUSINESS OFFICE STAFF ALSO COVERS THIS INFORMATION WITH SELF-PAY PATIENTS WHEN MAKING COLLECTION/PAYMENT PLAN CALLS. |
| PART VI, LINE 4: | SHERIDAN COUNTY IS LOCATED IN THE NORTHEAST CORNER OF MONTANA AND COVERS THE GEOGRAPHIC AREA OF 1,706 SQUARE MILES. POPULATION OF THE COUNTY IS 3,668 (BASED ON THE 2013 CENSUS). THE COMMUNITY IS RURAL AND PRIMARILY A FARMING AND RANCHING AREA. |
| PART VI, LINE 5: | SHERIDAN MEMORIAL HAS EXPANDED MEDICAL STAFF PRIVILEGES TO AN MD WHO HAS HIS OWN PRIVATE CLINIC IN THE AREA. MEDICAL PRIVILEGES ARE ALSO EXTENDED TO QUALIFIED PHYSICIANS IN THE COMMUNITY AND PROVIDERS WILLING TO SEE SHERIDAN MEMORIAL PATIENTS VIA TELE-MED/VIDEO CONFERENCE. THE BOARD OF DIRECTORS IS MADE UP OF VOLUNTEERS FROM THE COMMUNITY. WE TRY TO HAVE REPRESENTATION OF THE BOARD FROM INDIVIDUALS THROUGHOUT THE COUNTY AND NOT JUST OF THOSE LIVING IN PLENTYWOOD. SURPLUS FUNDS ARE APPLIED BACK TO PATIENT CARE AND EDUCATION. WE OFFER MANY SERVICES WHICH ARE A COMMUNITY BENEFIT TO THE COMMUNITIES WE SERVE WHICH INCLUDE THE FOLLOWING: * ALZHEIMER'S SUPPORT GROUP* GRIEF COUNSELOR* USE OF TELE-MED EQUIPMENT IS OPEN TO THE COMMUNITY FOR MENTAL HEALTH VISITS, BEHAVIORAL HEALTH CLASSES, MIP CLASSES, COMMUNITY GENERAL HEALTH EDUCATION AS WELL AS LIFESTYLE BALANCE CLASSES. CONTINUING EDUCATION OPPORTUNITIES ARE ALSO AVAILABLE VIA TELE-VIDEO FOR EMPLOYEES AND OTHER MEDICAL PERSONNEL OUTSIDE OF SHERIDAN MEMORIAL. ALL OF THE TELE-VIDEO OPPORTUNITIES ARE FREE OF CHARGE* ER IS OPEN 24 HOURS REGARDLESS OF ABILITY TO PAY* EDUCATION OF HEALTHCARE PROFESSIONALS* PARTICIPATION IN GOVERNMENT SPONSORED HEALTH PROGRAMS* SHERIDAN MEMORIAL IS INVOLVED IN COMMUNITY OUTREACH THROUGH THE SHERIDAN COUNTY CHAMBER, COUNCIL ON AGING, AND COUNTY HEALTH* ASSIST COMMUNITY MEMBERS IN APPLYING FOR STATE MEDICAID ASSISTANCE AND SSDI. APPLICATIONS CAN BE CONFUSING AND THE PROCESS FRUSTRATING THUS SHERIDAN MEMORIAL OFFERS ANY HELP WITH THESE PROCESSES* SOLE COMMUNITY PROVIDER OF MOST SERVICE LINES* OFFERS VOLUNTEER OPPORTUNITIES TO COMMUNITY THROUGH HOSPICE, EMS, ACTIVITIES, BEAUTY SHOP, PINK LADY PROGRAM AS WELL AS GIFT SHOP STAFFING* HAS A FOUNDATION THAT SERVES AS A VEHICLE FOR ATTRACTING AND EFFECTIVELY USING DONATED FUNDS* HAS THE SUPPORT OF AN AUXILIARY THAT HOSTS EVENTS THROUGHOUT THE YEAR TO RAISE FUNDS FOR THE HEALTH CARE FACILITY* EMERGENCY STANDBY COVERAGE FOR COMMUNITY EVENTS AT NO COST TO THE COMMUNITY* PARTICIPATION IN THE COUNTY FAIR AND PARADES* OFFERS COMMUNITY CPR AND FIRST AID CLASSES* OFFERS A COMMUNITY HEALTH FAIR* PARTICIPATES IN THE KID'S SAFETY FAIR* PROMOTES A COMMUNITY HEALTH PANEL |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Housing Allowance Or Residence | Yes (X) | HousingAllowanceOrResidenceInd |
| Written Policy Ref T And E Expnss | 0 | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | 0 | SubstantiationRequiredInd |
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CARLOS TREVINO | ||||||||||||||
| MD | $215,308 | $0 | $6,689 | $0 | $0 | $0 | $0 | $0 | $6,048 | $0 | $228,045 | $0 | $0 | $0 |
| ADAM GRAHAM | ||||||||||||||
| PA | $159,430 | $0 | $51 | $0 | $0 | $0 | $0 | $0 | $11,949 | $0 | $171,430 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 1A | FormAndLineReferenceDesc |
| Explanation | A HOUSING ALLOWANCE WAS PROVIDED FOR THE HIGHEST COMPENSATED EMPLOYEES ADAM AND LYNN GRAHAM. THIS WAS INCLUDED AS COMPENSATION ON THEIR FORM W-2. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| GREG MAURER | |||
| MR. MAURER IS SHERIDAN MEMORIAL HOSPITAL ASSOCIATION'S CEO. | $0 | MR. MAURER IS AN EMPLOYEE OF THE BILLINGS CLINIC, INC., THE INDEPENDENT CONTRACTOR HIRED TO MANAGE THE HOSPITAL, AND RECEIVED ALL COMPENSATION FOR HIS SERVICES AS CEO FROM BILLINGS CLINIC, INC. | 0 |
| KYLE GEE | |||
| MR. GEE IS SHERIDAN MEMORIAL HOSPITAL ASSOCIATION'S CFO. | $0 | MR. GEE IS AN EMPLOYEE OF THE BILLINGS CLINIC, INC., THE INDEPENDENT CONTRACTOR HIRED TO MANAGE THE HOSPITAL, AND RECEIVED ALL COMPENSATION FOR HIS SERVICES AS CFO FROM BILLINGS CLINIC, INC. | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE PRESIDENT, AS CHAIRMAN, THE VICE CHAIRPERSON AND THE SECRETARY/TREASURER. THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS SUBJECT TO ANY PRIOR LIMITATIONS IMPOSED BY THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 3 | THE HOSPITAL HAS A MANAGEMENT AGREEMENT WITH BILLINGS CLINIC. THEY PROVIDE GENERAL ACCOUNTING, HR, AND BUSINESS SUPPORT SERVICES. GREG MAURER, CEO, IS AN EMPLOYEE OF BILLINGS CLINIC AND IS COMPENSATED BY BILLING CLINIC. KYLE GEE, CFO, IS ALSO COMPENSATED BY BILLINGS CLINIC. |
| FORM 990, PART VI, SECTION A, LINE 6 | SHERIDAN MEMORIAL HOSPITAL ASSOCIATION HAS 789 LIFETIME VOTING MEMBERS. THESE MEMBERS ARE GRANTED VOTING PRIVILEGES IN ELECTING/RE-ELECTING ASSOCIATION BOARD MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 7A | SHERIDAN MEMORIAL HOSPITAL ASSOCIATION HAS 789 LIFETIME VOTING MEMBERS. THESE MEMBERS ARE GRANTED VOTING PRIVILEGES IN ELECTING/RE-ELECTING ASSOCIATION BOARD MEMBERS DURING THE ANNUAL MEETING HELD THE THIRD TUESDAY OF FEBRUARY EVERY YEAR. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE BOARD REVIEWS AN ELECTRONIC COPY OF THE FORM 990 BEFORE THE FINAL COPY IS FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD OF DIRECTORS, CEO, AND MEETING SECRETARY ARE ANNUALLY REQUIRED TO SIGN THE CONFLICT OF INTEREST POLICY. THE BOARD MEMBERS REVIEW ANY POTENTIAL CONFLICTS TO DETERMINE IF A CONFLICT EXISTS. IF THERE IS A CONFLICT OF INTEREST, THE CONFLICTED BOARD MEMBER IS NOT INCLUDED IN THE VOTE ON THE PARTICULAR MATTER. IF THE TRANSACTION IS RELATING TO A PARTICULARLY SENSITIVE TOPIC, THE CONFLICTED BOARD MEMEBER MAY BE ASKED TO EXCUSE THEMSELVES FROM BOTH THE DISCUSSION AND THE VOTE. |
| FORM 990, PART VI, SECTION B, LINE 15 | BILLINGS CLINIC, ALONG WITH THE INPUT FROM THE SHERIDAN MEMORIAL HOSPITAL BOARD OF DIRECTORS, DETERMINES COMPENSATION FOR THE CEO. THE BILLINGS CLINIC REVIEWS COMPARABILITY DATA TO ASSIST IN THIS PROCESS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,291,372. MANAGEMENT AND GENERAL EXPENSES 512,977. FUNDRAISING EXPENSES 1,895. TOTAL EXPENSES 1,806,244. |
| PART XII, LINE 2C | THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHERIDAN HEALTH CARE FOUNDATION INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 440 W LAUREL AVENUE | AddressLine1Txt |
| City | PLENTYWOOD | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810496987 | EIN |
| Primary Activities | SUPPORT ACTIVITIES OF SHERIDAN MEMORIAL HOSPITAL ASSOCIATION | PrimaryActivitiesTxt |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 7 | PublicCharityStatusTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | 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 | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHERIDAN HEALTH CARE FOUNDATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $126,585 | InvolvedAmt |