SHERIDAN MEMORIAL HOSPITAL ASSOCIATION: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- SHERIDAN MEMORIAL HOSPITAL ASSOCIATION (EIN 81-0243720)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-05-15
- IRS object ID
- 201801359349304590
- Schema version
- 2016v3.0
- 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 | 2018-05-15T11:20:24-05:00 | ReturnTs |
| Tax Period End | 2017-06-30 | 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 | PO Box 1699 | AddressLine1Txt |
| City | Helena | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59624 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-07-01 | 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 | 2018-05-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Nathan D McCarthy CPA | PreparerPersonNm |
| PTIN | P00368408 | PTIN |
| Phone | 4064425520 | PhoneNum |
| Preparation | 2018-05-14 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | 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 | $11,840,679 | 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 | 217 | TotalEmployeeCnt |
| Total Volunteers | 68 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $406,825 | PYContributionsGrantsAmt |
| CY Contributions Grants | $306,016 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $11,414,356 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $11,440,978 | CYProgramServiceRevenueAmt |
| PY Investment Income | $34,406 | PYInvestmentIncomeAmt |
| CY Investment Income | $4,853 | CYInvestmentIncomeAmt |
| PY Other Revenue | $19,442 | PYOtherRevenueAmt |
| CY Other Revenue | $88,832 | CYOtherRevenueAmt |
| PY Total Revenue | $11,875,029 | PYTotalRevenueAmt |
| CY Total Revenue | $11,840,679 | 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 | $7,037,972 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,735,048 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $51,782 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,235,785 | PYOtherExpensesAmt |
| CY Other Expenses | $4,984,587 | CYOtherExpensesAmt |
| PY Total Expenses | $12,273,757 | PYTotalExpensesAmt |
| CY Total Expenses | $11,719,635 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$398,728 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $121,044 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $7,896,749 | TotalAssetsBOYAmt |
| Total Assets EOY | $6,165,298 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,766,582 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,215,120 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,130,167 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,950,178 | 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 | $9,224,988 | ExpenseAmt |
| Revenue | $11,494,496 | 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 4,105 residents. Highlights of the organization's accomplishments during FY17 are included below:In FY16, EMS purchased a Zoll 12-lead monitor to assist in the care of patients during transport. In addition, they received a Lucas 2 device that allows for automated chest compressions for CPR. During FY17, Critical Access Hospital employees completed training for both the Zoll Monitor and Lucas 2 device and the equipment was placed into service. The Critical Access Hospital added a Patient/Resident Care & Quality Control coordinator position. The Laboratory Department purchased new equipment called Sysmex XN-100R for Hematology. Installation took place in April and a correlation study is in process. The equipment will interface with the Cerner system and is expected to go live in FY18. The Immunization Clinic, which opened at the end of FY16, registered 140 patients and had 288 appointments. The Hospital also received training from Billings Clinic regarding scheduling and documentation. Sheridan Memorial Rural Health Clinic added a new FNP, participated in numerous Emergency Preparedness drills, and improved workflow for Pre-Op and CPAP. EMS purchased 4 new Zoll AEDs and 2 new Lucas 3 devices that will be placed in service in the Westby and Med Lake QRUs. EMS was also awarded a MT DOT grant to purchase a new ambulance - delivery will occur in FY18. EMS also started offering Baby Sitter CPR 1st Aid Classes to local youth. The Nursing Home increased the number of Air Overlay Mattress devices and gel wheelchair cushions to provide pressure relief for patients. | Desc |
| Total Program Service Expenses | $9,224,988 | 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 | 8 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 217 | 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 | 0 | 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 (13 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 |
|---|---|---|---|---|---|---|---|---|
| Jake Fladager | ||||||||
| Chairperson | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Linda Nelson | ||||||||
| Vice Chairperson | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Jessica Schackelford | ||||||||
| Secretary/Treasurer | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Robert Michael | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Mike O'Toole | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Myrnette Miller | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Don Benson | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Greg Maurer | ||||||||
| CEO | 40.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Kyle Gee | ||||||||
| CFO | 10.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Carlos Trevino | ||||||||
| MD | 40.00 | 0.00 | $277,565 | $0 | $6,687 | Yes (X) | ||
| Adam Graham | ||||||||
| PA | 40.00 | 0.00 | $150,110 | $0 | $6,400 | Yes (X) | ||
| Lynne Graham | ||||||||
| PA | 40.00 | 0.00 | $124,219 | $0 | $6,400 | Yes (X) | ||
| Kristin McColly | ||||||||
| FNP | 37.00 | 0.00 | $116,106 | $0 | $6,400 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $668,000 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $25,887 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Montana Health Network | |||||
| 11 South 7th Street | Miles City | MT | 59301 | Rural Hospital Support | $628,673 |
| Billings Clinic | |||||
| PO Box 30977 | Billings | MT | 59107 | Management Company | $607,001 |
| Toshiba American Medical System | |||||
| 1 Marconi Ste A | Irvine | CA | 92618 | Radiology | $471,500 |
| Dakota Drug | |||||
| 1101 Lund Boulevard | Anoka | MN | 55303 | Health Care Products | $239,506 |
| Cerner Corporation | |||||
| PO Box 959156 | St Louis | MO | 63195 | Computer Program | $145,975 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $237,328 | RelatedOrganizationsAmt |
| Government Grants | $24,515 | GovernmentGrantsAmt |
| All Other Contributions | $44,173 | AllOtherContributionsAmt |
| Total Contributions | $306,016 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Service Revenue | 621990 | $10,651,150 | $10,651,150 |
| Other Operating Revenue | 900099 | $371,146 | $371,146 |
| Contract Revenue | 621990 | $211,086 | $211,086 |
| 340B Revenue | 621990 | $207,596 | $207,596 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $11,440,978 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $505 | TotalRevenueColumnAmt |
| Exclusion | $505 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $35,314 | 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 | $35,314 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $35,314 | TotalRevenueColumnAmt |
| Exclusion | $35,314 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $4,348 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $4,348 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,348 | TotalRevenueColumnAmt |
| Exclusion | $4,348 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Bad Debt Recovery | 621990 | $48,143 | $48,143 |
| Gift Shop Revenue | 900099 | $5,375 | $5,375 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $53,518 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,840,679 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,494,496 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $40,167 | 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 | $5,239,874 | TotalAmt |
| Program Services | $4,448,253 | ProgramServicesAmt |
| Management And General | $773,151 | ManagementAndGeneralAmt |
| Fundraising | $18,470 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,541 | TotalAmt |
| Management And General | $1,541 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,079,676 | TotalAmt |
| Program Services | $872,473 | ProgramServicesAmt |
| Management And General | $205,166 | ManagementAndGeneralAmt |
| Fundraising | $2,037 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $413,957 | TotalAmt |
| Program Services | $357,959 | ProgramServicesAmt |
| Management And General | $54,606 | ManagementAndGeneralAmt |
| Fundraising | $1,392 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $334,887 | TotalAmt |
| Management And General | $334,887 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,694 | TotalAmt |
| Management And General | $17,694 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,805 | TotalAmt |
| Management And General | $28,605 | ManagementAndGeneralAmt |
| Fundraising | $2,200 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,371,749 | TotalAmt |
| Program Services | $973,031 | ProgramServicesAmt |
| Management And General | $396,317 | ManagementAndGeneralAmt |
| Fundraising | $2,401 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,588 | TotalAmt |
| Program Services | $495 | ProgramServicesAmt |
| Management And General | $23,554 | ManagementAndGeneralAmt |
| Fundraising | $5,539 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $262,428 | TotalAmt |
| Program Services | $14,429 | ProgramServicesAmt |
| Management And General | $247,999 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,009 | TotalAmt |
| Program Services | $3,116 | ProgramServicesAmt |
| Management And General | $6,749 | ManagementAndGeneralAmt |
| Fundraising | $144 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,870 | TotalAmt |
| Program Services | $33,548 | ProgramServicesAmt |
| Management And General | $12,322 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,877 | TotalAmt |
| Program Services | $10,305 | ProgramServicesAmt |
| Management And General | $3,522 | ManagementAndGeneralAmt |
| Fundraising | $1,050 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $818,550 | TotalAmt |
| Program Services | $814,613 | ProgramServicesAmt |
| Management And General | $3,937 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $137,603 | TotalAmt |
| Program Services | $250 | ProgramServicesAmt |
| Management And General | $135,991 | ManagementAndGeneralAmt |
| Fundraising | $1,362 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Supplies | $948,995 | $895,794 | $52,200 | $1,001 |
| Bad Debt | $410,750 | $410,750 | ||
| Repairs and Maintenance | $217,903 | $176,187 | $41,716 | |
| Bed Tax | $157,034 | $142,528 | $14,506 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $175,845 | TotalAmt |
| Program Services | $71,257 | ProgramServicesAmt |
| Management And General | $88,402 | ManagementAndGeneralAmt |
| Fundraising | $16,186 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,719,635 | TotalAmt |
| Program Services | $9,224,988 | ProgramServicesAmt |
| Management And General | $2,442,865 | ManagementAndGeneralAmt |
| Fundraising | $51,782 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $851,603 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $712,193 | BOYAmt |
| EOY | $174,852 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,812 | BOYAmt |
| EOY | $5,000 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,379,614 | BOYAmt |
| EOY | $1,210,575 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $203,863 | BOYAmt |
| EOY | $223,594 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $136,659 | BOYAmt |
| EOY | $78,823 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $17,033,054 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $13,789,368 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,917,575 | BOYAmt |
| EOY | $3,243,686 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,854 | BOYAmt |
| EOY | $59,884 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,301,033 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $137,146 | BOYAmt |
| EOY | $317,281 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,896,749 | BOYAmt |
| EOY | $6,165,298 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,333,741 | BOYAmt |
| EOY | $884,677 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $261,868 | BOYAmt |
| EOY | $137,606 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $170,973 | BOYAmt |
| EOY | $192,837 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,766,582 | BOYAmt |
| EOY | $1,215,120 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,683,778 | BOYAmt |
| EOY | $4,941,687 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $332,405 | BOYAmt |
| EOY | $8,491 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $113,984 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,130,167 | BOYAmt |
| EOY | $4,950,178 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,896,749 | BOYAmt |
| EOY | $6,165,298 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $121,044 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$1,301,033 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| 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 Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| 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 Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| 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 Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| 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 |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $37,530 | BeginningYearBalanceAmt |
| Contributions | $76,386 | ContributionsAmt |
| Investment Earnings Or Losses | $27 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $27 | 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 | $9,417,031 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,212,304 | DepreciationAmt |
| Book Value | $1,204,727 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,228,884 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,577,064 | DepreciationAmt |
| Book Value | $1,651,820 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,383 | OtherCostOrOtherBasisAmt |
| Book Value | $2,383 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,243,686 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Cost Report Receivable | $180,701 |
| Guarantee of Patient Loan | $126,080 |
| Bed Tax Receivable | $10,500 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $317,281 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| Related Party Note Payable | $30,053 |
| Guarantee of Patient Loan | $126,080 |
| Bed Taxes Payable | $36,355 |
| Other Payables | $349 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $192,837 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (3 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 is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code (the "Code") and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. The Hospital is 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 Hospital 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. |
| Part V, Line 1(e) | The Foundation identified that the endowment fund balance was incorrect. $10,225 of "administrative expenses" were recorded this year to correct the balance of the endowment fund. |
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 | $161,421 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $161,421 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01380 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,045,166 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,045,166 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08920 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,206,587 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,206,587 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10300 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $49,642 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $49,642 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00420 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $125,932 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $75,999 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $49,933 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00430 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,585 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,585 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $177,159 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $75,999 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $101,160 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00860 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,383,746 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $75,999 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,307,747 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11160 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,935 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $9,935 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $890 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $890 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,825 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $10,825 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $344,168 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $3,555,541 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,822,529 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$266,988 | 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 | General Medical, 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 |
| 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. |
| 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 (13 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 and 7i: Actual costs were used to report community health improvement services and cash and in-kind contributions. |
| Part I, Line 7g: | A combination of actual costs and costs based on the Cost Report were used to report Subsidized Health Services. |
| Part I, Ln 7 Col(f): | The amount of bad debt expense removed from the denominator of the calculation was $344,168. |
| Part II, Community Building Activities: | Sheridan Memorial's activities listed in Part II promote the health and wellbeing of our community in several ways. We offer free telemed services to those who need to see a specialist. Being in a rural community we find that our patients have to travel for specialists and follow-up appointments. By making telemed services readily available we are saving our patients and community money and time as well as promoting health by making these services easily accessible. We performed a community health needs assessment in prior years and are diligently working towards goals set by that assessment. Our current work is focusing on creating a Community Health Worker program that will be piloted in a community 20 miles from Plentywood. Our program will focus on those who do not have support systems of family and friends as well as anyone who may need assistance in coordinating their health care. The CHW program will promote health care by ensuring patients are able to understand and follow their providers medical instructions, ensure patients have transport to and from medical appointments and ensure patients can maintain the needed care on their own through evaluations and monitoring. Marketplace Navigator Assistance is free to all residents in Sheridan County. This is a service Sheridan Memorial offers to help consumers understand health care insurance and the benefits received. There are many who do not see a medical provider or don't continue with their providers care instructions because they do not have and/or cannot afford health insurance; thus cannot afford the visit and/or follow-up care. Through education of insurance programs and assisting patients to enroll in an insurance plan, patients are more informed and have the opportunity for more affordable or free health care coverage. Sheridan Memorial staff attended the annual Sheridan County Safety fair and held a booth for youth and young adults. Attendees were educated on the importance of hand hygiene and while being educated on safety, they decorated and filled first aid kits for them to take home. Sheridan Memorial participated in a County-wide Disaster Preparedness Exercise that enabled our staff to have hands-on experience and utilize the training that we've learned through NIMS. Sheridan Memorial incident command was activated as well as our trauma team. Our facility also practiced the process of lock-down and evacuation. All these mock-practices keeps staff educated and up-to-date on patient and staff safety practices. From this hands-on, live training event we were able to identify our strengths and found areas where we could improve. In the event that an actual disaster happens within our community, our staff will be better prepared to handle the situation.Sheridan Memorial staff are involved in different community events and meetings to include Sheridan County Chamber and Sheridan County Council on Aging. By being involved with these events our staff are able to communicate with our community on services offered locally as well as get a pulse on issues or concerns that the community may have about our medical community. This is one of many ways that Sheridan Memorial communicates with the community. |
| 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: | Footnote from organization's financial statements: The footnote that describes bad debt expense is found on page 9 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 and financial assistance availability. Each statement sent out to the patient states that Financial Assistance is available. In addition, when making collection or payment plan calls, the self-pay collection clerk informs all of assistance availability. |
| Part VI, Line 4: | Sheridan Memorial Hospital is a private not-for-profit organization which is the only medical facility in Sheridan County with a population of approximately 4,105 residents. The facility provides acute, emergency, clinical and long term care for residents in the county and surrounding areas. Established in 1922 as primarily a hospital, Sheridan Memorial Hospital Association continued expanding throughout the years with first a relocation from our small main street location to our current location. In 2008 Sheridan Memorial Hospital added a Rehab suite including exam rooms, prep area, work out area and a hydrotherapy pool. The hospital has an active medical staff of one physician, three family nurse practitioners and two physician assistants as well as consulting medical doctors in the fields of radiology and surgery. Services provided at the hospital include: x-ray technology, physical, occupational and speech therapy, laboratory testing, visiting nurse and hospice care, durable medical equipment and home oxygen sales, social services and emergency services. In 2010 Sheridan Memorial became the first contracted tele-health VA clinic in the country offering area veterans' primary health care via tele-video equipment. |
| 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 patient's 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 country 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 offered free of charge* Grief counselor does counseling free of charge* Use of telemedicine equipment is open to the community for use such as mental health visits, behavioral health classes, MIP classes, Lunch and Learns community educational tele-meds when available, Lifestyle balance classes for community members as well as continuing education courses for employees, other medical personnel outside of Sheridan Memorial such as Pharmacists etc. all free of charge* ER open 24 hours regardless of ability to pay* Participates in education of healthcare professionals* Participates in government sponsored health programs* Sheridan Memorial is involved in community outreach through the Sheridan County Chamber, Council on Aging, a working relationship with County Health among other involvements* Assist community members in applying for State Medicaid assistance and SSDI. Applications can be confusing and the process frusterating thus Sheridan Memorial offers any help to get patients the help they need* 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. |
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 | $270,927 | $0 | $6,638 | $0 | $0 | $0 | $0 | $0 | $6,687 | $0 | $284,252 | $0 | $0 | $0 |
| Adam Graham | ||||||||||||||
| PA | $150,110 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $6,400 | $0 | $156,510 | $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 Lynne Graham. This was included as compensation on Adam's 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 CEO from Billings Clinic, Inc. | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 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 763 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 763 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 15a | Billings Clinic, along with the input from the SMH Board of Directors, determines compensation for the CEO. |
| 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 973,031. Management and general expenses 396,317. Fundraising expenses 2,401. Total expenses 1,371,749. |
| Form 990, Part XI, line 9: | Assets reported in prior year reported on related entity. -1,301,033. |
| 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 | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt |
|---|---|
| Sheridan Health Care Foundation Inc | |
| C | $237,328 |
| Sheridan Health Care Foundation Inc | |
| O | $60,046 |