EAST MOUNTAIN HOSPITAL INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- EAST MOUNTAIN HOSPITAL INC (EIN 01-0553478)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-05-14
- IRS object ID
- 201811349349302311
- Schema version
- 2016v3.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-05-14T09:15:45-05:00 | ReturnTs |
| Tax Period End | 2017-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EISNERAMPER LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 WOOD AVE SO STE 600 | AddressLine1Txt |
| City | ISELIN | CityNm |
| State Abbreviation | NJ | StateAbbreviationCd |
| ZIP | 088302700 | 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 | 010553478 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EAST MOUNTAIN HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % MICHAEL VOORHEES | InCareOfNm |
| Business Name Control | EAST | BusinessNameControlTxt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1029 | AddressLine1Txt |
| City | BELLE MEAD | CityNm |
| State Abbreviation | NJ | StateAbbreviationCd |
| ZIP | 085021029 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHAEL VOORHEES | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 9082811439 | PhoneNum |
| Signature | 2018-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL SOMER | PreparerPersonNm |
| PTIN | P00094591 | PTIN |
| Phone | 7322437000 | PhoneNum |
| 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 | MICHAEL VOORHEES | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1029 | AddressLine1Txt |
| City | BELLE MEAD | CityNm |
| State Abbreviation | NJ | StateAbbreviationCd |
| ZIP | 085021029 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $5,466,807 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | eastmountainhospital.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2003 | FormationYr |
| Legal Domicile State | NJ | LegalDomicileStateCd |
| Activity Or Mission | EAST MOUNTAIN HOSPITAL IS AN INPATIENT PSYCHIATRIC HOSPITAL | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 64 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $4,631,394 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $4,946,540 | CYProgramServiceRevenueAmt |
| PY Investment Income | $31,679 | PYInvestmentIncomeAmt |
| CY Investment Income | $37,665 | CYInvestmentIncomeAmt |
| PY Other Revenue | $241 | PYOtherRevenueAmt |
| CY Other Revenue | $825 | CYOtherRevenueAmt |
| PY Total Revenue | $4,663,314 | PYTotalRevenueAmt |
| CY Total Revenue | $4,985,030 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $600 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $600 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $2,427,955 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $2,553,911 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,157,610 | PYOtherExpensesAmt |
| CY Other Expenses | $2,399,994 | CYOtherExpensesAmt |
| PY Total Expenses | $4,586,165 | PYTotalExpensesAmt |
| CY Total Expenses | $4,954,505 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $77,149 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $30,525 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,919,194 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,038,807 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $576,254 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $687,726 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,342,940 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,351,081 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TOGETHER WE WILL PROVIDE A SAFE, STRUCTURED, THERAPEUTIC COMMUNITY TO TREAT ADULTS WHO HAVE BEHAVIORAL AND SUBSTANCE ABUSE PROBLEMS AND RETURN THEM TO THEIR FAMILIES OR THE NEXT LEVEL OF CARE AS SOON AS POSSIBLE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $4,252,833 | ExpenseAmt |
| Grant | $600 | GrantAmt |
| Revenue | $4,946,540 | RevenueAmt |
| Desc | PSYCHIATRIC HOSPITAL WHICH CARED FOR 499 INPATIENTS AND HAD A TOTAL OF 4,969 PATIENT DAYS. | Desc |
| Total Program Service Expenses | $4,252,833 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 4 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 64 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHAEL VOORHEES | PersonNm |
| Phone | 9082811439 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 40 EAST MOUNTAIN ROAD | AddressLine1Txt |
| City | BELLE MEAD | CityNm |
| State Abbreviation | NJ | StateAbbreviationCd |
| ZIP | 085021029 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 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 |
|---|---|---|---|---|---|---|---|---|
| DAVID BUCH MD | ||||||||
| MEDICAL DIRECTOR & TRUSTEE | 40.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MICHAEL VOORHEES | ||||||||
| EXECUTIVE DIRECTOR & TRUSTEE | 40.0 | 0.0 | Yes (X) | Yes (X) | $140,891 | $0 | $16,908 | |
| DAVID CENTAFONT | ||||||||
| TRUSTEE | 0.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| ENRICO DEGIRONIMO | ||||||||
| TRUSTEE | 0.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| RANDOLPH JACOBSON | ||||||||
| TREASURER & TRUSTEE | 0.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| PATRICIA TOOLE | ||||||||
| CHAIRPERSON | 0.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| SUSAN BONFIELD | ||||||||
| TRUSTEE | 0.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| CAROL KOSZTYO | ||||||||
| SECRETARY & TRUSTEE | 0.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ASMA NISAR MD | ||||||||
| MEDICAL DIRECTOR & TRUSTEE | 40.0 | 0.0 | Yes (X) | Yes (X) | $247,141 | $0 | $13,833 | |
| SHAUN SWEENEY | ||||||||
| TRUSTEE | 0.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| DEBORAH CHARETTE | ||||||||
| DIRECTOR OF NURSING | 40.0 | 0.0 | $111,020 | $0 | $14,845 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $499,052 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $45,586 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 3 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CARRIER CLINIC | |||||
| PO BOX 147 | BELLE MEAD | NJ | 08502 | ADMIN/CLINICAL | $929,335 |
| SODEXO INC | |||||
| PO BOX 905374 | CHARLOTTE | NC | 28290 | DIETARY/HOUSEKEEPING | $150,016 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Total Contributions | $0 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT REVENUE | Desc |
| Business | 624100 | BusinessCd |
| Total Revenue Column | $4,946,540 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,946,540 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $4,946,540 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,442 | TotalRevenueColumnAmt |
| Exclusion | $19,442 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $500,000 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $481,777 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $18,223 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,223 | TotalRevenueColumnAmt |
| Exclusion | $18,223 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ALL OTHER REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $825 | TotalRevenueColumnAmt |
| Exclusion | $825 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $825 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,985,030 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,946,540 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $38,490 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $600 | TotalAmt |
| Program Services | $600 | ProgramServicesAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $370,078 | TotalAmt |
| Program Services | $230,920 | ProgramServicesAmt |
| Management And General | $139,158 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,739,156 | TotalAmt |
| Program Services | $1,683,787 | ProgramServicesAmt |
| Management And General | $55,369 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $76,100 | TotalAmt |
| Program Services | $69,082 | ProgramServicesAmt |
| Management And General | $7,018 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $186,788 | TotalAmt |
| Program Services | $168,989 | ProgramServicesAmt |
| Management And General | $17,799 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $181,789 | TotalAmt |
| Program Services | $165,859 | ProgramServicesAmt |
| Management And General | $15,930 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $82,626 | TotalAmt |
| Program Services | $72,230 | ProgramServicesAmt |
| Management And General | $10,396 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,725 | TotalAmt |
| Management And General | $15,725 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,819 | TotalAmt |
| Management And General | $38,819 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $929,335 | TotalAmt |
| Program Services | $641,576 | ProgramServicesAmt |
| Management And General | $287,759 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,018 | TotalAmt |
| Management And General | $1,018 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,609 | TotalAmt |
| Program Services | $27,810 | ProgramServicesAmt |
| Management And General | $30,799 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $239,884 | TotalAmt |
| Program Services | $236,072 | ProgramServicesAmt |
| Management And General | $3,812 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,637 | TotalAmt |
| Program Services | $6,637 | ProgramServicesAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $714 | TotalAmt |
| Program Services | $714 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,758 | TotalAmt |
| Management And General | $7,758 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,235 | TotalAmt |
| Program Services | $72,598 | ProgramServicesAmt |
| Management And General | $25,637 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PATIENT RELATED | $551,007 | $551,007 | |
| DIETARY/ENVIRONMENTAL SVS | $186,540 | $186,540 | |
| CONSULTING | $22,598 | $22,598 | |
| BAD DEBTS | $8,758 | $8,758 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $151,731 | TotalAmt |
| Program Services | $129,654 | ProgramServicesAmt |
| Management And General | $22,077 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,954,505 | TotalAmt |
| Program Services | $4,252,833 | ProgramServicesAmt |
| Management And General | $701,672 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $406,313 | BOYAmt |
| EOY | $188,510 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $498,112 | BOYAmt |
| EOY | $386,692 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $62,147 | BOYAmt |
| EOY | $69,077 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $130,045 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $91,510 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,093 | BOYAmt |
| EOY | $38,535 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $618,629 | BOYAmt |
| EOY | $133,910 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $294,900 | BOYAmt |
| EOY | $1,222,083 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,919,194 | BOYAmt |
| EOY | $2,038,807 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $412,114 | BOYAmt |
| EOY | $504,595 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $164,140 | BOYAmt |
| EOY | $183,131 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $576,254 | BOYAmt |
| EOY | $687,726 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,342,940 | BOYAmt |
| EOY | $1,351,081 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,342,940 | BOYAmt |
| EOY | $1,351,081 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,919,194 | BOYAmt |
| EOY | $2,038,807 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $30,525 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$22,384 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp | |
| Land | LandGrp | |
| Buildings | BuildingsGrp |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $112,255 | OtherCostOrOtherBasisAmt |
| Depreciation | $73,720 | DepreciationAmt |
| Book Value | $38,535 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,790 | OtherCostOrOtherBasisAmt |
| Depreciation | $17,790 | DepreciationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Land Buildings | OtherLandBuildingsGrp | |
| Total Book Value Land Buildings | $38,535 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | 3RD PARTY PAYOR SETTLEMENTS | Desc |
| Book Value | $1,222,083 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,222,083 | TotalBookValueOtherAssetsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO CARRIER CLINIC | $101,122 |
| ACCRUED PENSION | $48,200 |
| ACCRUED TAIL INSURANCE | $33,809 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $183,131 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $4,953,888 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$22,384 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$22,384 | RevenueNotReportedAmt |
| Revenue Subtotal | $4,976,272 | RevenueSubtotalAmt |
| Other Revenues Not Included | $8,758 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $8,758 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $4,985,030 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $4,945,747 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $4,945,747 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $8,758 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $8,758 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $4,954,505 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, QUESTION #2 | THE HOSPITAL IS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND, THEREFORE, IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE CODE. THERE ARE CERTAIN TRANSACTIONS THAT COULD BE DEEMED UNRELATED BUSINESS INCOME AND WOULD RESULT IN A TAX LIABILITY. MANAGEMENT REVIEWS TRANSACTIONS USING A THRESHOLD OF MORE LIKELY THAN NOT TO ESTIMATE POTENTIAL TAX LIABILITIES. IT IS MANAGEMENT'S ESTIMATION THAT THERE ARE NO MATERIAL TAX LIABILITIES THAT NEED TO BE RECORDED. |
| PART XI, LINE 4B | PATIENT BAD DEBTS $8,758 ARE REPORTED AS A REDUCTION OF REVENUE ON THE AUDITED FINANCIAL STATEMENTS. |
| PART XII, LINE 4B | PATIENT BAD DEBTS $8,758 ARE REPORTED AS A REDUCTION OF REVENUE ON THE AUDITED FINANCIAL STATEMENTS. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 100 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,952 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $8,952 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,952 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $8,952 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,952 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $8,952 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,739 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,739 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,739 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,739 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $5,226 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $354,122 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $380,486 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$26,364 | 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 (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | false | 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 | EAST MOUNTAIN HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1029 | AddressLine1Txt |
| City | BELLE MEAD | CityNm |
| State Abbreviation | NJ | StateAbbreviationCd |
| ZIP | 085021029 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.eastmountainhospital.com | WebsiteAddressTxt |
| State License | 22970 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EAST MOUNTAIN HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | 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 | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.eastmountainhospital.com | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.eastmountainhospital.com | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 100 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | www.eastmountainhospital.com | FAPAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | www.eastmountainhospital.com | 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 |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Collection Activities | false | CollectionActivitiesInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, SECTION B, LINE 5 | WHILE CONDUCTING EMH'S MOST RECENT CHNA, A REPRESENTATIVE OF EMH INTERVIEWED MENTAL HEALTH ADMINISTRATORS FROM MIDDLESEX AND SOMERSET COUNTIES TO DISCUSS SERVICE GAPS IN THE COMMUNITY. THESE COUNTIES REPRESENT APPROXIMAELY 40% OF EMH ADMISSIONS. |
| PART V, SECTION B, LINE 6A | IN AN EFFORT TO BE COST-EFFECTIVE, EMH CONDUCTED ITS CHNA IN CONJUNCTION WITH CARRIER CLINIC. EMH IS A HOSPITAL-WITHIN-A-HOSPITAL ON THE CARRIER CLINIC CAMPUS AND THEIR COMMUNITIES ARE SIMILAR. EMH ALSO COLLABORATED WITH SOMERSET MEDICAL CENTER FOR SOMERSET COUNTY'S DATA COLLECTION. THE CHNA WAS FIRST CONDUCTED IN 2013 AND THEN AGAIN IN 2016. |
| PART V, SECTION B, LINE 11 | IN EMH'S IMPLEMENTATION STRATEGY OF THE CHNA THAT WAS CONDUCTED, APPROVED BY ITS BOARD AND PUBLISHED IN 2016, EMH IDENTIFIED CERTAIN COMMUNITY NEEDS INCLUDING PUBLIC EDUCATION AND ACCESS TO MENTAL HEALTH CARE. EMH ADOPTED A TIMELINE AND STATEGIES TO ADDRESS THESE NEEDS OVER A THREE-YEAR TIME PERIOD. THE GOALS AND OBJECTIVES SET TO BE COMPLETED BY JUNE 30, 2017 HAVE BEEN MET. THE CHNA PROCESS IDENTIFIED OTHER COMMUNITY NEEDS THAT WERE NOT INCLUDED IN THE IMPLEMETATION STRATEGY DUE TO LIMITATIONS IN EXPERTISE AND RESOURCES. THE BOARD APPROVED THE CHNA AND IMPLEMENTATON STRATEGY IN JUNE 2016, WHICH IS IN EFFECT FOR THE PERIOD OF JULY 2016 THROUGH JUNE 2019. |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7, COLUMN F | BAD DEBT EXPENSE FOR THE YEAR ENDED JUNE 30, 2017 IS $8,758 AND IS EXCLUDED FROM TOTAL EXPENSES FOR CALCULATING THE PERCENTAGE OF TOTAL EXPENSE. |
| PART I, LINE 7 | THE COST-TO-CHARGE RATIO USED FOR PART I, LINE 7 IS BASED ON WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. |
| PART III, LINE 4 | REFER TO AUDITED FINANCIAL STATEMENTS, PAGE 7, FOR THE FOOTNOTE REGARDING BAD DEBT EXPENSE. |
| PART VI, SUPPLEMENTAL INFORMATION | #2 NEEDS ASSESSMENT: AS PART OF EAST MOUNTAIN HOSPITALS'S (EMH) STRATEGIC PLANNING PROCESS, THE HOSPITAL GATHERS AND INCORPORATES NATIONAL, STATE, AND CLINICAL INDUSTRY DATA IN THE DEVELOPMENT OF CLINICAL SERVICES AND EDUCATIONAL FORUMS. EMH IS A PARTICIPATORY MEMBER OF THE NEW JERSEY ASSOCIATION OF MENTAL HEALTH. THIS ORGANIZATION ALSO PROVIDES BEHAVIORAL HEALTH AND ADDICTION INFORMATION RELEVANT TO THE COMMUNITY'S NEEDS. EMH RECEIVES MANY TELEPHONE CALLS FROM THE GENERAL PUBLIC ON A REGULAR BASIS, REQUIRING REFERRALS TO AND INFORMATION REGARDING COMMUNITY RESOURCES, OTHER TREATMENT CENTERS OUTSIDE THE AREA, SUPPORT GROUPS, SELF-HELP GROUPS, ETC. INFORMATION IS PROVIDED WITHOUT CHARGE. IT IS THROUGH THIS CONTACT WITH THE COMMUNITY THAT ENABLES EMH TO UNDERSTAND WHAT SERVICES ARE NEEDED THROUGHOUT THE GEOGRAPHIC AREA. |
| PART VI, SUPPLEMENTAL INFORMATION | #3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: UNDER A SERVICE AGREEMENT WITH CARRIER CLINIC, A PATIENT SERVICE REPRESENTATIVE MEETS WITH EACH EMH PATIENT, IF THEY ARE MENTALLY CAPABLE, AND/OR A DESIGNATED FAMILY MEMBER OR GUARDIAN INDIVIDUALLY AND ADVISES THEM THAT THEY CAN APPLY FOR CHARITY CARE FOR THEIR SELF PAY BALANCES IF THEY HAVE LIMITED INCOME. THE PATIENT SERVICE REPRESENTATIVE PROVIDES CHARITY CARE APPLICATIONS TO THE PATIENT ACCORDINGLY. |
| PART VI, SUPPLEMENTAL INFORMATION | #4 COMMUNITY INFORMATION: EMH SERVES THE ENTIRE STATE OF NEW JERSEY; HOWEVER, THE MAIN PATIENT POPULATION IS FROM SUBURBAN AREAS. THE MAIN SOURCE OF ADMISSIONS IN 2016/2017 WAS FROM MIDDLESEX AND SOMERSET COUNTIES, BOTH LOCATED IN NEW JERSEY. OF THESE COUNTIES, AN AVERAGE OF 8.9% OF THE POPULATION FALLS BELOW POVERTY LEVEL. |
| PART VI, SUPPLEMENTAL INFORMATION | #5 PROMOTION OF COMMUNITY HEALTH: EMH ALSO PROVIDES EDUCATIONAL MATERIALS REGARDING MENTAL HEALTH TO THE COMMUNITY AT NO COST ON ITS WEBSITE. EDUCATIONAL WHITEPAPERS, NATIONAL INSTITUTE OF MENTAL HEALTH FACT SHEETS AND SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION FACT SHEETS ARE AVAILABLE IN BOTH ENGLISH AND SPANISH. EDUCATIONAL MENTAL HEALTH VIDEOS AND RESOURCES BY COUNTY ARE ALSO AVAILABLE ON THE WEBSITE. |
| PART III, LINE 8 | THE COST-TO-CHARGE RATIO IS USED FOR PART III, LINE 6. THIS IS THE RATIO OF PATIENT CARE COSTS APPLIED TO CHARGES. THE AMOUNTS REPORTED ON LINES 5, 6 AND 7 ARE TAKEN FROM EAST MOUNTAIN HOSPITALS FILED 2016/2017 MEDICARE COST REPORT PURSUANT TO THE SCHEDULE H INSTRUCTIONS. THESE AMOUNTS DO NOT INCLUDE INCURRED LOSSES FROM PHYSICIAN SERVICES TOTALING OVER $16,000 AS FOLLOWS: PHYSICIAN COST (SALARIES, FRINGES, MALPRACTICE INSURANCE) $38,188 REIMBURSEMENT RECEIVED FROM MEDICARE $21,605, UNREIMBURSED COST $16,583. THE HOSPITAL BELIEVES THAT ALL OF THE MEDICARE SHORTFALL SHOULD BE CONSIDERED AS A COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITY. THIS YEAR, MEDICARE ACCOUNTED FOR 8% OF HOSPITAL REVENUES. THE HOSPITAL PROVIDES CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVES THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. CARING FOR MEDICARE PATIENTS FULFILLS A COMMUNITY NEED AND RELIEVES A GOVERNMENT BURDEN AS THESE PATIENTS TYPICALLY HAVE LOW AND/OR FIXED INCOMES. MEDICARE DOES NOT PROVIDE SUFFICIENT REIMBURSEMENT TO COVER THE COST OF PROVIDING CARE FOR THESE PATIENTS AND THE INPATIENT SHORTFALL IN 2016/2017 OF $26,364 SHOULD BE COUNTED AS COMMUNITY BENEFIT. MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT BECAUSE OUR MISSION IS TO PROMOTE HEALTH IN THE COMMUNITY AND WE DO NOT LIMIT THE CARE AVAILABLE TO ANY PATIENTS, INCLUDING THOSE COVERED BY MEDICARE. TAX-EXEMPT HOSPITALS ARE EXPECTED TO PARTICIPATE IN THE MEDICARE PROGRAM. |
| PART III, LINE 2 | BAD DEBT EXPENSE FOR THE YEAR ENDED JUNE 30, 2017 IS $8,758, WHICH IS BASED ON CHARGES. THE RATIO OF PATIENT CARE COSTS TO CHARGES IS 59.67% WHICH IS APPLIED TO THE BAD DEBT AMOUNT FOR AN ESTIMATED COST OF $5,226. THIS EXPENSE IS REPORTED ON PART III, LINE 2. |
| PART VI, SUPPLEMENTAL INFORMATION | #7 STATE FILING OF COMMUNITY BENEFIT REPORT: NOT APPLICABLE |
| PART II, COMMUNITY BUILDING | EMH IS A MEMBER OF SOMERSET COUNTY'S "ADOPT-A-ROAD" PROGRAM WHICH SUPPORTS THE COMMUNITY'S ONGOING EFFORT TO KEEP ITS ROADS MORE ATTRACTIVE AND SAFE. THE PROGRAM ALLOWS ORGANIZATIONS AND INDIVIDUALS TO HELP JOIN THE COUNTY IN PRODUCING SAFE, ATTRACTIVE, LITTER-FREE ROADWAYS WITHIN THEIR COMMUNITIES. SAFER ROADWAYS CREATE FEWER ACCIDENTS WHICH PROMOTES THE HEALTH AND SAFETY OF OUR COMMUNITY. THE PROGRAM ALSO LOWERS THE COST OF LITTER REMOVAL BY THE COUNTY AND IS BENEFICIAL FOR EVERYONE. EMH STAFF IS RESPONSIBLE FOR A TWO MILE STRETCH OF ROAD AND SPENT APPROXIMATELY THIRTY-SIX HOURS DURING THE YEAR COLLECTING TRASH. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|---|
| MICHAEL VOORHEES | |||||
| EXECUTIVE DIRECTOR & TRUSTEE | $131,791 | $9,100 | $5,700 | $11,208 | $157,799 |
| ASMA NISAR MD | |||||
| MEDICAL DIRECTOR & TRUSTEE | $247,141 | $12,900 | $933 | $260,974 | |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PART II | FormAndLineReferenceDesc |
| Explanation | MICHAEL VOORHEES' OTHER REPORTABLE COMPENSATION (iii) OF $9,100 REPRESENTS PENSION CONTRIBUTION THAT FAILED DISCRIMINATION TESTING, RETIREMENT (c) $5,700 REPRESENTS EAST MOUNTAIN HOSPITAL'S CONTRIBUTION INTO THE TARGET BENEFIT PLAN, AN ERISA PLAN, AND NONTAXABLE BENEFITS (d) $11,208 REPRESENTS HOSPITALIZATION, MEDICAL, DENTAL AND PRESCRIPTION PLAN COVERAGE AS WELL AS LIFE INSURANCE AND LONG-TERM DISABILITY INSURANCE PAID BY EAST MOUNTAIN HOSPITAL. DR. ASMA NISAR'S RETIREMENT(C) $12,900 REPRESENTS EAST MOUNTAIN HOSPITAL'S CONTRIBUTION INTO THE TARGET BENEFIT PLAN, AN ERISA PLAN, AND NONTAXABLE BENEFITS (d) $933 REPRESENTS LIFE INSURANCE AND LONG-TERM DISABILITY INSURANCE PAID BY EAST MOUNTAIN HOSPITAL. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 IS PREPARED BY INTERNAL FINANCIAL STAFF, IS REVIEWED BY AN OUTSIDE CPA CONSULTING FIRM AND IS THEN REVIEWED BY THE BOARD OF TRUSTEES IN ADVANCE OF THE FILING WITH THE IRS. THIS REVIEW IS DOCUMENTED IN THE BOARD OF TRUSTEE MINUTES. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH TRUSTEE AND OFFICER ANNUALLY SIGNS A STATEMENT WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY AND UNDERSTANDS EAST MOUNTAIN HOSPITAL IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ITS TAX-EXEMPT PURPOSE. |
| FORM 990, PART VI, SECTION B, LINE 15 | EAST MOUNTAIN HOSPITAL UTILIZES THE NEW JERSEY HOSPITAL ASSOCIATION, SULLIVAN AND COTTER, HOSPITAL AND HEALTHCARE COMPENSATION SERVICE, MODERN HEALTHCARE PUBLICATIONS AND OTHER VARIOUS SALARY SURVEYS FOR MARKET COMPARISONS. THE INFORMATION IS THEN PROVIDED TO THE BOARD OF TRUSTEES TO ENSURE THE SALARIES ARE WITHIN APPROPRIATE MARKET AND NONPROFIT EXECUTIVE COMPENSATION BASES. THE BOARD REVIEWS THE REASONABLENESS OF THE SALARY STRUCTURE FOR OFFICERS WITHIN THE ORGANIZATION AND ALSO REVIEWS AND ESTABLISHES THE REBUTTABLE PRESUMPTION OF REASONABLENESS FOR THESE SALARIES ANNUALLY. |
| FORM 990, PART VI, SECTION C, LINE 19 | EAST MOUNTAIN HOSPITAL PROVIDES DOCUMENTS TO THE PUBLIC UPON REQUEST. THE IRS FORM 990 IS ALSO ACCESSIBLE FROM GUIDESTAR ON THE INTERNET. |
| FORM 990, PART VII, SECTION B, INDEPENDENT CONTRACTORS | EAST MOUNTAIN HOSPITAL PURCHASED ADMINISTRATIVE AND CLINICAL SUPPORT SERVICES AT COST FROM CARRIER CLINIC AS PER THE DULY EXECUTED SERVICE AGREEMENT BETWEEN THE TWO ENTITIES. FOR THE FISCAL YEAR ENDED JUNE 30, 2017, THE TOTAL COST OF THESE SERVICES AMOUNTED TO $929,335: $641,576 FOR CLINICAL SERVICES AND $287,759 FOR VARIOUS BUSINESS SUPPORT FUNCTIONS SUCH AS FINANCIAL REPORTING, BILLING, INFORMATION TECHNOLOGY, HUMAN RESOURCES, AND OTHER BUSINESS FUNCTIONS. |
| FORM 990, PART VII, SECTION A, OFFICERS | DR. NISAR IS NO LONGER EMPLOYED AS A MEDICAL DIRECTOR AS OF JANUARY 2, 2017. HER ROLE AS TRUSTEE ALSO ENDED ON THIS DATE, PER THE BY-LAWS. DR. BUCH IS THE NEW MEDICAL DIRECTOR EFFECTIVE JANUARY 15, 2017. HIS SALARY WILL BE REPORTED IN THE 2017 W-2 AND ACCORDINGLY WILL BE REPORTED IN THE 2017/2018 990 ON PART VII & SCHEDULE J. HE IS A TRUSTEE AS OF JUNE 30, 2017, PER THE BY-LAWS. |
| FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICE | OTHER FEES FOR SERVICE INCLUDE $929,335 FOR ADMINISTRATION AND CLINICAL SUPPORT SERVICES PURCHASED AT COST FROM CARRIER CLINIC. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER TOTAL FEES:929335 |