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BUCKTAIL MEDICAL CENTER: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
BUCKTAIL MEDICAL CENTER (EIN 24-0701920)
Tax period
2016-07-01 to 2017-06-30
Filed
2018-05-15
IRS object ID
201821359349307307
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 ReturnHeader

FieldValueIRS element (for citing)
Return2018-05-15T13:15:35-05:00ReturnTs
Tax Period End2017-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN460722692PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1SICKLER TARPEY & ASSOCIATESBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1227 JEFFERSON AVENUEAddressLine1Txt
CityTYRONECityNm
State AbbreviationPAStateAbbreviationCd
ZIP16686ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN240701920EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1BUCKTAIL MEDICAL CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlBUCKBusinessNameControlTxt
Phone5709231000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11001 PINE STREETAddressLine1Txt
CityRENOVOCityNm
State AbbreviationPAStateAbbreviationCd
ZIP177641618ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonTIMOTHY REEVES NHAPersonNm
Person TitleADMINISTRATORPersonTitleTxt
Phone5709231000PhoneNum
Signature2018-05-15SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonCHRISTOPHER DEANTONIOPreparerPersonNm
PTINP00976440PTIN
Phone8146844640PhoneNum
Preparation2018-05-15PreparationDt
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerTIMOTHY REEVES NHAPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11001 PINE STREETAddressLine1Txt
CityRENOVOCityNm
State AbbreviationPAStateAbbreviationCd
ZIP177641618ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$6,635,661GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressN/AWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1909FormationYr
Legal Domicile StatePALegalDomicileStateCd
Activity Or MissionBUCKTAIL MEDICAL CENTER IS A CRITICAL ACCESS HOSPITAL, NURSING HOME FACILITY AND A COMMUNITY CLINIC SERVING THE HEALTHCARE NEEDS OF WESTERN CLINTON COUNTY, PA. BUCKTAIL MEDICAL CENTER OFFERS 21 HOSPITAL BEDS, 43 NURSING HOME BEDS, AND A COMMUNITY CLINIC OFFERING OUT PATIENT SERVICES.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent9VotingMembersIndependentCnt
Total Employee121TotalEmployeeCnt
Total Volunteers50TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$903,167PYContributionsGrantsAmt
CY Contributions Grants$1,195,271CYContributionsGrantsAmt
PY Program Service Revenue$5,857,282PYProgramServiceRevenueAmt
CY Program Service Revenue$5,440,040CYProgramServiceRevenueAmt
PY Investment Income$346PYInvestmentIncomeAmt
CY Investment Income$350CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$6,760,795PYTotalRevenueAmt
CY Total Revenue$6,635,661CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$3,486,407PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$3,337,184CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$3,295,144PYOtherExpensesAmt
CY Other Expenses$3,701,315CYOtherExpensesAmt
PY Total Expenses$6,781,551PYTotalExpensesAmt
CY Total Expenses$7,038,499CYTotalExpensesAmt
PY Revenues Less Expenses-$20,756PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$402,838CYRevenuesLessExpensesAmt
Total Assets BOY$3,040,550TotalAssetsBOYAmt
Total Assets EOY$2,662,815TotalAssetsEOYAmt
Total Liabilities BOY$4,612,991TotalLiabilitiesBOYAmt
Total Liabilities EOY$4,636,236TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$1,572,441NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$1,973,421NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionBUCKTAIL MEDICAL CENTER IS A CRITICAL ACCESS HOSPITAL, NURSING HOME FACILITY AND A COMMUNITY CLINIC SERVING THE HEALTHCARE NEEDS OF WESTERN CLINTON COUNTY, PA. BUCKTAIL MEDICAL CENTER OFFERS 21 HOSPITAL BEDS, 43 NURSING HOME BEDS, AND A COMMUNITY CLINIC OFFERING OUT PATIENT SERVICES.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$3,978,593ExpenseAmt
Revenue$3,571,256RevenueAmt
DescBUCKTAIL MEDICAL CENTER PROVIDES HOSPITAL INPATIENT AND OUTPATIENT SERVICES. THE CENTER HAS 21 BEDS TO MEET ITS CRITICAL ACCESS NEEDS AS WELL AS AN EMERGENCY ROOM AND COMMUNITY CLINIC.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$2,359,260ExpenseAmt
Revenue$1,868,784RevenueAmt
DescBUCKTAIL MEDICAL CENTER PROVIDES NURSING HOME FACILITIES WITH 43 BEDS. SERVICES ALSO INCLUDE PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, EXERCISE AND RECREATIONAL ACTIVITIES.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$6,337,853TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation EasementsYes (1)ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document19IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee121EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member9IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1THE ORGANIZATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone5709231000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11001 PINE STREETAddressLine1Txt
CityRENOVOCityNm
State AbbreviationPAStateAbbreviationCd
ZIP177641618ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
HARRIET NUSS
BOARD PRESIDENT1.00Yes (X)Yes (X)$0$0$0
JOHN KURUTZ
BOARD MEMBER1.00Yes (X)$0$0$0
ANNA KNAUFF
BOARD VICE PRESIDENT1.00Yes (X)Yes (X)$0$0$0
WILLIAM FORNWALT
BOARD MEMBER1.00Yes (X)$0$0$0
ALAN EDWARDS MD
MEDICAL DIRECTOR40.00Yes (X)Yes (X)$0$0$0
ROBERT GETZ SR
BOARD MEMBER1.00Yes (X)$0$0$0
ALINE PETERSEN
BOARD MEMBER1.00Yes (X)$0$0$0
CARLA FLACK
BOARD SEC/TREAS.1.00Yes (X)$0$0$0
GEORGE GERBER
CONTROLLER40.00Yes (X)$75,197$0$0
TIMOTHY REEVES NHS
DIRECTOR40.00Yes (X)$85,096$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$160,293TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
EMCARE INC
815 SOUTH PALAFOX 3RD FLOORPENSACOLAFL32502PHYSICIAN SERVICES$649,244
BENCHMARK THERAPIES
403 6TH STREETHUNTINGDONPA16652THERAPY SERVICES$245,590
OMNICARE INC
3570 W 4TH STREETWILLIAMSPORTPA17701PHARMACY SERVICES$221,225
ALLIED RESOURCES STAFFING SOLUITONS
135 DOWLIN FORGE ROADEXTONPA19341AGENCY-NURSING$207,148
BRIDGEPORT CAPITAL FUNDING
PO BOX 101004ATLANTAGA30392AGENCY-LABORATORY$191,341
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K5CntrctRcvdGreaterThan100KCnt
Government Grants$1,059,767GovernmentGrantsAmt
All Other Contributions$135,504AllOtherContributionsAmt
Total Contributions$1,195,271TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT SERVICE REVENU900099$3,571,256$3,571,256
LONG TERM CARE FACILIT623000$1,868,784$1,868,784
FieldValueIRS element (for citing)
Total Program Service Revenue$5,440,040TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$350TotalRevenueColumnAmt
Exclusion$350ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$6,635,661TotalRevenueColumnAmt
Related Or Exempt Func Income$5,440,040RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$350ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$160,293TotalAmt
Management And General$160,293ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$2,587,400TotalAmt
Program Services$2,147,313ProgramServicesAmt
Management And General$440,087ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$589,491TotalAmt
Program Services$489,225ProgramServicesAmt
Management And General$100,266ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$128,948TotalAmt
Program Services$128,948ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$199,700TotalAmt
Program Services$199,700ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$129,485TotalAmt
Program Services$129,485ProgramServicesAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
SUPPLIES$2,268,075$2,268,075
PROFESSIONAL FEES$790,416$790,416
BAD DEBT EXPENSE$184,691$184,691

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$7,038,499TotalAmt
Program Services$6,337,853ProgramServicesAmt
Management And General$700,646ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$875,098BOYAmt
EOY$657,549EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$24,584BOYAmt
EOY$136,585EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$789,228BOYAmt
EOY$646,721EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$91,784BOYAmt
EOY$88,006EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$86,697BOYAmt
EOY$95,608EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$8,017,199LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$7,026,877LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$1,137,224BOYAmt
EOY$990,322EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$10,886BOYAmt
EOY$12,744EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$25,049BOYAmt
EOY$35,280EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$3,040,550BOYAmt
EOY$2,662,815EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,269,310BOYAmt
EOY$2,480,931EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$98,160BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$2,063,022BOYAmt
EOY$1,923,036EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$182,499BOYAmt
EOY$232,269EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$4,612,991BOYAmt
EOY$4,636,236EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$1,621,580BOYAmt
EOY-$2,020,021EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$49,139BOYAmt
EOY$46,600EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$1,572,441BOYAmt
EOY-$1,973,421EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$3,040,550BOYAmt
EOY$2,662,815EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$402,838ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$1,858NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Protection Natural HabitatYes (X)ProtectionNaturalHabitatInd
Preservation Open SpaceYes (X)PreservationOpenSpaceInd
Total Easements2TotalEasementsCnt
Total Acreage685.00TotalAcreageCnt
Written Policy Monitoring0WrittenPolicyMonitoringInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$144,218OtherCostOrOtherBasisAmt
Book Value$144,218BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,331,998OtherCostOrOtherBasisAmt
Depreciation$2,704,236DepreciationAmt
Book Value$627,762BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$352,958OtherCostOrOtherBasisAmt
Depreciation$314,170DepreciationAmt
Book Value$38,788BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,188,025OtherCostOrOtherBasisAmt
Depreciation$4,008,471DepreciationAmt
Book Value$179,554BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$990,322TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
BANKRUPTCY RESERVE$111,283
ESTIMATED THIRD PARTY SETTLEMENTS$120,986
FieldValueIRS element (for citing)
Total Liability$232,269TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$6,450,970TotalRevEtcAuditedFinclStmtAmt
Other Revenue-$184,375OtherRevenueAmt
Revenue Not Reported-$184,375RevenueNotReportedAmt
Revenue Subtotal$6,635,345RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$6,635,345TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$6,853,808TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$6,853,808ExpensesSubtotalAmt
Investment Expenses Not Incld2$316InvestmentExpensesNotIncld2Amt
Other Expenses Not Included$184,375OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$184,691ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$7,038,499TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART X, LINE 2:THE CENTER ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES BY PRESCRIBING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD IS MET. MANAGEMENT DETERMINED THERE WAS NO TAX UNCERTAINTIES THAT MET THE REGONITION THRESHOLD FOR FISCAL YEAR END JUNE 30, 2017.
PART XI, LINE 2D - OTHER ADJUSTMENTS:BAD DEBT
PART XII, LINE 4B - OTHER ADJUSTMENTS:BAD DEBT
SCHEDULE D PART XI LINE 1THE AUDITED FINANCIAL STATEMENTS INCLUDE THE PROVISION FOR BAD DEBT IN THE AMOUNT OF 184,375 IN THE GROSS REVENUE. FOR TAX PURPOSES THIS IS PART OF THE EXPENSES.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent100Yes (X)Percent100Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent200 DYes (X)Percent200DInd
Free Care Medically Indigent0FreeCareMedicallyIndigentInd
Financial Assistance Budget0FinancialAssistanceBudgetInd
Annual Community Bnft Report0AnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,139TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$5,139NetCommunityBenefitExpnsAmt
Total Expense0.00070TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,835,456TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,668,859DirectOffsettingRevenueAmt
Net Community Benefit Expns$166,597NetCommunityBenefitExpnsAmt
Total Expense0.02370TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,840,595TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,668,859DirectOffsettingRevenueAmt
Net Community Benefit Expns$171,736NetCommunityBenefitExpnsAmt
Total Expense0.02440TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$188,864TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$188,864NetCommunityBenefitExpnsAmt
Total Expense0.02680TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,402TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$5,402NetCommunityBenefitExpnsAmt
Total Expense0.00080TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$194,266TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$194,266NetCommunityBenefitExpnsAmt
Total Expense0.02760TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,034,861TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,668,859DirectOffsettingRevenueAmt
Net Community Benefit Expns$366,002NetCommunityBenefitExpnsAmt
Total Expense0.05200TotalExpensePct

Coalition Building CoalitionBuildingGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,260TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,260NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,817TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,140DirectOffsettingRevenueAmt
Net Community Benefit Expns$677NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,796TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$4,796NetCommunityBenefitExpnsAmt
Total Expense0.00070TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$7,873TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,140DirectOffsettingRevenueAmt
Net Community Benefit Expns$6,733NetCommunityBenefitExpnsAmt
Total Expense0.00100TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$184,375BadDebtExpenseAmt
Bad Debt Expense Attributable$184,375BadDebtExpenseAttributableAmt
Reimbursed By Medicare$1,380,279ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$1,533,885CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$153,606MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost Accounting SystemYes (X)CostAccountingSystemInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1BUCKTAIL MEDICAL CENTERBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11001 PINE STREETAddressLine1Txt
CityRENOVOCityNm
State AbbreviationPAStateAbbreviationCd
ZIP17764ZIPCd
FieldValueIRS element (for citing)
State License549601StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1BUCKTAIL MEDICAL CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted15CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts0CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (1)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy Adopt0ImplementationStrategyAdoptInd
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care300.000000000000FPGFamilyIncmLmtDscntCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Other CriteriaYes (X)OtherCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit Other ActionsYes (X)PermitOtherActionsInd
Collection Activities0CollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Other Actions TakenYes (X)OtherActionsTakenInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Look Back MedicareYes (X)LookBackMedicareInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
BUCKTAIL MEDICAL CENTERPART V, SECTION B, LINE 5: BUCKTAIL MEDICAL CENTER POLLED COMMUNITY MEMBERS, OTHER HEALTH PROFESSIONALS, CLERGY AND BUSINESS COMMUNITY TO GATHER THE INPUT REQUIRED TO PRODUCE AN ACCURATE REPORT.
BUCKTAIL MEDICAL CENTERPART V, SECTION B, LINE 6A: PRR AND CTA
BUCKTAIL MEDICAL CENTERPART V, SECTION B, LINE 11: DEVELOPING PROGRAMS THAT MEET THE NEEDS THAT THE COMMUNITY FELT WERE THE MOST URGENT.
BUCKTAIL MEDICAL CENTERPART V, SECTION B, LINE 13H: FAMILY SIZE.
BUCKTAIL MEDICAL CENTERPART V, SECTION B, LINE 18E: PROMPT PAYMENT DISCOUNT OFFER; PAYMENT PLAN OFFER; FAP APPLICATION.
BUCKTAIL MEDICAL CENTERPART V, SECTION B, LINE 20E: IN PERSON OR PHONE CONTACT TO ASSIST PATIENT WITH APPLICAITON COMPLETION; ASSIST PATIENT IN EXPLORING ALTERNATE SOURCES OF PAYMENT AND COVERAGE.
FieldValueIRS element (for citing)
Facility3FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
1 - BUCKTAIL MEDICAL CENTER
1001 PINE STREETRENOVOPA17764LONG-TERM CARE
2 - BUCKTAIL MEDICAL CENTER
1001 PINE STREETRENOVOPA17764AMBULANCE
3 - BUCKTAIL MEDICAL CENTER COMMUNITY CLINIC
1001 PINE STREETRENOVOPA17764COMMUNITY CLINIC

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART VI, LINE 2:BUCKTAIL MEDICAL CENTER CONDUCTED THE NEEDS ASSESSMENT WITH THE ASSISTANCE OF VARIOUS COMMUNITY ORGANIZATIONS.
PART VI, LINE 4:BUCKTAIL MEDICAL CENTER SERVICE AREA INCLUDES WESTERN CLINTON AND SOUTHERN POTTER COUNTIES. IT SERVES THE COMMUNITIES OF RENOVO, SOUTH RENOVO, NORTH BEND, HYNER, SHINTOWN, WESTPORT, AND HAMERSLEY FORK LOCATED IN CLINTON COUNTY. IT ALSO SERVES CROSS FORK LOCATED IN POTTER COUNTY. THE POPULATION OF THE AREA IS APPROXIMATELY 1,600. THE HOSPITAL IS ISOLATED AND SURROUNDED BY PENNSYLVANIA STATE PARKS AND GAME LAND KNOWN AS THE PENNSYLVANIA WILDS.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BTHE BOARD OF DIRECTORS ARE PROVIDED WITH A DRAFT COPY OF THE TAX FORM 990 AND RELATED SCHEDULES AS WELL AS A DRAFT COPY OF THE AUDITED FINANCIAL STATEMENTS TO REVIEW AND APPROVE BEFORE FINAL SUBMISSION.
FORM 990, PART VI, SECTION B, LINE 12CBOARD MEMBERS SIGN CONFLICT OF INTEREST STATEMENTS AT THE BEGINNING OF THE FISCAL YEAR AND ANY TIME THERE IS A BOARD MEMBER CHANGE. BOARD MEMBERS ARE REQUIRED TO RECUSE THEMSELVES IN THE EVENT THERE EVER COULD BE A CONFLICT OF INTEREST DURING THE COURSE OF OPERATIONS.
FORM 990, PART VI, SECTION B, LINE 15SALARY DETERMINATION FOR TOP MANAGEMENT AND KEY EMPLOYEES IS SET AFTER COMPARISION TO MARKET REQUIREMENTS AND PEER GROUP BENCHMARKS.
FORM 990, PART VI, SECTION C, LINE 18ALL DOCUMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19ALL GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST.
FORM 990 PART XII LINE 2CTHE BOARD REVIEWS THE FINANCIAL STATEMENTS AND APPROVES AS IN PAST YEARS.