SUMMERSVILLE REGIONAL MEDICAL CENTER: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- SUMMERSVILLE REGIONAL MEDICAL CENTER (EIN 55-0491651)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-15
- IRS object ID
- 201713199349308616
- 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 C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-15T12:36:08-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 550486667 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Arnett Carbis Toothman LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O Box 2629 | AddressLine1Txt |
| City | Charleston | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25329 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550491651 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Summersville Regional Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SUMM | BusinessNameControlTxt |
| Phone | 3048722891 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 Fairview Heights Road | AddressLine1Txt |
| City | Summersville | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 266519308 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Tim Howard | PersonNm |
| Person Title | Interim CFO | PersonTitleTxt |
| Phone | 3048722891 | PhoneNum |
| Signature | 2017-11-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Dolores Rose | PreparerPersonNm |
| PTIN | P01286262 | PTIN |
| Phone | 3043460441 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 216.12.119.47 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-13 | IPDt |
| IP Tm | 18:03:53 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | EFD85F53444C93A008866C846AC1A54A412EFC7B | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 9BAAE1AE8F7C799F6A2C05DF6C6A66846D7BC49B | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Karen Fudicia | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 Fairview Heights Road | AddressLine1Txt |
| City | Summersville | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 266519308 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $58,841,420 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.summersvilleregional.org | WebsiteAddressTxt |
| Type Of Organization Other | Yes (X) | TypeOfOrganizationOtherInd |
| Other Organization Dsc | Municipal Public Work | OtherOrganizationDsc |
| Formation | 1968 | FormationYr |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Activity Or Mission | Summersville Regional Medical Center provides acute care services through 49 licensed beds including Intensive Care Unit, Medical/Surgery, OB and Swing Bed. In addition there are 52 extended care beds providing Long Term Care services to the residents. Summersville Regional Medical Center operates an Emergency Room taking all patients regardless of insurance in conjunction with a regional medical center approach, connecting patients to tertiary care facilities as necessary for services. Ancillary diagnostic services are also provided including Lab, X-ray, CT, MRI, Ultrasound, PT/OT, Nuclear medicine, Surgery, and Emergency Room. Physician clinics include Rural Health Clinics, Surgery practice, Women's health practice and Orthopedics practice. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 669 | TotalEmployeeCnt |
| Total Volunteers | 30 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $80,426 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,345 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $54,178,542 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $57,095,650 | CYProgramServiceRevenueAmt |
| PY Investment Income | $58,866 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,608 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,262,647 | PYOtherRevenueAmt |
| CY Other Revenue | $1,701,306 | CYOtherRevenueAmt |
| PY Total Revenue | $56,580,481 | PYTotalRevenueAmt |
| CY Total Revenue | $58,800,909 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $2,500 | 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 | $30,778,113 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $29,681,361 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $27,937,977 | PYOtherExpensesAmt |
| CY Other Expenses | $30,064,572 | CYOtherExpensesAmt |
| PY Total Expenses | $58,718,590 | PYTotalExpensesAmt |
| CY Total Expenses | $59,745,933 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$2,138,109 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$945,024 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $23,974,128 | TotalAssetsBOYAmt |
| Total Assets EOY | $25,648,039 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $18,224,590 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $20,843,525 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,749,538 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,804,514 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Above all else, Summersville Regional Medical Center is committed to the care and improvement of human life. In recognition of this commitment, we will strive to deliver quality, cost effective healthcare to the communities we serve. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $51,381,500 | ExpenseAmt |
| Revenue | $58,643,511 | RevenueAmt |
| Desc | The Hospital provided 27,962 inpatient days of care as follows: 7,375 acute intensive care, 2,162 swing bed and 18,425 long-term care. Other services provided include 64,466 outpatient procedures, 19,743 emergency room visits and 44,723 rural health clinic visits. The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Charges foregone for charity during the year amounted to $487,496 for hospital services. The level of financial assistance provided by the Hospital has decreased over the last couple of years due to the fact that the State of West Virginia expanded Medicaid. With the Medicaid expansion, individuals with income at 138% of the poverty guidelines are now eligible for Medicaid. Prior to the Medicaid expansion, the level of income to qualify for Medicaid was much lower. | Desc |
| Total Program Service Expenses | $51,381,500 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | 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 | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln 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 | 11 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 669 | 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 | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | 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 | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Tim Howard Interim CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3048722891 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 Fairview Heights Road | AddressLine1Txt |
| City | Summersville | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26651 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| Stephen Boone RPh | |||||||
| Chairman | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Gary Withee | |||||||
| Vice Chair | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Saundra Kinser | |||||||
| Secretary | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Bruce Tallamy | |||||||
| Treasurer | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Brian Johnson | |||||||
| Trustee | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Robert Shafer | |||||||
| Trustee | 3.00 | Yes (X) | $0 | $32,000 | $0 | ||
| Mike Steadham | |||||||
| Trustee | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Bandy Mullins MD | |||||||
| Trustee/Chief of Staff | 40.00 | Yes (X) | $756,230 | $0 | $40,951 | ||
| Kenny Baker | |||||||
| Trustee | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| James Marsh | |||||||
| Trustee | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| James Epling | |||||||
| Trustee | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Judy Sentz | |||||||
| Trustee | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Kevin Brown DDS | |||||||
| Trustee | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Mark Shifflett | |||||||
| Trustee | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Jay Borrell | |||||||
| Trustee | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Daniel Ayers | |||||||
| CEO (termed 9/9/2016) | 40.00 | Yes (X) | $213,238 | $0 | $10,425 | ||
| Karen Fiducia FACHE | |||||||
| Interim CEO as of 10/2/2016 | 40.00 | Yes (X) | $0 | $0 | $0 | ||
| Mark Lovell | |||||||
| CFO 1/1/15-4/1/16 | 40.00 | Yes (X) | $13,640 | $0 | $2,000 | ||
| Joe Barnes | |||||||
| CFO 4/18/16-5/5/17 | 40.00 | Yes (X) | $121,332 | $0 | $8,453 | ||
| Benjamin Hensley DO | |||||||
| Physician | 40.00 | $667,266 | $0 | $40,951 | Yes (X) | ||
| Stanley Morris MD | |||||||
| Physician | 40.00 | $432,909 | $0 | $39,776 | Yes (X) | ||
| Michael Taylor MD | |||||||
| Physician | 40.00 | $396,596 | $0 | $40,655 | Yes (X) | ||
| Lukasz Rostocki MD | |||||||
| Physician | 40.00 | $383,892 | $0 | $46,951 | Yes (X) | ||
| Jonathan Dale MD | |||||||
| Physician | 40.00 | $362,541 | $0 | $40,951 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,347,644 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $32,000 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $271,113 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 33 | 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 |
|---|---|---|---|---|---|
| Weatherby Locums Inc | |||||
| PO Box 972633 | Dallas | TX | 75397 | Locum Physicians | $1,067,348 |
| QHR | |||||
| 105 Continental Place | Brentwood | TN | 37027 | Consulting | $835,651 |
| Flaherty Sensabaugh & Bonasso | |||||
| PO Box 3843 | Charleston | WV | 25338 | Legal Services | $296,499 |
| Arnett Carbis Toothman | |||||
| PO Box 2629 | Charleston | WV | 25329 | Accounting Services | $217,852 |
| Comprehensive Pharmacy Services | |||||
| PO Box 638316 | Cincinnati | OH | 45201 | Pharmacy Management | $167,202 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $2,345 | AllOtherContributionsAmt |
| Total Contributions | $2,345 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Patient service revenue | Desc |
| Business | 622110 | BusinessCd |
| Total Revenue Column | $57,095,650 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $57,095,650 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $57,095,650 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,608 | TotalRevenueColumnAmt |
| Exclusion | $1,608 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $193,956 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $40,511 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $153,445 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $153,445 | TotalRevenueColumnAmt |
| Exclusion | $153,445 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Pharmacy | 446110 | $1,336,588 | $1,336,588 |
| Cafeteria Sales | 722210 | $121,475 | $121,475 |
| Refunds and Rebates | 900099 | $73,099 | $73,099 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $16,699 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $16,699 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,547,861 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $58,800,909 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $58,643,511 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $155,053 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,145,105 | TotalAmt |
| Program Services | $948,147 | ProgramServicesAmt |
| Management And General | $196,958 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,854,897 | TotalAmt |
| Program Services | $19,751,855 | ProgramServicesAmt |
| Management And General | $4,103,042 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $274,950 | TotalAmt |
| Program Services | $227,659 | ProgramServicesAmt |
| Management And General | $47,291 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,742,706 | TotalAmt |
| Program Services | $2,270,961 | ProgramServicesAmt |
| Management And General | $471,745 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,663,703 | TotalAmt |
| Program Services | $1,377,546 | ProgramServicesAmt |
| Management And General | $286,157 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $466,369 | TotalAmt |
| Management And General | $466,369 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,632 | TotalAmt |
| Management And General | $36,632 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,635,956 | TotalAmt |
| Program Services | $4,666,571 | ProgramServicesAmt |
| Management And General | $969,385 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,962 | TotalAmt |
| Program Services | $51,305 | ProgramServicesAmt |
| Management And General | $10,657 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,372,679 | TotalAmt |
| Program Services | $1,136,578 | ProgramServicesAmt |
| Management And General | $236,101 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,336,659 | TotalAmt |
| Program Services | $1,106,754 | ProgramServicesAmt |
| Management And General | $229,905 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,156 | TotalAmt |
| Program Services | $66,369 | ProgramServicesAmt |
| Management And General | $13,787 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $468,961 | TotalAmt |
| Management And General | $468,961 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,774,864 | TotalAmt |
| Program Services | $1,469,587 | ProgramServicesAmt |
| Management And General | $305,277 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $837,451 | TotalAmt |
| Program Services | $693,409 | ProgramServicesAmt |
| Management And General | $144,042 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical supplies | $8,117,256 | $8,117,256 | |
| Bad Debt Expense | $5,959,757 | $5,959,757 | |
| Repairs and maintenance | $1,313,790 | $1,087,818 | $225,972 |
| Provider tax | $1,135,803 | $1,135,803 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,466,277 | TotalAmt |
| Program Services | $1,314,125 | ProgramServicesAmt |
| Management And General | $152,152 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,745,933 | TotalAmt |
| Program Services | $51,381,500 | ProgramServicesAmt |
| Management And General | $8,364,433 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,048 | BOYAmt |
| EOY | $2,045 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $711,399 | BOYAmt |
| EOY | $555,051 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,201,257 | BOYAmt |
| EOY | $5,481,992 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $211,000 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,433,454 | BOYAmt |
| EOY | $1,777,429 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $361,897 | BOYAmt |
| EOY | $303,991 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $46,039,438 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $32,406,736 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,032,654 | BOYAmt |
| EOY | $13,632,702 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $231,419 | BOYAmt |
| EOY | $3,683,829 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,974,128 | BOYAmt |
| EOY | $25,648,039 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,507,055 | BOYAmt |
| EOY | $10,704,562 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,025,844 | BOYAmt |
| EOY | $9,637,290 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $691,691 | BOYAmt |
| EOY | $501,673 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,224,590 | BOYAmt |
| EOY | $20,843,525 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,740,971 | BOYAmt |
| EOY | $4,794,700 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,567 | BOYAmt |
| EOY | $9,814 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,749,538 | BOYAmt |
| EOY | $4,804,514 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,974,128 | BOYAmt |
| EOY | $25,648,039 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$945,024 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $2,414 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $2,414 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | The organization pays membership fees to the American Hospital Association and WV American Hospital Association, which participates in lobbying activities. The amount reported above represents the portion of the dues allocated for lobbying by the Associations. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $288,184 | OtherCostOrOtherBasisAmt |
| Book Value | $288,184 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $22,164,207 | OtherCostOrOtherBasisAmt |
| Depreciation | $12,127,228 | DepreciationAmt |
| Book Value | $10,036,979 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $21,662,848 | OtherCostOrOtherBasisAmt |
| Depreciation | $19,468,159 | DepreciationAmt |
| Book Value | $2,194,689 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,924,199 | OtherCostOrOtherBasisAmt |
| Depreciation | $811,349 | DepreciationAmt |
| Book Value | $1,112,850 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $13,632,702 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Third party payor settlements | $3,632,691 |
| Flex spending | $14,227 |
| Other receivables | $36,911 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $3,683,829 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Capital leases | Desc |
| Amt | $501,673 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $501,673 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $52,394,167 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $40,511 | OtherRevenueAmt |
| Revenue Not Reported | $40,511 | RevenueNotReportedAmt |
| Revenue Subtotal | $52,353,656 | RevenueSubtotalAmt |
| Other Revenues Not Included | $6,447,253 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $6,447,253 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $58,800,909 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $53,339,191 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $40,511 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $40,511 | ExpensesNotReportedAmt |
| Expenses Subtotal | $53,298,680 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $6,447,253 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $6,447,253 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $59,745,933 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part XI, Line 2d - Other Adjustments: | Rental expenses netted with income on form 990 40,511. |
| Part XI, Line 4b - Other Adjustments: | Bad debt expense netted with income on fin. stmts. 5,959,757. Charity care expense netted with income on fin. stmts. 487,496. |
| Part XII, Line 2d - Other Adjustments: | Rental expenses netted with income on form 990 40,511. |
| Part XII, Line 4b - Other Adjustments: | Bad debt expense netted with income on fin. stmts. 5,959,757. Charity care expense netted with income on fin. stmts. 487,496. |
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 |
| Percent200 | Yes (X) | Percent200Ind |
| 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 | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $206,858 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $206,858 | DirectOffsettingRevenueAmt |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,545,335 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $20,282,179 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $263,156 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00490 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,752,193 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $20,489,037 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $263,156 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00490 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,752,193 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $20,489,037 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $263,156 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00490 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $5,959,757 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $11,520,224 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $11,575,136 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$54,912 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| 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 | Summersville Regional Medical Center | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 Fairview Heights Road | AddressLine1Txt |
| City | Summersville | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26651 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | Long-term nursing care | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Summersville Regional Medical Center | 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 | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Part V page 8 for URL | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Part V, page 8 for URL | 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 | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| 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 | See Part V, Page 8 for URL | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | See Part V, Page 8 for URL | FAPAppAvailableOnWebsiteURLTxt |
| 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 (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Summersville Regional Medical Center | Part V, Section B, Line 5: Input for completion of the CHNA was obtained from public health officials;local health departments and agencies; publically elected officials; religious officials; long-term care and work shelter executives; and representatives of or members of chronic disease groups or organizations. |
| Summersville Regional Medical Center | Part V, Section B, Line 11: Financial constraints prevent the Hospital from addressing all needs. |
| Part V, Section B, Line 7a | URL for CHNA:http://summersvilleregional.org/wp-content/uploads/2017/08/community-needs-assessment-2015_201512221209.pdf |
| Part V, Section B, Line 10a | URL for Implementation Strategy:http://summersvilleregional.org/wp-content/uploads/2017/08/community-needs-assessment-2015_201512221209.pdf |
| Part V, Section B, Line 16a | URL for FAP:http://summersvilleregional.org/wp-content/uploads/2017/10/FAP-Policy-Revised-2017.pdf |
| Part V, Section B, Line 16b | URL for FAP Application:http://summersvilleregional.org/wp-content/uploads/2017/10/FAP-App-2017.pdf |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 - Summersville Rural Health Clinic | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 Fairview Heights Road | AddressLine1Txt |
| City | Summersville | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26651 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | Rural Health Clinic | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | Charity care at cost and unreimbursed Medicaid are computed using the cost to charge ratio method in Worksheet 2 of the Schedule H instructions. |
| Part I, Line 7, Column (f): | The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 5,959,757. |
| Part III, Line 2: | Bad debt expense as reported on the audited financial statements. |
| Part III, Line 4: | Patient accounts receivable are carried at the original charge less an estimate made for doubtful or uncollectible accounts. The allowance is based upon a review of the outstanding balances aged by financial class. Management uses collection percentages based upon historical collection experience to determine collectability. Management also reviews troubled, aged accounts to determine collection potential. Patient accounts receivable are written off when deemed uncollectible. Recoveries of accounts previously written off are recorded as a reduction to bad debt expense when received. Interest is not charged on patient accounts receivable. |
| Part III, Line 8: | The organization used the Medicare cost report information for revenues and expenses. The organization does not consider this to be a community benefit expense due to fluctuations in reimbursements related to Medicare audits. |
| Part VI, Line 2: | To assess the health care needs of the community served, the hospital conducts a Community Health Needs Assessment every 3 years. The data obtained from the research is then utilized to implement a strategy to provide additional services and/or improve current services to better serve the needs of the community. |
| Part VI, Line 3: | To educate patients regarding the financial assistance available, the hospital provides a copy of the financial assistance application and policy on their website. |
| Part VI, Line 4: | We are a small rural hospital which is surrounded by Critical Access hospitals and also the only remaining hospital in Nicholas County as the other hospital closed in bankruptcy in 2008. We have a group of volunteers who are able to gain charitable support in order to encourage charitable donations by providing activities throughout our facility and through the State of West Virginia NIPS program that were not previously available to our community. As of 2015, the population of Nicholas county is estimated to be 25,979. The estimated median household income in 2015 is $41,753 versus a median of $43,153 for the whole state of West Virginia. An estimated 19.2% of residents lived below the poverty level in 2009 while 7.7% were estimated to live below 50% of the poverty level. |
| Part VI, Line 5: | The Hospital operates three primary care clinics, two of which are located in Richwood, West Virginia and Ansted, West Virginia. Both Richwood and Ansted are located in very rural areas with very small populations. During 2015, both of these clinics lost a total of approximately $750,000.The Hospital also provides obstetrical and gynecology services to patients of Summersville, West Virginia and the surrounding areas. The vast majority of the patients qualify for Medicaid {70%), and a large percentage of the babies born in the unit have health problems such as drug addiction. During 2015, the Hospital lost approximately $1.0 million operating this program. As you can tell, these are very high risks pregnancies with women with very low income and limited ability to travel to larger cities to receive these services.The Hospital provides 24/7 emergency room services to the patients residing in the Hospital's service area. Due to the low number of patients being served, and the payor mix of the patients the Hospital does treat, the Hospital has to provide a subsidy to the physician group who staffs the emergency room. During FY 2015, the Hospital's emergency room physician cost was approximately $1,350,000. Even though the Affordable Care Act was supposed to encourage Medicaid patients to primary care clinics, this has not been as successful as the industry had hoped. Consequently, the Emergency Room still treats a large number of Medicaid patients.Our Board of Directors all reside in our primary care area of Nicholas County, West Virginia. The Board is comprised of small business, union, low income, members at large, medical staff director, and mayor of the City of Summersville. Board members are not employees, contractors of the organization nor family members. We extend medical staff privileges to all qualified physicians in our community or providers who have a visiting clinic in our community. Any surplus funds are reinvested back into the organization through capital expenditure projects, or payment on existing debt, which has been secured on a tax-free basis. Our emergency room is available to all clients regardless of ability to pay. |
| Part VI, Line 6: | The organization is not part of a health care system. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Bandy Mullins MD | ||||||||||||||
| Trustee/Chief of Staff | $404,551 | $0 | $351,679 | $0 | $0 | $0 | $21,975 | $0 | $20,812 | $0 | $799,017 | $0 | $0 | $0 |
| Daniel Ayers | ||||||||||||||
| CEO (termed 9/9/2016) | $213,238 | $0 | $0 | $0 | $0 | $0 | $3,000 | $0 | $7,425 | $0 | $223,663 | $0 | $0 | $0 |
| Benjamin Hensley DO | ||||||||||||||
| Physician | $374,774 | $0 | $292,492 | $0 | $0 | $0 | $21,975 | $0 | $20,813 | $0 | $710,054 | $0 | $0 | $0 |
| Stanley Morris MD | ||||||||||||||
| Physician | $365,371 | $0 | $67,538 | $0 | $0 | $0 | $20,800 | $0 | $20,813 | $0 | $474,522 | $0 | $0 | $0 |
| Michael Taylor MD | ||||||||||||||
| Physician | $169,769 | $0 | $226,827 | $0 | $0 | $0 | $27,975 | $0 | $14,516 | $0 | $439,087 | $0 | $0 | $0 |
| Lukasz Rostocki MD | ||||||||||||||
| Physician | $296,682 | $0 | $87,210 | $0 | $0 | $0 | $27,975 | $0 | $20,813 | $0 | $432,680 | $0 | $0 | $0 |
| Jonathan Dale MD | ||||||||||||||
| Physician | $337,541 | $0 | $25,000 | $0 | $0 | $0 | $21,975 | $0 | $20,813 | $0 | $405,329 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 3 | FormAndLineReferenceDesc |
| Explanation | The Interim CEO is an employee of the management company contracted to provide consulting services to the Hospital. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|
| City of Summersville Building Commission | |||||||
| A | 550716940 | 2006-09-29 | $7,750,000 | Debt refunding and hospital improvements | 0 | 0 | 0 |
| City of Summersville Building Commission | |||||||
| B | 550716940 | 2008-03-03 | $5,000,000 | Hospital facilities | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Working Capital ExpendituresWorkingCapitalExpendituresAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|---|
| A | $2,203,112 | $7,750,000 | $3,843,860 | $3,906,140 | 2007 | 0 | Yes (1) | Yes (1) | Yes (1) |
| B | $860,794 | $5,000,000 | $5,000,000 | 2009 | 0 | 0 | Yes (1) | Yes (1) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
| B | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 3 | The Hospital entered into an agreement with Quorum Health Resources, LLC (QHR)to provide consulting services and an Interim CEO and CFO for the hospital. The CEO and CFO are employees of QHR. |
| Form 990, Part VI, Section B, line 11b | The board reviews and approves the 990 form before it is filed with the IRS. If this cannot be accomplished at a regularly scheduled meeting, a special meeting will be held to uphold this board action. |
| Form 990, Part VI, Section B, line 12c | Conflict of interest statements require a board member with a conflict to excuse themselves from the discussion and boardroom if a matter of discussion and voting would be a conflict of interest with them individually. Statements completed by other board members are reviewed by the Chairman. The vice-chairman reviews the chairman's conflict of interest statement. |
| Form 990, Part VI, Section C, line 19 | Governing documents, conflict of interest policy and financial statements are available upon request by persons. They are not posted on the website at the present time. This has been discussed in public session of the board meetings. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Summersville Building Commission | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 Fairview Heights Road | AddressLine1Txt |
| City | Summersville | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26651 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550716940 | EIN |
| Primary Activities | Building Commission | PrimaryActivitiesTxt |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 6 | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| 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 | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |