BELMONT COMMUNITY HOSPITAL INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- BELMONT COMMUNITY HOSPITAL INC (EIN 34-0714643)
- Tax period
- 2015-10-01 to 2016-09-30
- Filed
- 2017-08-11
- IRS object ID
- 201722239349300527
- Schema version
- 2015v3.0
- 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 F
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-08-11T10:39:19-05:00 | ReturnTs |
| Tax Period End | 2016-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 550526247 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILSON KOZICKI & GWYNN PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 32 TWENTIETH STREET SUITE 300 | AddressLine1Txt |
| City | WHEELING | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26003 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 340714643 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELMONT COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BELM | BusinessNameControlTxt |
| Phone | 7406711200 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4697 HARRISON STREET | AddressLine1Txt |
| City | BELLAIRE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43906 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JAMES B MURDY | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3042433681 | PhoneNum |
| Signature | 2017-08-01 | SignatureDt |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DENNIS A KOZICKI | PreparerPersonNm |
| PTIN | P00366642 | PTIN |
| Phone | 3042322280 | PhoneNum |
| Preparation | 2017-08-01 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JAMES B MURDY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 MEDICAL PARK | AddressLine1Txt |
| City | WHEELING | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26003 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $24,213,715 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.WHEELINGHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1903 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE NEEDED CARE TO THE COMMUNITY REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 6 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 226 | TotalEmployeeCnt |
| Total Volunteers | 9 | TotalVolunteersCnt |
| Total Gross UBI | $3,156,131 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $84 | PYContributionsGrantsAmt |
| CY Contributions Grants | $459,922 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $19,874,491 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $19,911,269 | CYProgramServiceRevenueAmt |
| PY Investment Income | $108,435 | PYInvestmentIncomeAmt |
| CY Investment Income | $88,298 | CYInvestmentIncomeAmt |
| PY Other Revenue | $3,954,128 | PYOtherRevenueAmt |
| CY Other Revenue | $3,680,860 | CYOtherRevenueAmt |
| PY Total Revenue | $23,937,138 | PYTotalRevenueAmt |
| CY Total Revenue | $24,140,349 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $10,768,816 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $11,352,781 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $15,437,888 | PYOtherExpensesAmt |
| CY Other Expenses | $14,909,618 | CYOtherExpensesAmt |
| PY Total Expenses | $26,206,704 | PYTotalExpensesAmt |
| CY Total Expenses | $26,262,399 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$2,269,566 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,122,050 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $11,187,441 | TotalAssetsBOYAmt |
| Total Assets EOY | $13,465,105 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,338,870 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,753,047 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,848,571 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $6,712,058 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | BELMONT COMMUNITY HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE TO PATIENTS FROM BELMONT COUNTY AND SURROUNDING COMMUNITIES REGARDLESS OF RACE, CREED, SEX, SEXUAL ORIENTATION, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATIONS AND STABILITY OF THE HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PAY FOR ESSENTIAL MEDICAL SERVICES, AND OUR MISSION IS TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTHCARE EDUCATION. THEREFORE, IN KEEPING WITH BELMONT COMMUNITY HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF ITS COMMUNITY, FREE CARE OR SUBSIDIZED CARE, CARE PROVIDED TO PERSONS COVERED BY GOVERNMENT PROGRAMS AT OR BELOW COST, AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR INDIVIDUAL'S INABILITY TO PAY COEXIST. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $24,852,044 | ExpenseAmt |
| Revenue | $19,911,269 | RevenueAmt |
| Desc | BELMONT COMMUNITY HOSPITAL SERVED 602 INPATIENTS AND 87,078 OUTPATIENTS DURING THE PERIOD OCTOBER 1, 2015 THROUGH SEPTEMBER 30, 2016. | Desc |
| Total Program Service Expenses | $24,852,044 | 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 | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | Yes (1) | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | Yes (1) | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 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 | 36 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 226 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| 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 |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 6 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | 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 | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAMES B MURDY CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3042433681 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE MEDICAL PARK | AddressLine1Txt |
| City | WHEELING | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26003 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| ROBERT A BITTENGLE | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| NELLIE T MAGYAR | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| JEFFREY A PATEY | |||||||||
| TRUSTEE/CHIEF OF STAFF | 41.00 | Yes (X) | $0 | $235,707 | $21,415 | ||||
| BRUCE A ARCHER | |||||||||
| TRUSTEE | 1.00 | Yes (X) | $0 | $131,836 | $32,863 | 40.00 | |||
| C GARY HILL | |||||||||
| PRESIDENT | 1.00 | $0 | $0 | $0 | Yes (X) | ||||
| RICHARD M POLINSKY | |||||||||
| SECRETARY/TREASURER | 1.00 | $0 | $0 | $0 | Yes (X) | ||||
| JAMES B MURDY | |||||||||
| CHIEF FINANCIAL OFFICER | 4.00 | $0 | $304,112 | $46,291 | 56.00 | Yes (X) | |||
| JOHN DEBLASIS | |||||||||
| ADMINISTRATOR | 30.00 | $0 | $168,039 | $21,057 | 30.00 | Yes (X) | |||
| MARWAN YANES | |||||||||
| PHYSICIAN | 40.00 | $218,703 | $0 | $10,452 | Yes (X) | ||||
| SHASHI GUPTA | |||||||||
| PHYSICIAN | 40.00 | $241,602 | $0 | $23,420 | Yes (X) | ||||
| DANIEL B JONES | |||||||||
| PHYSICIAN | 40.00 | $326,711 | $0 | $22,364 | Yes (X) | ||||
| GEORGE CHOLAK | |||||||||
| PHYSICIAN | 40.00 | $281,927 | $0 | $1,612 | Yes (X) | ||||
| MAHESHWAR MUSUNURI | |||||||||
| PHYSICIAN | 40.00 | $266,587 | $0 | $28,360 | Yes (X) | ||||
| CHAGANLAL N PATEL | |||||||||
| FORMER TRUSTEE/ FORMER CHIEF OF STAFF | 41.00 | $175,354 | $0 | $22,110 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,510,884 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $839,694 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $229,944 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 14 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEREK H ANDREINI MD | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4697 HARRISON STREET | AddressLine1Txt |
| City | BELLAIRE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43906 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | PHYSICIAN SERVICES | ServicesDesc |
| Compensation | $206,250 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $459,922 | GovernmentGrantsAmt |
| Total Contributions | $459,922 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| GROSS PATIENT REVENUE | 623990 | $53,407,540 | $53,407,540 |
| CHARITY CARE | 623990 | -$553,567 | -$553,567 |
| BAD DEBT | 623990 | -$772,971 | -$772,971 |
| CONTRACTUAL ALLOWANCE | 623990 | -$32,169,733 | -$32,169,733 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $19,911,269 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $91,776 | TotalRevenueColumnAmt |
| Exclusion | $91,776 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $147,677 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $62,196 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $85,481 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $85,481 | TotalRevenueColumnAmt |
| Exclusion | $85,481 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $7,692 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $11,170 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$3,478 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$3,478 | TotalRevenueColumnAmt |
| Exclusion | -$3,478 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| OUTPATIENT PHARMACY | 446110 | $3,156,131 | $3,156,131 | |
| OTHER | 624210 | $387,831 | $387,831 | |
| CONVENIENCE | 900099 | $51,417 | $51,417 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $3,595,379 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $24,140,349 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $19,911,269 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $3,156,131 | UnrelatedBusinessRevenueAmt |
| Exclusion | $613,027 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,630,116 | TotalAmt |
| Program Services | $9,572,739 | ProgramServicesAmt |
| Management And General | $57,377 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,742 | TotalAmt |
| Program Services | $30,604 | ProgramServicesAmt |
| Management And General | $138 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,039,195 | TotalAmt |
| Program Services | $1,034,521 | ProgramServicesAmt |
| Management And General | $4,674 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $652,728 | TotalAmt |
| Program Services | $648,820 | ProgramServicesAmt |
| Management And General | $3,908 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $102,481 | TotalAmt |
| Management And General | $102,481 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,592 | TotalAmt |
| Management And General | $62,592 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $673 | TotalAmt |
| Management And General | $673 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,107,206 | TotalAmt |
| Program Services | $5,087,217 | ProgramServicesAmt |
| Management And General | $19,989 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $116,576 | TotalAmt |
| Management And General | $116,576 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,057,440 | TotalAmt |
| Program Services | $1,057,440 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,398 | TotalAmt |
| Program Services | $5,847 | ProgramServicesAmt |
| Management And General | $13,551 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,996 | TotalAmt |
| Program Services | $31,996 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $837,011 | TotalAmt |
| Program Services | $837,011 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $540,190 | TotalAmt |
| Program Services | $540,190 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PURCHASED SERVICES | $6,087,316 | $5,282,325 | $804,991 |
| OTHER EXPENSES | $620,356 | $417,894 | $202,462 |
| MEDICAL SERVICES | $259,800 | $259,800 | |
| DUES, BOOKS, SUBSCRIPTI | $66,583 | $45,640 | $20,943 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,262,399 | TotalAmt |
| Program Services | $24,852,044 | ProgramServicesAmt |
| Management And General | $1,410,355 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $505,548 | BOYAmt |
| EOY | $646,642 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $104,572 | BOYAmt |
| EOY | $105,098 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,978,688 | BOYAmt |
| EOY | $2,453,924 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $775,605 | BOYAmt |
| EOY | $708,317 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $608,769 | BOYAmt |
| EOY | $598,678 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $23,160,565 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $18,656,178 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,936,256 | BOYAmt |
| EOY | $4,504,387 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,526,081 | BOYAmt |
| EOY | $3,211,619 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $751,922 | BOYAmt |
| EOY | $1,236,440 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,187,441 | BOYAmt |
| EOY | $13,465,105 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,216,971 | BOYAmt |
| EOY | $6,645,468 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $121,899 | BOYAmt |
| EOY | $107,579 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,338,870 | BOYAmt |
| EOY | $6,753,047 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,317,190 | BOYAmt |
| EOY | $3,495,139 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $67,597 | BOYAmt |
| EOY | $68,038 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,463,784 | BOYAmt |
| EOY | $3,148,881 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,848,571 | BOYAmt |
| EOY | $6,712,058 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,187,441 | BOYAmt |
| EOY | $13,465,105 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$2,122,050 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $3,985,537 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule 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 | $673 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $673 | 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 | BELMONT COMMUNITY HOSPITAL IS A MEMBER OF THE OHIO HOSPITAL ASSOCIATION AND PAYS ANNUAL DUES. FOR 2016, THE PERCENTAGE OF OHA DUES RELATED TO LOBBYING ACTIVITIES IS 3.5%. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,463,784 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $685,097 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $0 | AdministrativeExpensesAmt |
| End Year Balance | $3,148,881 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,973,170 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $490,614 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $2,463,784 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,532,203 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $512,811 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $71,844 | OtherExpendituresAmt |
| End Year Balance | $1,973,170 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,603,404 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$16,205 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $54,996 | OtherExpendituresAmt |
| End Year Balance | $1,532,203 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,080,422 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $578,017 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $55,035 | OtherExpendituresAmt |
| End Year Balance | $1,603,404 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $274,164 | OtherCostOrOtherBasisAmt |
| Book Value | $274,164 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,510,593 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,051,338 | DepreciationAmt |
| Book Value | $1,459,255 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,804,725 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,214,286 | DepreciationAmt |
| Book Value | $2,590,439 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $571,083 | OtherCostOrOtherBasisAmt |
| Depreciation | $390,554 | DepreciationAmt |
| Book Value | $180,529 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,504,387 | TotalBookValueLandBuildingsAmt |
Invst Program Related Org InvstProgramRelatedOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| DORIS C NARDELLA TRUST | $62,738 | F |
| MELLOTT TRUST | $3,148,881 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Program Rltd | $3,211,619 | TotalBookValueProgramRltdAmt |
Other Assets Org OtherAssetsOrgGrp (7 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| MELLOTT TRUST RECEIVABLE | $15,539 |
| OTHER RECEIVABLE | $7,007 |
| AMOUNTS DUE 3RD PARTY PAYORS | $924,996 |
| ACUITY RECEIVABLE | $279,305 |
| WHEELING HOSPITAL PHYSICIAN RENT RECEIVABLE | $15 |
| CAPTURE RX RECEIVABLE | $9,003 |
| A/R GIFT SHOP EMPLOYEE SALES | $575 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,236,440 | TotalBookValueOtherAssetsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part V, Line 4: | FormAndLineReferenceDesc |
| Explanation | THE INCOME FROM THE ENDOWMENT FUND MUST BE USED FOR THE UPKEEP AND MAINTENANCE OF THE HOSPITAL. | ExplanationTxt |
Schedule F IRS990ScheduleF
Account Activities Outside US AccountActivitiesOutsideUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Region | Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, | RegionTxt |
| Offices | 0 | OfficesCnt |
| Employee | 1 | EmployeeCnt |
| Type Of Activities Conducted | PROGRAM SERVICES | TypeOfActivitiesConductedTxt |
| Specific Services Provided | CAPTIVE INSURANCE COMPANY | SpecificServicesProvidedTxt |
| Region Total Expenditures | $356,243 | RegionTotalExpendituresAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Offices | 0 | SubtotalOfficesCnt |
| Subtotal Employees | 1 | SubtotalEmployeesCnt |
| Continutation Total Office | 0 | ContinutationTotalOfficeCnt |
| Continutation Total Employee | 0 | ContinutationTotalEmployeeCnt |
| Total Office | 0 | TotalOfficeCnt |
| Total Employee | 1 | TotalEmployeeCnt |
| Subtotal Spent | $356,243 | SubtotalSpentAmt |
| Continuation Spent | $0 | ContinuationSpentAmt |
| Total Spent | $356,243 | TotalSpentAmt |
| Transfer To Foreign Corp | 0 | TransferToForeignCorpInd |
| Interest In Foreign Trust | 0 | InterestInForeignTrustInd |
| Foreign Corp Ownership | 0 | ForeignCorpOwnershipInd |
| Passive Foreign Investmest Co | 0 | PassiveForeignInvestmestCoInd |
| Foreign Partnership | 0 | ForeignPartnershipInd |
| Boycott Countries | 0 | BoycottCountriesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, line 3: | FormAndLineReferenceDesc |
| Explanation | ACCRUAL | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| 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 | $156,529 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $156,529 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00600 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,105,274 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,758,271 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,347,003 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08940 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,261,803 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,758,271 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,503,532 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09540 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,100 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,100 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,100 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,100 | NetCommunityBenefitExpnsAmt |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,262,903 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,758,271 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,504,632 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09540 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $315,990 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $2,213 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,294,610 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $4,440,418 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,145,808 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELMONT COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4697 HARRISON STREET | AddressLine1Txt |
| City | BELLAIRE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43906 | 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 |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELMONT COMMUNITY HOSPITAL | 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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| 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 | WWW.WHEELINGHOSPITAL.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | 0 | StrategyPostedWebsiteInd |
| Strategy Attached | Yes (1) | StrategyAttachedInd |
| 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 |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| 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 |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.WHEELINGHOSPITAL.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.WHEELINGHOSPITAL.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.WHEELINGHOSPITAL.ORG | 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 Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| BELMONT COMMUNITY HOSPITAL | Part V, Section B, Line 5: INTERVIEWS WERE CONDUCTED OVER A THREE DAY PERIOD IN LATE AUGUST AND THE BEGINNING OF SEPTEMBER 2016 WITH SELECTED STAKEHOLDERS FROM THE WHEELING SERVICE AREA TO DISCUSS THE COMMUNITY HEALTH NEEDS IN THE WHEELING SERVICE AREA. THE FOLLOWING IDEAS WERE DISCUSSED:-POPULATION AND ECONOMIC TRENDS IN BOTH THE PRIMARY AND SECONDARY SERVICE AREAS AND FUTURE EXPECTATIONS-CURRENT PERCEPTIONS ABOUT OVERALL HEALTH CARE IN THE SERVICE AREA INCLUDING WHEELING HOSPITAL'S HEALTH CARE-WHEELING HOSPITAL'S CURRENT OPERATIONS AND THE EXTENT TO WHICH THESE SERVICES ARE MEETING COMMUNITY NEEDS-THE QUALITY AND ACCESS OF PRIMARY CARE SERVICES, EMERGENCY SERVICES, INPATIENT SERVICES, LONG TERM CARE SERVICES AND PUBLIC HEALTH SERVICES IN THE SERVICE AREA-WHEELING HOSPITAL'S POSSIBLE ROLES FOR MEETING FUTURE HEALTH CARE NEEDS FOR COMMUNITY HEALTH SERVICES-POTENTIAL FOR SUCCESS IN EXPANDING SERVICES AT WHEELING HOSPITAL AND THE CHALLENGES FACED IN EXPANDING SERVICES IN THE AREAA VARIETY OF VARIOUS COMMUNITY REPRESENTATIVES WERE INTERVIEWED, INCLUDING THE DIRECTOR OF NURSING FROM BELMONT COMMUNITY HOSPITAL, THE WHEELING HOSPITAL DIRECTOR OF FAMILY MEDICINE, THE WHEELING HEALTH DEPARTMENT'S DEPUTY HEALTH COMMISSIONER, A LOCAL CATHOLIC CHARITIES' REPRESENTATIVE, AND THE ADMINISTRATOR OF BISHOP J. HODGES CONTINUOUS CARE CENTER. THESE INDIVIDUALS WERE CHOSEN BECAUSE THEY PROVIDED A RANGE OF PERSPECTIVES ON THE STATE OF THE COMMUNITY AND HEALTH CARE, AS WELL AS PROVIDING DIVERSIFIED BACKGROUNDS. ADDITIONALLY, A MONTH LONG ONLINE SURVEY WAS CONDUCTED BY THE HOSPITAL IN ORDER TO GATHER INFORMATION FROM RECENT PATIENTS AND/OR THEIR FAMILY MEMBERS. THEY WERE ASKED TO RATE THEIR EXPERIENCE AS WELL AS COMMENT ON EXISTING OR NEEDED SERVICES. |
| BELMONT COMMUNITY HOSPITAL | Part V, Section B, Line 11: SEE ATTACHED "BELMONT HOSPITAL CHNA IMPLEMENTATION PLAN" FOR ADDITIONAL DETAILS ON HOW THE HOSPITAL IS ADDRESSING THE NEEDS IDENTIFIED IN THE CHNA.PART V, SECTION B, LINE 16G:IN ADDITION TO PROVIDING THE FULL FAP UPON REQUEST, A SUMMARY IS POSTED IN THE HOSPITAL FACILITY'S EMERGENCY ROOMS AND WAITING ROOMS. ALSO, SIGNAGE AND LITERATURE HAS BEEN DEPLOYED IN POINTS OF THE FACILITY, AND IN PHYSICIAN OFFICES, TO EDUCATE PATIENTS ABOUT THE FAP PROGRAM. |
| BELMONT COMMUNITY HOSPITAL | Part V, Section B, Line 22d: THE HOSPITAL CHARGES THE SAME TO EVERY PATIENT REGARDLESS OF FINANCIAL CLASS. BELMONT COMMUNITY HOSPITAL UTILIZES THE "LOOK-BACK METHOD" TO DETERMINE THE AMOUNTS GENERALLY BILLED (AGB) TO DETERMINE THE CHARGES BILLED TO PATIENTS THAT QUALIFY FOR PARTICIPATION IN THE FINANCIAL ASSISTANCE PROGRAM. INPATIENT AND OUTPATIENT SERVICES WERE CALCULATED SEPARATELY. THE PERCENTAGES WERE DETERMINED BY UTILIZING THE CALCULATION OF THE SUM OF ALL CLAIMS PAID BY MEDICARE FEE FOR SERVICE AND ALL PRIVATE HEALTH INSURERS DIVIDED BY THE SUM OF THE GROSS CHARGES FOR THESE CLAIMS. INPATIENT SERVICE PERCENTAGE IS 65%. OUTPATIENT SERVICE PERCENTAGE IS 54%. |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | THE RATIO FROM WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS WAS USED. |
| Part I, Ln 7 Col(f): | NO BAD DEBT EXPENSE WAS INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), AS BAD DEBT WAS REPORTED AS A REDUCTION TO NET PATIENT SERVICE REVENUE. |
| Part III, Line 4: | THE PERCENTAGE FROM WORKSHEET 2 WAS USED TO CALCULATE THE AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE AT COST REFLECTED ON LINE 2. THIS RATIO WAS APPLIED TO THE TOTAL BAD DEBT EXPENSE (BAD DEBT WRITE OFF) INCLUDED IN NET PATIENT SERVICES REVENUE. DISCOUNTS TO PATIENT ACCOUNTS ARE RECORDED AS CONTRACTUAL WRITE-OFF'S AND NOT AS BAD DEBT. THEREFORE, THE CALCULATED BAD DEBT EXPENSE DOES NOT INCLUDE ANY PORTION OF PATIENT'S CHARGES THAT WERE DISCOUNTED. THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE THAT COULD REASONABLY BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICY WAS CALCULATED BY APPLYING THE PERCENTAGE OF CHARITY TO GROSS PATIENT REVENUE TO THE TOTAL BAD DEBT EXPENSE AT COST.BELMONT COMMUNITY HOSPITAL DOES NOT HAVE SEPARATE AUDITED FINANCIAL STATEMENTS SO THERE IS NO TEXT OF THE BAD DEBT EXPENSE FOOTNOTE TO PROVIDE. THE BAD DEBT REFLECTED ON THE FINANCIAL STATEMENTS IS THE GROSS AMOUNT OF THE ACCOUNTS DEEMED UNCOLLECTIBLE. THIS WOULD BE FOR ACCOUNTS THAT HAVE HAD NO PAYMENT FOR 60 DAYS AND HAVE HAD A MINIMUM OF STATEMENTS PRODUCED. THEREFORE, THE BAD DEBT AMOUNTS WOULD BE AFTER ANY DISCOUNTS OR PATIENT PAYMENTS HAVE BEEN APPLIED. THE PROVISION FOR BAD DEBTS, WHICH RELATES ENTIRELY TO COMMERCIAL, OTHER AND SELF-PAY PAYERS, IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE WRITE-OFF EXPERIENCE BY PAYER. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE PROVISION FOR BAD DEBTS AS A PERCENTAGE OF NET PATIENT REVENUES WAS 2.96% AND 2.88% FOR THE YEARS ENDED SEPTEMBER 30, 2016 AND 2015, RESPECTIVELY.PROVISIONS FOR BAD DEBT FOR 2016 AND 2015 WERE $10,408,036 AND $9,338,354, RESPECTIVELY. |
| Part III, Line 8: | THE COSTS REFLECTED IN LINE 6 ARE THE ALLOWABLE INPATIENT COSTS FROM WORKSHEET D-1 AND ALLOWABLE OUTPATIENT COSTS FROM D, PART V OF THE 12/31/15 CMS COST REPORT. THIS REPORT WAS USED AS BELMONT COMMUNITY HOSPITAL'S COST REPORT IS FILED ON A CALENDAR YEAR BASIS, AND 12/31/15 CMS COST REPORT IS THE CALENDAR YEAR FILING THAT WOULD FALL IN THE FISCAL YEAR REPORTED ON FORM 990. NONE OF THE SHORTFALL ON LINE 7 IS TREATED AS COMMUNITY BENEFIT. DESPITE THE FACT THAT THE PROGRAM SERVES ALL ELDERLY AND DISABLED BENEFICIARIES AND COULD REPRESENT COMMUNITY BENEFIT, IT IS NOT TREATED AS COMMUNITY BENEFIT TO BE CONSISTENT WITH THE PRESENTATION OF THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS. |
| Part III, Line 9b: | BELMONT COMMUNITY HOSPITAL'S COLLECTION POLICY HAS BEEN ESTABLISHED TO DEFRAY THE COSTS OF MEDICALLY NECESSARY SERVICES FOR THOSE PATIENTS WHO MEET CERTAIN GUIDELINES AND HAVE NO OTHER MEDICAL FUNDING SOURCES. INPATIENT, OUTPATIENT, EMERGENCY ROOM SERVICES, PROFESSIONAL SERVICES OF EMPLOYED PHYSICIANS AND PRESCRIPTION DRUGS ON AN ACUTE/EMERGENT BASIS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE/CHARITY CARE. THE FINANCIAL ASSISTANCE/CHARITY CARE APPLICATION MUST BE SIGNED BYTHE APPLICANT ATTESTING TO THE TRUTHFULNESS AND ACCURACY OF THE INFORMATION PROVIDED. CERTAIN DENIAL LETTERS ARE REQUIRED IN ORDER TO BE ELIGIBLE FOR CHARITY CARE. ELIGIBILITY IS DETERMINED BY REFERENCING THE FINANCIAL ASSISTANCE/CHARITY CARE MATRIX, WHICH IS BASED ON THE FEDERAL POVERTY GUIDELINES FOR THE MOST CURRENT YEAR AVAILABLE. THOSE APPROVED APPLICANTS WHO ARE AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES AND HAVE PROVIDED THE REQUIRED DOCUMENTATION ARE ELIGIBLE TO RECEIVE CHARITY CARE, AND THOSE WHO ARE FROM 201% TO 400% OF THOSE LIMITS ARE ELIGIBILE FOR DISCOUNTS. IN REGARDS TO COLLECTION PRACTICES FOR PATIENTS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE (I.E. "CHARITY FOR A PORTION OF THEIR BILL") FROM THE HOSPITAL: THE HOSPITAL'S BILLING AND COLLECTION POLICIES NOTE THAT HOSPITAL PERSONNEL ARE TO OBTAIN THE DETAILS OF EACH PATIENT'S FINANCIAL SITUATION AND ASSIST EACH PATIENT BY PROVIDING THEM WITH THE VARIOUS SETTLEMENT OPTIONS THAT THE HOSPITAL MAKES AVAILABLE. FOR PATIENTS WHO ARE FAP-ELIGIBLE FOR A PORTION OF THEIR BILL, THIS GENERALLY MEANS THAT A PATIENT FINANCIAL COUNSELOR WILL ARRANGE A PAYMENT PLAN THAT IS MANAGEABLE FOR THE PATIENT. |
| Part VI, Line 2: | BELMONT COMMUNITY HOSPITAL ENGAGED ARNETT CARBIS TOOTHMAN TO PERFORM A FORMAL NEEDS ASSESSMENT TO ASSESS THE HEALTH CARE NEEDS FOR THE COMMUNITY THAT IT SERVES. THIS ASSESSMENT WAS COMPLETED AND DATED SEPTEMBER 2016. AN IMPLEMENTATION PLAN WILL BE ESTABLISHED BY BELMONT COMMUNITY IN RESPONSE TO THE CHNA. |
| Part VI, Line 3: | INFORMATION IS INCLUDED ON THE BACK OF PATIENT INVOICES REGARDING THE HCAP PROGRAM. SELF PAY ACCOUNTS OVER $500 ARE SCREENED BY THE MEDICAL ADVOCACY SERVICES FOR HEALTHCARE (MASH) SERVICE OFF SITE FOR GOVERNMENT PROGRAM ELIGIBILITY. IN ADDITION, SELF PAY PATIENTS ARE CONTACTED BY THE PATIENT ACCOUNTING DEPARTMENT TO DISCUSS MEANS OF PAYMENT. IF THE PATIENT STATES THAT THEY DO NOT HAVE THE MEANS TO PAY, BCH STAFF REVIEWS OTHER OPTIONS, SUCH AS PAYMENT PLAN, CHARITY OR DISCOUNT. |
| Part VI, Line 4: | BELMONT COMMUNITY HOSPITAL PREDOMINANTLY SERVICES THE WHEELING METROPOLITAN STATISTICAL AREA. THE PRIMARY SERVICES AREA INCLUDES ONE COUNTY IN THE NORTHERN PANHANDLE OF WEST VIRGINIA (OHIO COUNTY) AND ONE COUNTY IN OHIO (BELMONT COUNTY), WITH A TOTAL POPULATION OF APPROXIMATELY 111,189.THE RACIAL MAKEUP OF THE MSA AS OF THE 2015 CENSUS WAS 93.45% WHITE, 3.95% AFRICAN AMERICAN, 0.65% ASIAN, 0.20% NATIVE AMERICAN, WITH THE REMAINDER FROM OTHER RACES OR A COMBINATION OF TWO OR MORE RACES.THE MEDIAN HOUSEHOLD INCOME FOR 2015 WAS APPROXIMATELY $42,201, WHILE THE MEDIAN HOUSEHOLD INCOME FOR THE UNITED STATES WAS APPROXIMATELY $53,889. THE BELOW POVERTY LEVEL PERCENTAGE FOR 2015 WAS APPROXIMATELY 14.3%, WHILE THE BELOW POVERTY LEVEL PECENTAGE WAS APPROXIMATELY 13.5% FOR THE UNITED STATES. |
| Part VI, Line 5: | A MAJORITY OF THE HOSPITAL'S BOARD MEMBERS ARE RESIDENTS OF THE PRIMARY SERVICE AREA AND ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE HOSPITAL.IN ADDITION, THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ANY QUALIFIED PHYSICIAN IN THE COMMUNITY. |
| Part VI, Line 6: | BELMONT COMMUNITY HOSPITAL IS AN AFFILIATE OF WHEELING HOSPITAL, OFFERING PRIMARY CARE AND SELECTED SPECIALITY SERVICES FOR THE RESIDENTS OF THE UPPER OHIO VALLEY. |
| Part VI, Line 7: | BELMONT COMMUNITY HOSPITAL DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH THE STATE OF OHIO, OR ANY OTHER STATE. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (1) | 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 (10 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JEFFREY A PATEY | ||||||||||||||
| TRUSTEE/CHIEF OF STAFF | $0 | $235,707 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $21,415 | $0 | $257,122 | $0 | $0 |
| BRUCE A ARCHER | ||||||||||||||
| TRUSTEE | $0 | $106,728 | $0 | $25,108 | $0 | $0 | $0 | $7,107 | $0 | $25,756 | $0 | $164,699 | $0 | $0 |
| JAMES B MURDY | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $0 | $244,010 | $0 | $60,102 | $0 | $0 | $0 | $20,095 | $0 | $26,196 | $0 | $350,403 | $0 | $0 |
| JOHN DEBLASIS | ||||||||||||||
| ADMINISTRATOR | $0 | $152,938 | $0 | $15,101 | $0 | $0 | $0 | $10,842 | $0 | $10,215 | $0 | $189,096 | $0 | $0 |
| MARWAN YANES | ||||||||||||||
| PHYSICIAN | $218,600 | $0 | $103 | $0 | $0 | $0 | $0 | $0 | $10,452 | $0 | $229,155 | $0 | $0 | $0 |
| SHASHI GUPTA | ||||||||||||||
| PHYSICIAN | $208,564 | $0 | $33,038 | $0 | $0 | $0 | $2,450 | $0 | $20,970 | $0 | $265,022 | $0 | $0 | $0 |
| DANIEL B JONES | ||||||||||||||
| PHYSICIAN | $326,609 | $0 | $102 | $0 | $0 | $0 | $0 | $0 | $22,364 | $0 | $349,075 | $0 | $0 | $0 |
| GEORGE CHOLAK | ||||||||||||||
| PHYSICIAN | $281,825 | $0 | $102 | $0 | $0 | $0 | $0 | $0 | $1,612 | $0 | $283,539 | $0 | $0 | $0 |
| MAHESHWAR MUSUNURI | ||||||||||||||
| PHYSICIAN | $206,119 | $0 | $60,468 | $0 | $0 | $0 | $2,277 | $0 | $26,083 | $0 | $294,947 | $0 | $0 | $0 |
| CHAGANLAL N PATEL | ||||||||||||||
| FORMER TRUSTEE/ FORMER CHIEF OF STAF | $175,251 | $0 | $103 | $0 | $0 | $0 | $895 | $0 | $21,215 | $0 | $197,464 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 5 | MUSUNURI'S INCENTIVES ARE BASED ON NET INCOME. GUPTA'S INCENTIVES ARE BASED ON CASH RECEIPTS. OVERALL PHYSICIAN COMPENSATION WAS DETERMINED TO BE REASONABLE. |
| PART II: | THE REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS FOR JAMES B MURDY IS FOR SERVICES RENDERED AS CFO FOR THE FILING ORGANIZATION AND THE RELATED ORGANIZATION. THE MAJORITY OF HIS TIME IS SPENT AT THE RELATED ORGANIZATION. EXPLANATION: THE REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS FOR JOHN DEBLASIS IS FOR SERVICES RENDERED AS ADMINISTRATOR FOR THE FILING ORGANIZATION. HIS TIME IS SPENT EVENLY BETWEEN THE FILING ORGANIZATION AND THE RELATED ORGANIZATION. EXPLANATION: THE REPORTABLE COMPENSATION FROM RELATED ORGANIZATION FOR BRUCE ARCHER IS FOR SERVICES RENDERED AS ADMINISTRATOR FOR THE FILING ORGANIZATION AND THE RELATED ORGANIZATION. THE MAJORITY OF HIS TIME IS SPENT AT THE RELATED ORGANIZATION. NONE OF THE WAGES PAID ARE RELATED TO BEING A TRUSTEE ON THE BOARD OF DIRECTORS. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section B, line 11 | AN OUTSIDE CPA FIRM IS HIRED TO REVIEW THE 990. COPIES OF THE 990 ARE SENT TO ALL BOARD MEMBERS PRIOR TO FILING THE RETURN. |
| Form 990, Part VI, Section B, line 12c | ALL MEMBERS OF THE BOARD OF DIRECTORS AND OFFICERS RECEIVE A COPY OF THE CONFLICT OF INTEREST POLICY ANNUALLY. RECIPIENTS ARE ANNUALLY ASKED TO ACKNOWLEDGE THEY HAVE READ THE POLICY, IDENTIFY ANY AREAS OF CONFLICT AND RETURN THE SIGNED DISCLOSURE FORM TO BELMONT COMMUNITY HOSPITAL. RESPONSES ARE REVIEWED AND IDENTIFIED. CONFLICTS ARE REFERRED TO THE BOARD OF DIRECTORS FOR DISCUSSION AND APPROVAL. EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE AT HIRING AND WHEN A CHANGE OCCURS THAT MAY BE A CONFLICT OF INTEREST. |
| Form 990, Part VI, Section B, line 15 | OFFICERS AND KEY EMPLOYEES COMPENSATION IS REVIEWED BY A BELMONT COMMUNITY HOSPITAL COMMITTEE. THE COMMITTEE REVIEWS NATIONAL, REGIONAL AND LOCAL COMPENSATION SURVEYS. ADDITIONALLY, YEARS OF SERVICE ARE ALSO TAKEN INTO ACCOUNT. |
| Form 990, Part VI, Section C, line 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |
| PART VII, SECTION A, 1A (E) | THE REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS FOR JAMES B MURDY IS FOR SERVICES RENDERED AS CFO FOR THE FILING ORGANIZATION AND THE RELATED ORGANIZATION. THE MAJORITY OF HIS TIME IS SPENT AT THE RELATED ORGANIZATION. THE REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS FOR JOHN DEBLASIS IS FOR SERVICES RENDERED AS ADMINISTRATOR FOR THE FILING ORGANIZATION AND FOR OTHER SERVICES TO THE RELATED ORGANIZATION. THE REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS FOR BRUCE ARCHER IS FOR SERVICES RENDERED AS ADMINISTRATOR FOR THE FILING ORGANIZATION AND FOR OTHER SERVICES TO THE RELATED ORGANIZATION. THE MAJORITY OF HIS TIME IS SPENT AT THE RELATED ORGANIZATION. NONE OF THE WAGES PAID ARE RELATED TO BEING A TRUSTEE ON THE BOARD OF DIRECTORS. |
| Form 990, Part XI, line 9: | REVALUATION OF PERMANENTLY RESTRICTED FOR OTHER-THAN-TEMPORARY IMPAIRMENT 685,097. TEMPORARILY RESTRICTED CONTRIBUTIONS 440. FORGIVENESS OF DEBT 3,300,000. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED. |
| SCHEDULE F, PART I, LINE 3: | MOUNTAINEER FREEDOM, LTD SELLS INSURANCE PREMIUMS TO BELMONT COMMUNITY HOSPITAL. MOUNTAINEER FREEDOM, LTD IS SOLEY OWNED BY THE PARENT COMPANY, WHEELING HOSPITAL. BELMONT COMMUNITY HOSPITAL DOES NOT HAVE ANY DIRECT OWNERSHIP IN MOUNTAINEER FREEDOM, LTD. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| WHEELING HOSPITAL INC | |||||||||
| ONE MEDICAL PARK | WHEELING | WV | 26003 | 550357057 | HOSPITAL | WV | 501C(3) | 3 | 0 |
| BELMONT COMMUNITY HOSPITAL AUXILIARY | |||||||||
| 4697 HARRISON STREET | BELLAIRE | OH | 43906 | 346567473 | FUNDRAISING FOR HOSPITAL | OH | 501C(3) | 9 | 0 |
| THE MEDICAL PARK FOUNDATION | |||||||||
| ONE MEDICAL PARK | WHEELING | WV | 26003 | 550744690 | RAISING CONTRIBUTIONS FOR RELATED ORGANIZATION | WV | 501C(3) | 1 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOUNTAINEER FREEDOM LIMITED | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE MEDICAL PARK | AddressLine1Txt |
| City | WHEELING | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26003 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | CAPTIVE INSURANCE COMPANY | PrimaryActivitiesTxt |
| Legal Domicile Foreign Country | CJ | LegalDomicileForeignCountryCd |
| Entity Type | C | EntityTypeTxt |
| 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 | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | Yes (1) | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (5 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| WHEELING HOSPITAL INC | ||
| K | $108,319 | ACTUAL AMOUNT |
| WHEELING HOSPITAL INC | ||
| M | $426,452 | ACTUAL AMOUNT |
| WHEELING HOSPITAL INC | ||
| O | $1,583,600 | ACTUAL AMOUNT |
| WHEELING HOSPITAL INC | ||
| P | $1,393,564 | ACTUAL AMOUNT |
| MOUNTAINEER FREEDOM LTD | ||
| R | $492,317 | ACTUAL AMOUNT |