PLEASANT VALLEY HOSPITAL INC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- PLEASANT VALLEY HOSPITAL INC (EIN 55-0440086)
- Tax period
- 2014-10-01 to 2015-09-30
- Filed
- 2016-08-15
- IRS object ID
- 201602289349303680
- Schema version
- 2014v6.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-08-15T12:53:24-05:00 | ReturnTs |
| Tax Period End | 2015-09-30 | 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 | 2014-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550440086 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pleasant Valley Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PLEA | BusinessNameControlTxt |
| Phone | 3046754340 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2520 Valley Drive | AddressLine1Txt |
| City | Pt Pleasant | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25550 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Grover G Kerns III | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3046754340 | PhoneNum |
| Signature | 2016-08-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Tessa W Carr | PreparerPersonNm |
| PTIN | P01291277 | PTIN |
| Phone | 3043460441 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-09-27 15:27:22Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Glen Washington | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2520 Valley Drive | AddressLine1Txt |
| City | Pt Pleasant | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25550 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $68,392,152 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.pvalley.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1955 | FormationYr |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Activity Or Mission | Provide quality inpatient and outpatient healthcare to the community regardless of ability to pay. Provide a wellness center to promote community health through fitness programs. | ActivityOrMissionDesc |
| Voting Members Governing Body | 18 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 880 | TotalEmployeeCnt |
| Total Volunteers | 100 | TotalVolunteersCnt |
| Total Gross UBI | $2,103 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $77,668 | PYContributionsGrantsAmt |
| CY Contributions Grants | $98,997 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $68,652,995 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $68,081,362 | CYProgramServiceRevenueAmt |
| PY Investment Income | $288,538 | PYInvestmentIncomeAmt |
| CY Investment Income | $12,230 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,104,339 | PYOtherRevenueAmt |
| CY Other Revenue | -$29,615 | CYOtherRevenueAmt |
| PY Total Revenue | $70,123,540 | PYTotalRevenueAmt |
| CY Total Revenue | $68,162,974 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $49,383 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $47,029 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $39,881,479 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $36,520,325 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $30,678,722 | PYOtherExpensesAmt |
| CY Other Expenses | $35,376,192 | CYOtherExpensesAmt |
| PY Total Expenses | $70,609,584 | PYTotalExpensesAmt |
| CY Total Expenses | $71,943,546 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$486,044 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$3,780,572 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $35,112,016 | TotalAssetsBOYAmt |
| Total Assets EOY | $33,094,574 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $15,181,291 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $16,944,421 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $19,930,725 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $16,150,153 | NetAssetsOrFundBalancesEOYAmt |
| Mission | To operate an acute care hospital facility for the citizens of Point Pleasant, West Virginia and the surrounding communities and counties. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $60,343,703 | ExpenseAmt |
| Grant | $47,029 | GrantAmt |
| Revenue | $67,521,595 | RevenueAmt |
| Desc | The hospital provided 38,603 acute, nursery, and skilled nursing days; 118,198 outpatient visits; 15,222 emergency room visits; 2,225 ambulatory surgeries; 1,122 observation visits; 17,838 home health visits; 1,342 hospice visits; and 33,182 physician office visits. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $88,876 | ExpenseAmt |
| Revenue | $91,285 | RevenueAmt |
| Desc | The hospital operates a wellness center which provides community health education and fitness programs that are available to hospital employees and all residents of the surrounding communities. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $60,432,579 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 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 | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | 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 | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | 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 | 51 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 880 | 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 |
| 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 | 18 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | 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 | NC | StatesWhereCopyOfReturnIsFldCd |
| States Where Copy Of Return Is Fld | NY | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Grover G Kerns III | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3046754340 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2520 Valley Drive | AddressLine1Txt |
| City | Point Pleasant | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25550 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Amanda Clark | ||||||||
| Trustee | 0.50 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| Annette Boyles | ||||||||
| Vice Chairperson | 0.50 | 0.30 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| C Dallas Kayser | ||||||||
| Trustee | 0.50 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| Charles Lanham | ||||||||
| Trustee | 0.50 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| Clayton Faber | ||||||||
| Trustee | 0.50 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| Dorsel Keefer | ||||||||
| Trustee | 0.50 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| Jack Buxton | ||||||||
| Trustee | 0.50 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| James Lockhart | ||||||||
| Trustee | 1.50 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| James Rossi | ||||||||
| Trustee | 1.50 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| John Sauer | ||||||||
| Trustee | 0.50 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| Lannes Williamson | ||||||||
| Secretary | 1.50 | 0.20 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Mario Liberatore | ||||||||
| Trustee | 1.50 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| Michael Lieving | ||||||||
| Trustee | 1.50 | 0.30 | Yes (X) | $0 | $0 | $0 | ||
| Pete Allinder | ||||||||
| Chairman | 1.50 | 0.20 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Randall Hawkins | ||||||||
| Trustee | 39.90 | 0.20 | Yes (X) | $367,885 | $0 | $27,726 | ||
| Scott Barnitz | ||||||||
| Trustee | 0.50 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| Thomas Willoughby | ||||||||
| Treasurer | 1.50 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| William Knight | ||||||||
| Trustee | 0.50 | 0.20 | Yes (X) | $0 | $0 | $0 | ||
| Glen Washington | ||||||||
| CEO | 40.00 | $0 | $0 | $0 | Yes (X) | |||
| Richard Hogan | ||||||||
| CFO | 40.00 | $177,329 | $0 | $27,743 | Yes (X) | |||
| Clifford Roberson MD | ||||||||
| Physician | 40.00 | $553,228 | $0 | $19,795 | Yes (X) | |||
| Daniel Trent MD | ||||||||
| Physician | 40.00 | $372,645 | $0 | $32,434 | Yes (X) | |||
| James Toothman MD | ||||||||
| Physician | 40.00 | $604,569 | $0 | $32,434 | Yes (X) | |||
| Ori Tzuk MD | ||||||||
| Physician | 40.00 | $639,738 | $0 | $32,434 | Yes (X) | |||
| Timothy Crouch MD | ||||||||
| Physician | 40.00 | $356,927 | $0 | $32,434 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,072,321 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $205,000 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 28 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Quest Diagnostics | |||||
| P O Box 740709 | Atlanta | GA | 30374 | Lab Services | $446,934 |
| NAPS Incorporated | |||||
| 714 1/2 Lee Street | Charleston | WV | 25301 | Professional Anesthesia Services | $443,642 |
| Crest Services | |||||
| 735 Plaza Blvd 210 | Coppell | TX | 75019 | Biomedical | $357,327 |
| Hammack Medical | |||||
| 143 Benhring Street | Lavalette | WV | 25535 | Emergency Physicians | $349,835 |
| Jackson & Coker | |||||
| P O Box 277638 | Atlanta | GA | 303847638 | Emergency Physicians | $282,575 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $62,723 | GovernmentGrantsAmt |
| All Other Contributions | $36,274 | AllOtherContributionsAmt |
| Total Contributions | $98,997 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Services | 622110 | $67,990,048 | $67,990,048 |
| Wellness Center | 621111 | $91,285 | $91,285 |
| Sale of Drugs | 622110 | $29 | $29 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $68,081,362 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $63,823 | TotalRevenueColumnAmt |
| Exclusion | $63,823 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $412,756 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $27,585 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $385,171 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $385,171 | TotalRevenueColumnAmt |
| Exclusion | $385,171 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $150,000 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $201,593 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$51,593 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$51,593 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$51,593 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Electronic health records incenti | 900099 | $645,000 | $645,000 |
| Cafeteria & vending | 722212 | $213,321 | $213,321 |
| Purchase discounts | 900099 | $106,940 | $106,940 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$1,380,047 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$1,382,150 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $2,103 | UnrelatedBusinessRevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | -$414,786 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $68,162,974 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $67,612,880 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $2,103 | UnrelatedBusinessRevenueAmt |
| Exclusion | $448,994 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,029 | TotalAmt |
| Program Services | $47,029 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $215,513 | TotalAmt |
| Program Services | $171,484 | ProgramServicesAmt |
| Management And General | $44,029 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,921,800 | TotalAmt |
| Program Services | $19,830,276 | ProgramServicesAmt |
| Management And General | $5,091,524 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $622,767 | TotalAmt |
| Program Services | $495,536 | ProgramServicesAmt |
| Management And General | $127,231 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,977,974 | TotalAmt |
| Program Services | $7,143,774 | ProgramServicesAmt |
| Management And General | $1,834,200 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,782,271 | TotalAmt |
| Program Services | $1,418,153 | ProgramServicesAmt |
| Management And General | $364,118 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,326 | TotalAmt |
| Management And General | $15,326 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,688 | TotalAmt |
| Management And General | $50,688 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,797,690 | TotalAmt |
| Program Services | $7,000,322 | ProgramServicesAmt |
| Management And General | $1,797,368 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $398,375 | TotalAmt |
| Program Services | $316,987 | ProgramServicesAmt |
| Management And General | $81,388 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,372,754 | TotalAmt |
| Program Services | $1,886,537 | ProgramServicesAmt |
| Management And General | $486,217 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,628 | TotalAmt |
| Program Services | $25,962 | ProgramServicesAmt |
| Management And General | $6,666 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $985,217 | TotalAmt |
| Program Services | $783,937 | ProgramServicesAmt |
| Management And General | $201,280 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $469,630 | TotalAmt |
| Program Services | $373,685 | ProgramServicesAmt |
| Management And General | $95,945 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $412,430 | TotalAmt |
| Program Services | $328,171 | ProgramServicesAmt |
| Management And General | $84,259 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,713,610 | TotalAmt |
| Program Services | $2,159,219 | ProgramServicesAmt |
| Management And General | $554,391 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,092,321 | TotalAmt |
| Program Services | $869,160 | ProgramServicesAmt |
| Management And General | $223,161 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Bad debts | $8,340,835 | $8,340,835 | |
| Medical supplies | $5,805,320 | $5,805,320 | |
| Medicaid provider tax | $1,517,712 | $1,517,712 | |
| Repairs & maintenance | $1,453,504 | $1,156,553 | $296,951 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $918,152 | TotalAmt |
| Program Services | $761,927 | ProgramServicesAmt |
| Management And General | $156,225 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,943,546 | TotalAmt |
| Program Services | $60,432,579 | ProgramServicesAmt |
| Management And General | $11,510,967 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $88,306 | BOYAmt |
| EOY | $260,362 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,675,198 | BOYAmt |
| EOY | $4,421,603 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,930,441 | BOYAmt |
| EOY | $10,236,491 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $185,048 | BOYAmt |
| EOY | $193,670 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,210,736 | BOYAmt |
| EOY | $1,213,137 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $320,461 | BOYAmt |
| EOY | $235,136 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $77,812,269 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $63,419,458 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,585,812 | BOYAmt |
| EOY | $14,392,811 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $284,646 | BOYAmt |
| EOY | $44,646 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,831,368 | BOYAmt |
| EOY | $2,096,718 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,112,016 | BOYAmt |
| EOY | $33,094,574 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,549,600 | BOYAmt |
| EOY | $8,743,282 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,785,000 | BOYAmt |
| EOY | $5,195,000 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $470,827 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,846,691 | BOYAmt |
| EOY | $2,535,312 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,181,291 | BOYAmt |
| EOY | $16,944,421 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,930,725 | BOYAmt |
| EOY | $16,150,153 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,930,725 | BOYAmt |
| EOY | $16,150,153 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,112,016 | BOYAmt |
| EOY | $33,094,574 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$3,780,572 | 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,219,905 | OtherCostOrOtherBasisAmt |
| Book Value | $1,219,905 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $320,643 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $24,346,804 | OtherCostOrOtherBasisAmt |
| Depreciation | $17,949,017 | DepreciationAmt |
| Book Value | $6,718,430 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $311,829 | OtherCostOrOtherBasisAmt |
| Depreciation | $237,575 | DepreciationAmt |
| Book Value | $74,254 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $49,088,472 | OtherCostOrOtherBasisAmt |
| Depreciation | $43,246,342 | DepreciationAmt |
| Book Value | $5,842,130 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,524,616 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,986,524 | DepreciationAmt |
| Book Value | $538,092 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $14,392,811 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Due from related parties | $442,876 |
| Other receivables | $1,601,518 |
| Accrued interest | $7,658 |
| Estimated third party receivables | $44,666 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,096,718 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| Capital lease agreements | $1,509,613 |
| Estimated third party settlements | $190,105 |
| Bond issue liablities | $78,752 |
| Due to related parties | $756,842 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,535,312 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X, Line 2: | FormAndLineReferenceDesc |
| Explanation | The Hospital, Foundation and Health Foundation are exempt from Federal and state income taxes under Section 501(c)(3) of the Internal Revenue Code and similar state statutes relating to not-for-profit organizations. In addition, the Foundation and the Health Foundation have been classified as organizations other than a private foundation meaning of Section 509(a) of the Internal Revenue Code. Pleasant Valley Home Medical Equipment, Inc., the wholly-owned subsidiary corporation, is not exempt from Federal and state income taxes. Income tax expense, when incurred, is based upon reported income, with deferred income taxes provided on a liability method whereby deferred tax assets are recognized for deductible temporary differences and operating loss and tax credit carryforwards and deferred tax liabilities are recognized for taxable temporary differences. Temporary differences are the differences between the reported amounts of assets and liabilities and their tax bases. Deferred tax assets are reduced by a valuation allowance when, in the opinion of management, it is more likely than not that some portion or all of the deferred tax assets will not be realized. Deferred tax assets and liabilities are adjusted for the effects of changes in tax laws and rates on the date of enactment. Temporary differences result primarily from using accelerated depreciation methods and from reporting bad debts when incurred for tax purposes. Accounting principles generally accepted in the United States of America require the management of the Company to evaluate tax positions taken by the Company. Management has evaluated the Company s tax positions and concluded that the Company has maintained its tax exempt status and had taken no uncertain tax positions that require recognition or disclosure in the financial statements. Therefore, no provision or liability for income taxes has been included in the financial statements. The Company is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. The management of the Company believes it is no longer subject to income tax examinations for years prior to the fiscal year ended September 30, 2012. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 100.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $363,850 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $363,850 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00570 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,608,099 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $15,067,264 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,540,835 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03990 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,971,949 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $15,067,264 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,904,685 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04560 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $234,873 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $52,832 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $182,041 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00290 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,114,897 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,114,897 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01750 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $58,060 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $58,060 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,407,830 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $52,832 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,354,998 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02130 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $19,379,779 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $15,120,096 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,259,683 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06690 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,914 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,914 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,141 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $17,141 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,006 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,006 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $22,061 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $22,061 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $8,292,639 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $1,326,822 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,342,221 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,046,508 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $295,713 | 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 | Pleasant Valley Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2520 Valley Drive | AddressLine1Txt |
| City | Pt Pleasant | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25550 | 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 | Skilled nursing facility | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pleasant Valley 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 |
| CHNA Conducted | 12 | 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.pvalley.org | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 14 | ImplementationStrategyAdptYr |
| Strategy Posted Website | 0 | StrategyPostedWebsiteInd |
| Strategy Attached | 0 | 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 | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 100.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| 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 App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | http://pvalley.org/wp-content/uploads/2015/07/Financial-Assistance-Applicat | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | http://pvalley.org/patients/financial-counseling/ | 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 |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| 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 (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pleasant Valley Hospital | Part V, Section B, Line 5: First account perspectives were obtained from key community representatives through three different modes. These are: surveys, personal interviews and a focus group. The focus group was conducted on March 14, 2013 at the hospital. The focus group represented nine different community organizations plus various community representatives. The individuals who participated in the focus group are as follows: 1. City Dept. of Point Pleasant, WV / Mayor - Point Pleasant, 2. City Department of Point Pleasant, WV / City Clerk, 3. Early Education Station / Director, 4. Family Resource Network / Executive Director, 5. Mason County Health Department / Representative, 6. Mason County Schools / Director, 7. Mason County Commission / Commissioner, 8. Mason County Healthy Families / Supervisor, 9. Pleasant Valley Hospital / Director of Marketing, 10. Pleasant Valley Hospital / Radiologist, and 11. Prestera Ctr. / Clinical Psychologist. |
| Pleasant Valley Hospital | Part V, Section B, Line 16i: The policy is discussed with patients before they are discharged. Copy of the policy is provided to patients prior to discharge. |
| Pleasant Valley Hospital | Part V, Section B, Line 22d: Charges to bill patients are based on income level, asset level, and medical indigency. These were for patients who qualified for financial assistance. The Hospital also gave self-pay patients prompt pay discounts of of gross charges. Pateints were not denied financial assistance because the applications were incomplete. The applications were put on hold until the missing information was obtained. |
| Part V, Section B, Line 16 | Financial Assistance Policy Website Availability |
| Pleasant Valley Hospital Part V, Section B, line 16b website: | http://pvalley.org/wp-content/uploads/2015/07/Financial-Assistance-Applicat |
| Pleasant Valley Hospital Part V, Section B, line 16c website: | http://pvalley.org/patients/financial-counseling/ |
| 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 | Pleasant Valley Hospital Nursing & Rehab | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 640 Sand Hill Road | AddressLine1Txt |
| City | Point Pleasant | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25550 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | Skilled nursing facility | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | The cost of charity care and unreimbursed Medicaid were estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H Instructions.The cost of (1) community health improvement services and community bnefit operations, (2) health professions education, and (3) cash and in-kind contributions was obtained from the hospital's accounting records. |
| 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 $ 8,340,835. |
| Part II, Community Building Activities: | Our weight loss challenge gives the community the ability to use our wellness services. Our wellness services includes cardio and weight lifting machines and certified exercise physiologists. Blood pressure, weight, body fat were monitored before the challenge and after the challenge. This promotes a healthly lifestyle in the community. Mason County is a medically underserved area and the hospital spends money for recruitment for this area. The amount shown for workforce development is the amount paid to recruit new physicians to the area. |
| Part III, Line 3: | The Hospital determined that 16% of self pay accounts turned over to a collection agency came back as eligible for Financial Aid. The amount reported is 16% of the total bad debt expense. |
| Part II - Community Building Activities | Representation on boards of coalitions that build community capacity and share ideas. |
| 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 collectibility. 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: | Medicare allowable costs and reimbursements were obtained from the Medicare Cost Report. |
| Part III, Line 9b: | Pleasant Valley Hospital has a charity care policy and a Collection and Bad Debt policy that discusses qualifying and eligibility for charity care, collection practices and handling of bad debt accounts. It is a practice to handle all patient accounts in the same manner/precedent. Patients are sent monthly statements - even while applying and pending financial assistance and will continue to receive statements until determination is made. Once determination is made the account balance or the % portion of the account balance is adjusted to "Financial Assistance". |
| Part VI, Line 2: | The Hospital participates in the State of West Virginia Abeyance program. We prepare reports for this probran identifying our community benefit programs. This information is reported to the West Virginia Healthcare Authority which makes its records available to the publice. |
| Part VI, Line 3: | The process in place offers the uninsured and underinsured patient the ability to apply for charity care through a formal application process established by reviewing both income and expense to make a final determination of eligibility. It requires proper verification of income through a pay stub, tax return, etc. It is also verified that the patient is not eligible for a state assisted program via a denial letter from the program or verification through the state caseworker. The patient will either be contacted by the Business Office or will contact the Business Office during the collection and statement process to discuss financial arrangements regarding their patient account. All options of payments will be discussed and charity care offered as an alternative option after screening the patient's financial ability to make payment. |
| Part VI, Line 4: | Pleasant Valley Hospital is a rural hospital in Point Pleasant, WV. Pleasant Valley Hospital serves mainly the people of Mason and Jackson County, WV and Meigs and Gallia County, OH. We are a federally designated medically underserved area. Mason County has 27,179 residents, the median household income is $36,468, and 17.8% are below poverty levels. Jackson County has 29,234 residents, the median household income is $43,191, and 16.7% are below poverty levels. Meigs County has 23,593 residents, the median household income is $33,708, and 21.3% are below poverty levels. Gallia County has 30,708 residents, the median household income is $36,918 and 20% are below poverty levels. Medicaid patients made up 23.8% of our total discharges and 16.3% of our total outpatient visits in FY 2012. Uninsured patients made up 4.6% of our total discharges and 4.3% of our total outpatient visits in FY 2012. There is one other not-for-profit hospital within 15 miles of PVH. They serve many of the same areas that we do. |
| Part VI, Line 5: | The majority of the organization's governing body is comprised of persons who reside in the organization's primary service area, who are neither employees or contractors of the organization, nor family members thereof. The hospital extends medical staff privileges to all qualified physicians in its community. The hospital provides a 24 hour emergency room and is available to all regardless of the ability to pay. All the services provided by the hospital are provided regardless of the ability to pay. The hospital has an auxiliary that helps our patients and visitors if they need a wheelchair when they arrive or if they need dirctions on where to go within the Hospital. The hospital provides Breast Cancer Screenings/Mammograms free to patients who cannot pay for the service. The hospital has a fitness center for the community and it also conducts many health fairs throughout the year. The hospital provides many health screenings throughout the year in addition to a nutritional program. Our SNF provides transportation for its residents to health facilities. The hospital has support groups for members of the community. The hospital donates money to the community for various projects. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| Mason County Board of Education | |||||||
| 1200 Main Street | Point Pleasant | WV | 25550 | 556000353 | 501(c)(3) | $15,000 | High school athletic program support |
| Mason County Fair Inc | |||||||
| P O Box 334 | Point Pleasant | WV | 25550 | 550628521 | 501(c)(3) | $25,156 | Support of Fair Activities. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Randall Hawkins | ||||||||||||||
| Trustee | $213,771 | $0 | $154,114 | $0 | $0 | $0 | $12,090 | $0 | $16,163 | $0 | $396,138 | $0 | $0 | $0 |
| Richard Hogan | ||||||||||||||
| CFO | $177,329 | $0 | $0 | $0 | $0 | $0 | $7,399 | $0 | $21,046 | $0 | $205,774 | $0 | $0 | $0 |
| Clifford Roberson MD | ||||||||||||||
| Physician | $540,228 | $0 | $13,000 | $0 | $0 | $0 | $12,090 | $0 | $8,407 | $0 | $573,725 | $0 | $0 | $0 |
| Daniel Trent MD | ||||||||||||||
| Physician | $372,645 | $0 | $0 | $0 | $0 | $0 | $12,090 | $0 | $21,046 | $0 | $405,781 | $0 | $0 | $0 |
| James Toothman MD | ||||||||||||||
| Physician | $604,569 | $0 | $0 | $0 | $0 | $0 | $12,090 | $0 | $21,046 | $0 | $637,705 | $0 | $0 | $0 |
| Ori Tzuk MD | ||||||||||||||
| Physician | $525,138 | $0 | $114,600 | $0 | $0 | $0 | $12,090 | $0 | $21,046 | $0 | $672,874 | $0 | $0 | $0 |
| Timothy Crouch MD | ||||||||||||||
| Physician | $356,927 | $0 | $0 | $0 | $0 | $0 | $12,090 | $0 | $21,046 | $0 | $390,063 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Form 990, Part VII, Section A, Line 5 | FormAndLineReferenceDesc |
| Explanation | Unrelated organization officer compensation: For the calendar year ended, 12/31/2014, Pleasant Valley Hospital paid Cabell-Huntington Hospital $287,925 for the services of Glen Washington, CEO of Pleasant Valley Hospital. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| The County Commission of Mason County WV | ||||||||
| A | 556000352 | 575194BM6 | 2003-06-17 | $7,805,000 | To refund Series 1993 bonds | 0 | 0 | 0 |
| The County Commission of Mason County WV | ||||||||
| B | 556000352 | 575194CH6 | 2006-10-12 | $3,895,000 | Capital improvements & equipment acquisition | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | In Reserve FundInReserveFundAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Credit EnhancementCreditEnhancementAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | Capital ExpendituresCapitalExpendituresAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| A | $3,835,000 | $7,805,000 | $7,021,907 | $156,100 | $626,993 | 2003 | 0 | 0 | Yes (1) | Yes (1) | |
| B | $2,670,000 | $3,895,000 | $389,500 | $77,900 | 2008 | 0 | 0 | Yes (1) | Yes (1) | $3,427,600 |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
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 | 0 |
| B | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | 0 |
| B | 0 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (9 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| Lee Anne Kayser | |||
| Family member of C. Dallas Kayser, Hospital Trustee | $25,083 | Wages | 0 |
| Jane Zirkle | |||
| Family member of Mike Lieving, Hospital Trustee | $23,411 | Wages | 0 |
| David Faber MD | |||
| Family member of Clayton Faber, Hospital Trustee | $57,163 | Wages | 0 |
| Wes Lieving DO | |||
| Family member of Mike Lieving, Hospital Trustee | $29,012 | Wages | 0 |
| Peoples Bank | |||
| James Lockhart, Hospital Trustee, is a board member of the bank | $373 | Interest bearing checking accounts | 0 |
| Peoples Bank | |||
| Dorsal Keefer, Hospital Truste, is a board member of the bank | $373 | Interest bearing checking accounts | 0 |
| Ohio Valley Bank | |||
| Mario Liberatore, Hospital Trustee, is an officer of the bank | $500 | Interest on certificates of deposit | 0 |
| Ohio Valley Bank | |||
| Lannes Williamson, Hospital Trustee, is a board member of the bank | $500 | Interest on certificates of deposit | 0 |
| Ohio Valley Bank | |||
| Charles Lanham, Hospital Trustee, is a board member of the bank | $500 | Interest on certificates of deposit | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 2 | Dallas Kayser, Charles Lanham, and Michael Shaw have a business relationship. Mario Liberatore and Lannes Williamson have a business relationship. Dallas Kayers's spouse and James Rossi have a business relationship. |
| Form 990, Part VI, Section B, line 11 | The 990 is prepared by the Hospital's independent accountants. It is then reviewed by the CFO and CEO and a copy is provided to the governing board before it is filed with the IRS. |
| Form 990, Part VI, Section B, line 12c | Each board member fills out a questionnaire at the end of the fiscal year. The questionnaire has questions on it that determine independence status and other relationships between board members and between the board member and the hospital. This helps in determining possible conflicts that may arise. In addition, the board members must sign a conflict of interest policy that requires them with due diligence to state that they have a conflict of interest when that conflict arises. The board member must leave the board meeting during discussions and voting. |
| Form 990, Part VI, Section B, line 15 | The compensation committee is made up of independent board members. These members are appointed by the board. The compensation committee decides the compensation of the CEO and VPs. The compensation committee consults with an independent consultant to determine a fair compensation for the CEO and VPs based on peer data. The Compensation committee has used this study to determine base salary for the CEO and VPs. The CEO contract is taken back to the board for final approval. |
| Form 990, Part VI, Section C, line 19 | These documents are available upon request for inspection at the hospital or by mailing a copy upon request. |
| Form 990, Part IX, line 11g | Purchased Services: Program service expenses 463,592. Management and general expenses 119,030. Fundraising expenses 0. Total expenses 582,622. Nursing Services: Program service expenses 160,490. Management and general expenses 41,206. Fundraising expenses 0. Total expenses 201,696. Lab Services: Program service expenses 58,621. Management and general expenses 15,051. Fundraising expenses 0. Total expenses 73,672. Medical Services: Program service expenses 201,179. Management and general expenses 51,654. Fundraising expenses 0. Total expenses 252,833. Doctor Services: Program service expenses 3,792,301. Management and general expenses 973,692. Fundraising expenses 0. Total expenses 4,765,993. Therapy Services: Program service expenses 448,610. Management and general expenses 115,183. Fundraising expenses 0. Total expenses 563,793. Pharmacy Services: Program service expenses 74,293. Management and general expenses 19,075. Fundraising expenses 0. Total expenses 93,368. Administration Services: Program service expenses 1,801,236. Management and general expenses 462,477. Fundraising expenses 0. Total expenses 2,263,713. |
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 | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Pleasant Valley Hospital Foundation Inc | ||||||||||
| 2420 Valley Dr | Pt Pleasant | WV | 25550 | 200120079 | Fundraising | WV | 501(c)(3) | Line 9 | N/A | 0 |
| Pleasant Valley Hospital Health Foundation Inc | ||||||||||
| 2420 Valley Dr | Pt Pleasant | WV | 25550 | 550649849 | Scholarships/Healthcare | WV | 501(c)(3) | Line 11b, II | N/A | 0 |
| Pleasant Valley Medical Group Inc | ||||||||||
| 2520 Valley Dr | Pt Pleasant | WV | 25550 | 471358788 | Healthcare | WV | 501(c)(3) | Line 9 | N/A | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pleasant Valley Home Medical Equipment | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | Viand St | AddressLine1Txt |
| City | Pt Pleasant | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25550 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550653315 | EIN |
| Primary Activities | Retail - Medical equipment sales & rental | PrimaryActivitiesTxt |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | -$437,075 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $1,658,738 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| 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 |