HOSPITAL DEVELOPMENT CO: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- HOSPITAL DEVELOPMENT CO (EIN 55-0484469)
- Tax period
- 2014-10-01 to 2015-09-30
- Filed
- 2016-08-15
- IRS object ID
- 201602289349303955
- 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 J
- Schedule K
- 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 | 550484469 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Hospital Development Company Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HOSP | BusinessNameControlTxt |
| Phone | 3049274444 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 Hospital Drive | AddressLine1Txt |
| City | Spencer | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25276 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Douglas Bentz | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 3049274444 | PhoneNum |
| Signature | 2016-08-11 | 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
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Roane General Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Douglas Bentz | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 Hospital Drive | AddressLine1Txt |
| City | Spencer | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25276 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $28,255,298 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.roanegeneralhospital.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1966 | FormationYr |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Activity Or Mission | To promote the general health and welfare of Roane County and surrounding areas and all of the citizens thereof by furthering all legitimate methods for the prevention and treatment of disease and the positive promotion of health, both personal and public, including but not limited to the operation of hospitals, nursing schools, nursing homes and medical research facilities; to foster and conduct education in medicine in all its branches and in those adjacent and kindred arts and sciences such as nursing and technical training which contribute to the diagnosis, treatment, care and prevention of disease. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 14 | VotingMembersIndependentCnt |
| Total Employee | 338 | TotalEmployeeCnt |
| Total Volunteers | 30 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $97,912 | PYContributionsGrantsAmt |
| CY Contributions Grants | $14,439 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $28,787,593 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $26,191,752 | CYProgramServiceRevenueAmt |
| PY Investment Income | $148,043 | PYInvestmentIncomeAmt |
| CY Investment Income | $284,212 | CYInvestmentIncomeAmt |
| PY Other Revenue | $268,852 | PYOtherRevenueAmt |
| CY Other Revenue | $1,111,736 | CYOtherRevenueAmt |
| PY Total Revenue | $29,302,400 | PYTotalRevenueAmt |
| CY Total Revenue | $27,602,139 | 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 | $15,405,924 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $16,444,056 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $13,284,970 | PYOtherExpensesAmt |
| CY Other Expenses | $11,945,784 | CYOtherExpensesAmt |
| PY Total Expenses | $28,690,894 | PYTotalExpensesAmt |
| CY Total Expenses | $28,389,840 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $611,506 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$787,701 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $17,075,008 | TotalAssetsBOYAmt |
| Total Assets EOY | $17,997,633 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,845,179 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $10,644,410 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $8,229,829 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $7,353,223 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Roane General Hospital is dedicated to the delivery of high-quality, cost effective health care to all members of our community. The work we do makes a difference in people's lives. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $23,746,459 | ExpenseAmt |
| Revenue | $27,292,503 | RevenueAmt |
| Desc | Roane General Hospital generated gross revenue of $50,812,013 of which $24,025,234 was uncollectible due to contractual agreements with Medicare, Medicaid and other third-party payors. Bad debts due to inability or unwillingness of patients to pay amounted to $1,103,842. Additionally, charges for patients meeting 200% of the poverty level and who qualified for charity care were written off totaling $288,873. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | As a Critical Access hospital we provided health care services to our community which included the following days of care: Skilled/Intermediate Care Facility 12,268; Swing 1,997; Respite 31; and Acute Care 1,101.Additionally, we provided 31,553 outpatient diagnostic visits; 7,540 emergency room visits and 32,433 rural health clinic provider visits. Revenue and expenses related to these services are included above in box 4a. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $181,563 | ExpenseAmt |
| Revenue | $9,675 | RevenueAmt |
| Desc | The Hospital also provided community health education and health screening services at reduced fees during the year including health fairs that served 215 participants; diabetes education seminars that served 1,251 participants; diabetes education screening that served 375 participants and provided sports physicals to 123 participants. The Hospital served a total of 1,964 community participants through its community health education and health screening programs. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Other programs provided include Cardiac Rehab, Laboratory Services, Emergency Room, Pharmacy, Radiology, CT Scan, Ultrasound, MRI, Nuclear Medicine, Physical Therapy, Operating Room and RHC's. Revenue and expenses related to these services are included above in box 4a. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $23,928,022 | 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 | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 103 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 338 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 14 | 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 | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | 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 | 0 | 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Douglas Bentz | PersonNm |
| Phone | 3049276201 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 Hospital Drive | AddressLine1Txt |
| City | Spencer | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25276 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| Douglas Bentz | |||||||
| CEO | 41.50 | Yes (X) | Yes (X) | $295,990 | $0 | $28,037 | |
| Jack D Garrett II | |||||||
| President | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| William Downey Jr | |||||||
| Vice President | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Gregory Boggs | |||||||
| Vice President | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| John Varda | |||||||
| Treasurer | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Jennifer McCulty | |||||||
| Secretary | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Jeanette Atkinson | |||||||
| Board Member | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Martha Cooper | |||||||
| Board Member | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Christine Hedges | |||||||
| Board Member | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Paul Hughes | |||||||
| Board Member | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| John Taylor | |||||||
| Board Member | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Robert Zdanek | |||||||
| Board Member | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Robert G Ashley | |||||||
| Board Member | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Richard Bowlby | |||||||
| Board Member | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Gerald M Titus | |||||||
| Board Member | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Hong-Kin Ng MD | |||||||
| Board Member/Chief of Med Staff | 40.00 | Yes (X) | $368,645 | $0 | $33,559 | ||
| Daniel B Prudich MD | |||||||
| ER Physician | 47.00 | $342,537 | $0 | $33,379 | Yes (X) | ||
| Christopher Lambert MD | |||||||
| ER Physician | 39.00 | $321,209 | $0 | $9,800 | Yes (X) | ||
| Grant Parkins DO | |||||||
| Physician | 43.00 | $263,415 | $0 | $33,379 | Yes (X) | ||
| Brent Watson MD | |||||||
| ER Physician | 46.00 | $318,764 | $0 | $33,379 | Yes (X) | ||
| Paul Clancy MD | |||||||
| ER Physician | 36.00 | $256,071 | $0 | $20,616 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,166,631 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $192,149 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 19 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Odyssey Rehabilitation | |||||
| 415 Benedum Drive | Bridgeport | WV | 26330 | Rehabilitation Services | $352,283 |
| Barton Associates | |||||
| 10 Dearborn Road | Peabody | MA | 01960 | Locum Tenen Staffing | $196,854 |
| Arnett Carbis Toothman | |||||
| PO Box 2629 | Charleston | WV | 25329 | Consulting/Accounting | $139,798 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $9,360 | GovernmentGrantsAmt |
| All Other Contributions | $5,079 | AllOtherContributionsAmt |
| Total Contributions | $14,439 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient services | 622110 | $24,807,983 | $24,807,983 |
| Pharmacy-340B Program | 900099 | $1,250,980 | $1,250,980 |
| Wellness center | 713940 | $132,789 | $132,789 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $26,191,752 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $282,763 | TotalRevenueColumnAmt |
| Exclusion | $282,763 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,310 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,310 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,310 | TotalRevenueColumnAmt |
| Exclusion | $1,310 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $654,608 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $653,159 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,449 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,449 | TotalRevenueColumnAmt |
| Exclusion | $1,449 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| EHR Incentives | 900099 | $761,233 | $761,233 |
| Cafeteria | 722210 | $195,827 | $195,827 |
| Rebates | 900099 | $32,915 | $32,915 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $120,451 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $120,451 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,110,426 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $27,602,139 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $27,302,178 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $285,522 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $701,614 | TotalAmt |
| Program Services | $583,883 | ProgramServicesAmt |
| Management And General | $117,731 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,263,383 | TotalAmt |
| Program Services | $10,205,587 | ProgramServicesAmt |
| Management And General | $2,057,796 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $241,822 | TotalAmt |
| Program Services | $201,244 | ProgramServicesAmt |
| Management And General | $40,578 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,407,932 | TotalAmt |
| Program Services | $2,003,881 | ProgramServicesAmt |
| Management And General | $404,051 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $829,305 | TotalAmt |
| Program Services | $690,148 | ProgramServicesAmt |
| Management And General | $139,157 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $148,009 | TotalAmt |
| Management And General | $148,009 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $139,798 | TotalAmt |
| Management And General | $139,798 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,432,022 | TotalAmt |
| Program Services | $2,021,807 | ProgramServicesAmt |
| Management And General | $410,215 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $109,240 | TotalAmt |
| Program Services | $90,910 | ProgramServicesAmt |
| Management And General | $18,330 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,372,868 | TotalAmt |
| Program Services | $1,142,501 | ProgramServicesAmt |
| Management And General | $230,367 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $550,494 | TotalAmt |
| Program Services | $458,121 | ProgramServicesAmt |
| Management And General | $92,373 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $386,173 | TotalAmt |
| Program Services | $321,373 | ProgramServicesAmt |
| Management And General | $64,800 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $111,749 | TotalAmt |
| Program Services | $92,998 | ProgramServicesAmt |
| Management And General | $18,751 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $101,007 | TotalAmt |
| Management And General | $101,007 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,538,375 | TotalAmt |
| Program Services | $1,280,236 | ProgramServicesAmt |
| Management And General | $258,139 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $311,907 | TotalAmt |
| Program Services | $259,569 | ProgramServicesAmt |
| Management And General | $52,338 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical supplies | $2,009,473 | $2,009,473 | |
| Bad debt expense | $1,103,842 | $1,103,842 | |
| Health care provider ta | $622,323 | $622,323 | |
| Maintenance and repairs | $513,252 | $427,128 | $86,124 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $495,252 | TotalAmt |
| Program Services | $412,998 | ProgramServicesAmt |
| Management And General | $82,254 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,389,840 | TotalAmt |
| Program Services | $23,928,022 | ProgramServicesAmt |
| Management And General | $4,461,818 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,801 | BOYAmt |
| EOY | $86,820 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,066,765 | BOYAmt |
| EOY | $3,067,010 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,690,845 | BOYAmt |
| EOY | $3,462,590 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $284,272 | BOYAmt |
| EOY | $340,180 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $65,338 | BOYAmt |
| EOY | $172,167 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $23,170,717 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $15,050,418 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,885,610 | BOYAmt |
| EOY | $8,120,299 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,821,695 | BOYAmt |
| EOY | $1,692,188 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $405,921 | BOYAmt |
| EOY | $564,422 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $834,761 | BOYAmt |
| EOY | $491,957 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,075,008 | BOYAmt |
| EOY | $17,997,633 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,223,960 | BOYAmt |
| EOY | $3,814,347 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,702,401 | BOYAmt |
| EOY | $955,474 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,681,448 | BOYAmt |
| EOY | $2,275,607 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $420,444 | BOYAmt |
| EOY | $302,193 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $816,926 | BOYAmt |
| EOY | $3,296,789 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,845,179 | BOYAmt |
| EOY | $10,644,410 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,987,512 | BOYAmt |
| EOY | $7,110,194 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $242,317 | BOYAmt |
| EOY | $243,029 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,229,829 | BOYAmt |
| EOY | $7,353,223 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,075,008 | BOYAmt |
| EOY | $17,997,633 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$787,701 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$111,101 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $22,196 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule 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
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $242,317 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $712 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $243,029 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $241,772 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $545 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $242,317 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $241,141 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $631 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $241,772 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $240,468 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $673 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $241,141 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $239,558 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $910 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $240,468 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $125,809 | OtherCostOrOtherBasisAmt |
| Book Value | $125,809 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,841,889 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,857,208 | DepreciationAmt |
| Book Value | $1,984,681 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $18,114,573 | OtherCostOrOtherBasisAmt |
| Depreciation | $12,142,168 | DepreciationAmt |
| Book Value | $5,972,405 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $88,446 | OtherCostOrOtherBasisAmt |
| Depreciation | $51,042 | DepreciationAmt |
| Book Value | $37,404 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,120,299 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Capital leases | $114,287 |
| Patient funds | $7,052 |
| Third party payor settlements | $3,175,450 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,296,789 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $28,047,585 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $1,550,000 | OtherRevenueAmt |
| Revenue Not Reported | $1,550,000 | RevenueNotReportedAmt |
| Revenue Subtotal | $26,497,585 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,104,554 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,104,554 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $27,602,139 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $28,835,998 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $1,550,000 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $1,550,000 | ExpensesNotReportedAmt |
| Expenses Subtotal | $27,285,998 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,103,842 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,103,842 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $28,389,840 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | The income is restricted for the purchase of hospital equipment and for hospital operations. |
| Part X, Line 2: | The Hospital is exempt from Federal and state income taxes under Section 501(c)(3) of the Internal Revenue Code. Accounting principles generally accepted in the United States of America require the management of the Hospital to evaluate tax positions taken by the Hospital. Management has evaluated the Hospital's tax positions and concluded that the Hospital had 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 Hospital is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. The management of the Hospital believes it is no longer subject to income tax examinations for years prior to the fiscal year ended September 30, 2012. |
| Part XI, Line 2d - Other Adjustments: | Medicaid settlement netted against income on 990 1,550,000. |
| Part XI, Line 4b - Other Adjustments: | Bad debt expense netted with revenue on financial statements 1,103,842. Immaterial adjustment booked through beginning net assets 712. |
| Part XII, Line 2d - Other Adjustments: | Medicaid settlement netted against income on 990 1,550,000. |
| Part XII, Line 4b - Other Adjustments: | Bad debt expense netted with revenue on financial statements 1,103,842. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| 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 | $781,969 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $781,969 | DirectOffsettingRevenueAmt |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,535,518 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,754,694 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $780,824 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02860 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,317,487 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,536,663 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $780,824 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02860 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2791 | PersonsServedCnt |
| Total Community Benefit Expns | $181,563 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,675 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $171,888 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00630 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2791 | PersonsServedCnt |
| Total Community Benefit Expns | $181,563 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,675 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $171,888 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00630 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2791 | PersonsServedCnt |
| Total Community Benefit Expns | $5,499,050 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,546,338 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $952,712 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03490 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $610,038 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $5,353,001 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,353,001 | CostOfCareReimbursedByMedcrAmt |
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 | 5 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp (5 entries)
| FacilityFacilityNum | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Licensed HospitalLicensedHospitalInd | Critical Access HospitalCriticalAccessHospitalInd | Emergency Room24 HrsEmergencyRoom24HrsInd | OtherOtherDesc |
|---|---|---|---|---|---|---|---|---|
| Roane General Hospital | ||||||||
| 1 | 200 Hospital Drive | Spencer | WV | 25276 | Yes (X) | Yes (X) | Yes (X) | Distinct Part Skilled/Intermediate Care Facility Unit |
| Roane General Medical Clinic | ||||||||
| 2 | 200 Hospital Drive | Spencer | WV | 25276 | Rural Health Clinic | |||
| Roane General Medical Associates | ||||||||
| 3 | 200 Hospital Drive | Spencer | WV | 25276 | Rural Health Clinic | |||
| Southern Roane Medical Clinic | ||||||||
| 4 | 200 Hospital Drive | Spencer | WV | 25276 | Rural Health Clinic | |||
| Walton Medical Clinic | ||||||||
| 5 | 200 Hospital Drive | Spencer | WV | 25276 | Rural Health Clinic | |||
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Roane General 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 | 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 | http://media.wix.com/ugd/c7fb0f_b908aa30497b4bfa9dcee2d4dbaf2acc.pdf | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | 0 | ImplementationStrategyAdoptInd |
| 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 |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| 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 |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | http://www.roanegeneralhospital.com/#!patient-resources/c1jpd | FAPAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Medicare Rates | Yes (X) | MedicareRatesInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Roane General Hospital | Part V, Section B, Line 5: Individuals selected to participate in the key informant survey were health and human services providers, business leaders and individuals with unique knowledge of the community and/or public health. The key informants were requested to participate by completing a survey. Invitations to take the survey were communicated to 78 community and business leaders and health care professionals. Key informants identified obesity and overweight as the most serious health problem facing the community (96%). Also identified as serious issues were diabetes (69%), cardiovascular disease (54%), hypertension (31%) and COPD/asthma (13%). The top health behaviors to address were identified as prescription drug misuse/abuse (23%), illegal substance abuse (23%), and physical inactivity (21%). |
| Roane General Hospital | Part V, Section B, Line 11: Needs were reviewed in the strategic planning process for 2015 and included in goals. Implementation will depend on coordinating specialty clinics to meet the needs and finding partners willing to provide services at Roane General Hospital. Some services identified will be reviewed for financial feasibility and available space to provide services. |
| Roane General Hospital | Part V, Section B, Line 22d: Use of the Medicare fee schedule as a baseline and review by outside consultants for appropriate rates. |
| Part V, Section B, Line 16 | Financial Assistance Policy Website Availability |
| Roane General Hospital Part V, Section B, line 16a website: | http://www.roanegeneralhospital.com/#!patient-resources/c1jpd |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | The financial assistance program has been established to defray the costs of medically necessary services for those patients who meet the guidelines set forth in the Financial Assistance Policy. Proof of financial status is required as follows: a. If the patient is older than eighteen years old, b. If the patient is married or there are two parents in the household, documents showing both incomes must be provided, c. A patient will be required to re-verify and to re-apply for assistance every six (6) months. When a patient has brought sufficient documentation to prove financial status, financial counseling will determine their eligibility by referencing the matrix based on 200% of the Federal Poverty Guidelines. Required documentation as follows: 1. W-2 withholding forms or 2. Pay stub or 3. Federal Income Tax Return or 4. Forms approving or denying unemployment compensation or workers' compensation or 5. Written verification from DHHR or any other governmental agency that can attest to the patient/responsible party's income status for the prior 12 months or 6. Statement verifying application for unemployment benefits, and Proof of household expenses, if required. |
| Part I, Line 7: | The cost of charity care was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions.The cost of community health improvement services was derived from three factors: 1. Average hourly rate per department x employee hours. 2. Actual supply expense 3. Total charges that would have been generated if services were not "free". |
| 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 $ 1,103,842. |
| Part II, Community Building Activities: | RGH's Board is comprised of local community members representing small business, labor, elderly, low income, CEO and Chief of Medical Staff. Medical staff privileges are granted to qualified local physicians and consulting physicians after review by the Medical Staff Executive Committee and approval by RGH Board. All funds are used for daily operations, capital equipment or capital physical plant improvements. The emergency room operates 24/7 and provides care to all who present for service. Community support is provided upon request for special projects and donations. RGH Auxiliary operates the gift shop and provides support to RGH for capital equipment upon request. The Community Benefit Report is posted on the hospital website for review by interested parties. |
| Part III, Line 2: | The bad debt expense was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions. |
| 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 costs were obtained from the hospital's Medicare cost report. |
| Part III, Line 9b: | SCREENING: All patients identified as self-pay will be screened for Medicaid eligibility referral, provided financial counseling and processed for appropriate financial assistance. FINANCIAL ASSISTANCE: Roane General Hospital encourages patients to apply for financial assistance; patients will be screened according to eligibility rules as defined in governmental assistance program guidelines and/or Roane General Hospital's Financial Assistance Policy and Procedure. CHARITY CARE: Patients with income at or below 200% of Federal Poverty Guidelines are eligible to apply for Roane General Hospital's Charity Care program. Remaining self-pay accounts will be flagged and followed up for financial education regarding their obligation to finalize a mutually acceptable financial agreement to resolve their bill. |
| Part VI, Line 2: | Specific goals of the health care needs assessment was to identify:1. Health Care Issues of the Community: The health care need assessment identified prevalent health care issues and gaps in the current health services delivery in this region.2. Vulnerable Populations: The health care need assessment identified persons with barriers to receiving health care services. Rural citizens are a vulnerable population in general due to the lack of specialty services and the required travel to meet many health care needs, and this region provides no exception. Children, seniors, and uninsured/underinsured citizens face the greatest barriers due to the lack of specific services that are available for these populations. If these populations are also of low income, this further compounds the barriers and subsequent access to health care.3. Disparities in the Health Care Services Delivery System: Although many health care services are offered in the region, a number of factors influence access. For example, insurance status, income, and provider and community awareness all affect the ability to access care.4. Health Care Resources in the Community: An assessment of health care services was completed in order to gain an understanding of the availability of health care services in the country. The assessment of the health care services was compiled through general data collection.5. Next Steps (Strategic Planning): The community health needs assessment is a crucial step in future strategic planning. Setting priorities cannot be accomplished without gaining an understanding of the communitys health care needs and concerns. Addressing the health care service issues identified during the assessment is the next step in the process. |
| Part VI, Line 3: | All self-pay patients are screened at pre-registration, registration or final bill and are referred to the Financial Counselor for charity eligibility or referred to our in-house Medicaid Case Worker to establish Medicaid coverage. |
| Part VI, Line 4: | The total population in Roane County is 15,116 within a total land area of 483.56 square miles; the population density of the area is 31.26 (per square mile). The population is 50.45% female, which is comparable with state and national data. The total population decreased by 3.37% from the 2000 to the 2010 US Census.Roane County shows little ethnic diversity with a population that is 94.34% white; this ethnic diversity rate is very similar to the rate for West Virginia.The median age of individuals residing in Roane County is 42.80, which is higher than that of the state (41.10) and the US (36.90). In addition, approximately one-half of the population in Roane County is between the ages of above the age of 45, with approximately one-third of the population between 45-64 years old. This is especially critical to note since the 45-64 years old group will be reaching retirement age within the next 20 years.Roane County's linguistic isolated population is very small at 0.60%. This percent comparable with the state percent (0.72%) but is significantly less than the national percentage (8.70%). |
| Part VI, Line 5: | The members of the Board of Directors of Roane General Hospital are all local business leaders and other community representatives. Medical Staff privileges are extended to all qualified employed physicians, consulting physicians, independent practice physicians and medical staff of the local Federally Qualified Health Center. All surplus funds are reinvested in the new medical equipment, technology or upgrades and renovation of facilities built in 1970. Specifically in 2011, funds were invested to upgrade technology for Electronic Medical Records and to meet the standards for Meaningful Use. The hospital filed for Stage 1 Meaningful Use in September 2011 and was one of only two Critical Access Hospitals in West Virginia to meet these standards of providing and tracking quality patient care. The Emergency Room is operated 24/7 and is staffed by Board Certified Emergency Medicine physicians. The hospital also operates three Rural Health Clinics, provides Walk-In services and three School Based Clinics staffed by physicians employed by Roane General Hospital. Physicians including an orthopedist, urologist, podiatrist, and general practice/wound skin care use our clinics on specified days to screen and provide care not available in our community. Roane General Hospital's Auxiliary, operated independently from the hospital, has approx. 40 members who provide information and customer support services. They also conduct several fund raising events during the year and proceeds from their sales are donated to the hospital to offset the expense of new equipment or renovations. Roane General Hospital Foundation, Inc. was formed to allow charitable contributions to support the hospital and also as a vehicle for formal fundraising activities as required by the Hospital. This Foundation has a separate Board of Directors which oversees the operation and approves any donations to the Hospital. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | Yes (1) | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Douglas Bentz | ||||||||||||||
| CEO | $245,077 | $0 | $43,424 | $0 | $7,489 | $0 | $9,800 | $0 | $20,837 | $0 | $326,627 | $0 | $0 | $0 |
| Hong-Kin Ng MD | ||||||||||||||
| Board Member/Chief of Med Staff | $368,645 | $0 | $0 | $0 | $0 | $0 | $9,800 | $0 | $25,309 | $0 | $403,754 | $0 | $0 | $0 |
| Daniel B Prudich MD | ||||||||||||||
| ER Physician | $342,537 | $0 | $0 | $0 | $0 | $0 | $9,800 | $0 | $25,029 | $0 | $377,366 | $0 | $0 | $0 |
| Christopher Lambert MD | ||||||||||||||
| ER Physician | $321,209 | $0 | $0 | $0 | $0 | $0 | $9,800 | $0 | $1,450 | $0 | $332,459 | $0 | $0 | $0 |
| Grant Parkins DO | ||||||||||||||
| Physician | $240,215 | $0 | $23,200 | $0 | $0 | $0 | $9,800 | $0 | $25,029 | $0 | $298,244 | $0 | $0 | $0 |
| Brent Watson MD | ||||||||||||||
| ER Physician | $292,788 | $0 | $25,976 | $0 | $0 | $0 | $9,800 | $0 | $25,029 | $0 | $353,593 | $0 | $0 | $0 |
| Paul Clancy MD | ||||||||||||||
| ER Physician | $256,071 | $0 | $0 | $0 | $0 | $0 | $9,800 | $0 | $12,266 | $0 | $278,137 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 6 | FormAndLineReferenceDesc |
| Explanation | The Organization offers an incentive compensation plan to certain members of its executive staff including the CEO, Chief of Staff, VP of Financial and Support Services, VP of Quality and Ancillary Services, VP of Nursing Services and VP of Information Services/Technology. The program is intended to provide motivation and direction for the management team to accomplish the goals and objectives set forth by the Board at the beginning of each calendar year. These goals are based upon the annual strategic plan as well as the financial performance of the hospital. Shortly after the calendar year, the management team will present its progress and accomplishments to the Board with a recommended bonus based upon the criteria set forth. The board has discretion to approve, amend, or deny any recommendations. To be eligible for the program, the executive member must serve in his/her position for at least four months and be employed at the end of the program calendar year. If the individual serves less than one year but more than four months, the incentive will be prorated. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Roane County Building Commission | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 464100302 | BondIssuerEIN |
| Bond Issued | 2013-11-20 | BondIssuedDt |
| Issue Price | $2,950,000 | IssuePriceAmt |
| Purpose | Renovation of building and equipment acquisition | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $379,904 | RetiredAmt |
| Total Proceeds | $2,655,511 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $43,259 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $109,541 | CapitalExpendituresAmt |
| Other Spent Proceeds | $2,502,711 | OtherSpentProceedsAmt |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | 0 | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | Yes (1) | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | The corporation has one class of members which consist of (a) the original incorporators of the corporation; (b) each of the corporation's directors; (c) those individual residents of Roane County who are at least 25 years of age and have (i) contributed their time, talent or money to effectuate the purposes of the corporation, (ii) been invited by the Board of Directors of corporation of membership, (iii) received a notice of membership, and (iv) have been appointed as members by the Board of Directors in accordance with the bylaws of the corporation; and (d) who is at least 25 years of age of those companies (including sole proprietorships, partnerships, limited liability companies, and corporations) with their place of business located in Roane County that have (i) contributed their time, talent or money to effectuate the purposes of the corporation, (ii) been invited by the Board of Directors of corporation for a representative of the company identified by the Board of Directors to be a member, (iii) received a notice of membership, and (iv) had such representative approved as a member by the Board of Directors of the corporation in accordance with the bylaws of the corporation. However if such designated member ceases to be affiliated with such company, his membership in the corporation will be automatically revoked. Members of the corporation shall not be entitled to vote on any matter other than (a) election of directors at the annual meeting of the members of the corporation, (b) the removal of directors for cause, (c) the approval of any amendment to the articles of incorporation approved and recommended by the Board of Directors, (d) the amendment or repeal of the corporation's bylaws, and (e) the dissolution and liquidation of the corporation. There are 16 Board of Directors and 36 members that make up the class of members. |
| Form 990, Part VI, Section A, line 7a | See line 6 explanation above. |
| Form 990, Part VI, Section B, line 11 | The 990 is prepared by our accounting firm who works with the CEO and the VP of Finance to obtain data. Once complete, the 990 is submitted to the CEO for review and approval prior to filing. |
| Form 990, Part VI, Section B, line 12c | Board members are required to complete and sign a conflict of interest statement each year sent from either the hospital auditors or from the hospital compliance officer. We monitor compliance by making this part of the annual review of our compliance program. |
| Form 990, Part VI, Section B, line 15 | The CEO's salary/benefits are identified in his employment contract and an annual increase is recommended based on comparison data from public records showing other CEO salaries of similar sized hospitals in West Virginia and is approved by the Executive Committee of the Board. The key employee and physician salaries are contract driven and negotiated by the CEO based on market data. All other employees' salaries are based on an annual review ranging from 2-4% (avg. 3%) and reviewed annually against the WVHA salary survey with pay scale market upgrades as appropriate. |
| Form 990, Part VI, Section C, line 19 | An annual audited financial statement is published in the local newspaper as required by the Health Care Authority under Public Disclosure requirements. Audited financial statements are also submitted to any financing entities as required. |
| Form 990, Part XI, line 9: | Change in interest in net assets of Foundation 22,196. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Roane General Hospital Foundation | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 Hospital Drive | AddressLine1Txt |
| City | Spencer | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25276 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550745015 | EIN |
| Primary Activities | To support in furthering development of high quality health care. | PrimaryActivitiesTxt |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 11a, I | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Roane Medical Building Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 Hospital Drive | AddressLine1Txt |
| City | Spencer | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 25276 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550521219 | EIN |
| Primary Activities | Health care and social assistance - offices of physicians | PrimaryActivitiesTxt |
| Legal Domicile State | WV | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Hospital Development Co dba Roane General Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | $20,438 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $22,128 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | 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 | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | 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 |