Fayette Memorial Hospital Association: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- Fayette Memorial Hospital Association (EIN 35-0900741)
- Tax period
- 2014-10-01 to 2015-09-30
- Filed
- 2016-08-15
- IRS object ID
- 201622289349300842
- 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 C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-08-15T08:32:15-05:00 | ReturnTs |
| Tax Period End | 2015-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 351178661 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUE & CO LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 N MERIDIAN ST SUITE 200 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46204 | 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 | 350900741 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAYETTE MEMORIAL HOSPITAL ASSOCIATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FAYE | BusinessNameControlTxt |
| Phone | 7658255131 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1941 VIRGINIA AVE | AddressLine1Txt |
| City | CONNERSVILLE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47331 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RANDALL WHITE | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7658255131 | PhoneNum |
| Signature | 2016-08-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | ANGELA N CRAWFORD CPA | PreparerPersonNm |
| PTIN | P00573197 | PTIN |
| Phone | 3176334705 | PhoneNum |
| Preparation | 2016-08-12 | PreparationDt |
| 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 | FAYETTE REGIONAL HOSPITAL SYSTEM SERVES WHITEWATER VALLEY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | RANDALL WHITE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1941 VIRGINIA AVE | AddressLine1Txt |
| City | CONNERSVILLE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47331 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $52,413,396 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.FAYETTEREGIONAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1913 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | OUR VISION IS FOR OUR TEAM TO SERVE THE HEALTH NEEDS OF THE WHITEWATER VALLEY RESIDENTS BY PROVIDING COMPASSIONATE, HIGH QUALITY, COST EFFECTIVE CARE. FAYETTE REGIONAL HEALTH SYSTEM (FRHS) IS COMMITTED TO THE HEALTHCARE THAT THE COMMUNITY WANTS AND DESERVES; ACHIEVING THIS GOAL BY CONTINUING TO PROVIDE A FULL CONTINUUM OF INPATIENT AND OUTPATIENT HEALTHCARE SERVICES TO CONNERSVILLE AND THE SURROUNDING AREA' RESIDENTS. AT FRHS, WE ARE COMMITTED TO PROVIDING THE CARE FOR THE NEEDS OF THE COMMUNITY THROUGHOUT ITS LIFETIME. FOUNDED IN 1913, FRHS HAS BEEN PROVIDING QUALITY AND COMPASSIONATE HEALTH CARE FOR OVER 100 YEARS. THE MAIN HOSPITAL IS LOCATED IN THE HEART OF CONNERSVILLE, INDIANA, WITH FACILITIES IN ONE ADDITIONAL COUNTY IN ORDER TO PROVIDE QUALITY SERVICES CLOSE TO HOME. THE EQUIPMENT AND FACILITIES ENABLES US TO LIVE OUR MISSION. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 724 | TotalEmployeeCnt |
| Total Volunteers | 103 | TotalVolunteersCnt |
| Total Gross UBI | $1,393 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $393 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $45,242 | PYContributionsGrantsAmt |
| CY Contributions Grants | $22,256 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $50,715,751 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $45,164,649 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,347,485 | PYInvestmentIncomeAmt |
| CY Investment Income | $569,475 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,341,968 | PYOtherRevenueAmt |
| CY Other Revenue | $1,613,607 | CYOtherRevenueAmt |
| PY Total Revenue | $55,450,446 | PYTotalRevenueAmt |
| CY Total Revenue | $47,369,987 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $29,038 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $89,056 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $30,523,811 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $27,180,069 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $28,852,838 | PYOtherExpensesAmt |
| CY Other Expenses | $27,274,112 | CYOtherExpensesAmt |
| PY Total Expenses | $59,405,687 | PYTotalExpensesAmt |
| CY Total Expenses | $54,543,237 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$3,955,241 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$7,173,250 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $63,597,928 | TotalAssetsBOYAmt |
| Total Assets EOY | $56,150,827 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $38,312,251 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $38,783,089 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $25,285,677 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $17,367,738 | NetAssetsOrFundBalancesEOYAmt |
| Mission | FAYETTE REGIONAL HEALTH SYSTEM IS A MULTI-FACETED HEALTH CARE CENTER WHICH PROVIDES SAFE, ACCURATE AND COMPASSIONATE HEALTH CARE THROUGH SERVICE EXCELLENCE TO THE CITIZENS OF EAST CENTRAL INDIANA TO PROMOTE HEALING AND HEALTHY LIVING. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $47,328,982 | ExpenseAmt |
| Grant | $89,056 | GrantAmt |
| Revenue | $45,178,703 | RevenueAmt |
| Desc | THE HOSPITAL PROVIDES INPATIENT AND OUTPATIENT SERVICES AND ACUTE REHAB SERVICES. MEDICARE AND MEDICAID AMOUNTED TO APPROXIMATELY 73% OF TOTAL SERVICES PROVIDED BY THE HOSPITAL. UNINSURED CARE WAS APPROXIMATELY $1.7 MILLION, AS CALCULATED BY GROSS CHARGES, FOR THE YEAR ENDED SEPTEMBER 30, 2015. TOTAL COMMUNITY BENEFIT CONTRIBUTIONS ARE $142,504. | Desc |
| Total Program Service Expenses | $47,328,982 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | 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 | 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 | 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 | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 117 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 724 | 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 | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEBRA MICHALEK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7658277989 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1941 VIRGINIA AVENUE | AddressLine1Txt |
| City | CONNERSVILLE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47331 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| JAMES THOMAS | ||||||||
| BOARD CHAIR | 1.00 | 0.00 | Yes (X) | Yes (X) | $5,625 | $0 | $0 | |
| LOUISE WHITAKER | ||||||||
| BOARD VICE-CHAIR | 1.00 | 0.00 | Yes (X) | Yes (X) | $9,000 | $0 | $0 | |
| SANDRA CATES | ||||||||
| TREASURER | 1.00 | 0.00 | Yes (X) | Yes (X) | $4,500 | $0 | $0 | |
| JOEL LONG | ||||||||
| SECRETARY | 1.00 | 0.00 | Yes (X) | Yes (X) | $4,500 | $0 | $0 | |
| CHARLES BROCHIN | ||||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $5,625 | $0 | $0 | ||
| MELISSA MATNEY | ||||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MALCOLM MILES | ||||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $4,500 | $0 | $0 | ||
| RYAN MINNICH MD | ||||||||
| MEMBER & PHYSICIAN | 1.00 | 0.00 | Yes (X) | $292,417 | $0 | $1,936 | ||
| DAN PARKER | ||||||||
| MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL ROWE MD | ||||||||
| CHIEF OF STAFF | 40.00 | 0.00 | Yes (X) | $369,378 | $0 | $11,605 | ||
| WENDE SHIPLEY | ||||||||
| MEMBER | 40.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| RANDALL WHITE | ||||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | 1.00 | Yes (X) | Yes (X) | $253,703 | $0 | $16,114 | |
| DEBRA M MICHALEK | ||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | 0.00 | Yes (X) | $109,158 | $0 | $10,008 | ||
| BETH WAMPLER | ||||||||
| VP OF PATIENT CARE SVCS | 40.00 | 0.00 | Yes (X) | $152,711 | $0 | $10,255 | ||
| RHONDA MCPHERSON | ||||||||
| VP HUMAN RESOURCES | 40.00 | 0.00 | Yes (X) | $116,818 | $0 | $4,913 | ||
| DENNIS KNOEPFLER MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $433,294 | $0 | $14,078 | Yes (X) | ||
| SHIV KAPOOR MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $389,432 | $0 | $15,681 | Yes (X) | ||
| WILLIAM NESBITT MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $367,323 | $0 | $8,413 | Yes (X) | ||
| PETRONIO ILAGAN MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $302,721 | $0 | $15,893 | Yes (X) | ||
| JOHN LANDRY MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $298,407 | $0 | $16,114 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,119,112 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $125,010 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 27 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| AMERISOURCE - BERGEN | |||||
| 27550 NETWORK PLACE | CHICAGO | IL | 60673 | PHARMACEUTICAL SERVICES | $2,352,217 |
| RESOURCE ANESTHESIOLOGY | |||||
| 10 COMMERCE DRIVE | NEW ROCHELLE | NY | 10801 | ANESTHESIOLOGY SERVICES | $865,517 |
| SINGH MEDICAL ASSOCIATES | |||||
| 9020 HEYDON HALL CIRCLE | CHAROLETTE | NC | 28210 | PHYSICIAN SERVICES | $667,400 |
| INDIANA EMERGENCY PHYSICIANS | |||||
| PO BOX 674579 | DETROIT | MI | 48267 | PHYSICIAN SERVICES | $635,671 |
| WEATHERBY LOCUMS INC | |||||
| PO BOX 6972633 | DALLAS | TX | 75397 | LOCUM TENENS SERVICE PROVIDER | $625,890 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 40 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $22,256 | RelatedOrganizationsAmt |
| Total Contributions | $22,256 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $45,164,649 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $45,164,649 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $45,164,649 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $449,191 | TotalRevenueColumnAmt |
| Exclusion | $449,191 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $75,493 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $60,046 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $15,447 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,447 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,054 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $1,393 | UnrelatedBusinessRevenueAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $5,103,647 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $4,978,591 | SecuritiesAmt |
| Other | $4,772 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $125,056 | SecuritiesAmt |
| Other | -$4,772 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $120,284 | TotalRevenueColumnAmt |
| Exclusion | $120,284 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| EHR INCENTIVE PROGRAM | 900099 | $637,394 | $637,394 |
| BILLING SERVICES | 900099 | $245,974 | $245,974 |
| CAFETERIA REVENUE | 900099 | $209,087 | $209,087 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $505,705 | TotalRevenueColumnAmt |
| Exclusion | $505,705 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,598,160 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $47,369,987 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $45,178,703 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $1,393 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,167,635 | 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 | $89,056 | TotalAmt |
| Program Services | $89,056 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,327,935 | TotalAmt |
| Program Services | $1,152,502 | ProgramServicesAmt |
| Management And General | $175,433 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,574,656 | TotalAmt |
| Program Services | $18,724,434 | ProgramServicesAmt |
| Management And General | $2,850,222 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $387,814 | TotalAmt |
| Program Services | $336,580 | ProgramServicesAmt |
| Management And General | $51,234 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,287,111 | TotalAmt |
| Program Services | $1,984,961 | ProgramServicesAmt |
| Management And General | $302,150 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,602,553 | TotalAmt |
| Program Services | $1,390,840 | ProgramServicesAmt |
| Management And General | $211,713 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $384,366 | TotalAmt |
| Program Services | $333,588 | ProgramServicesAmt |
| Management And General | $50,778 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $208,534 | TotalAmt |
| Program Services | $180,985 | ProgramServicesAmt |
| Management And General | $27,549 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,873,060 | TotalAmt |
| Program Services | $8,568,733 | ProgramServicesAmt |
| Management And General | $1,304,327 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $299,801 | TotalAmt |
| Program Services | $260,194 | ProgramServicesAmt |
| Management And General | $39,607 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,163,065 | TotalAmt |
| Program Services | $5,348,864 | ProgramServicesAmt |
| Management And General | $814,201 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,655,498 | TotalAmt |
| Program Services | $3,172,571 | ProgramServicesAmt |
| Management And General | $482,927 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,951 | TotalAmt |
| Program Services | $65,917 | ProgramServicesAmt |
| Management And General | $10,034 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,538,160 | TotalAmt |
| Program Services | $1,334,954 | ProgramServicesAmt |
| Management And General | $203,206 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,885,498 | TotalAmt |
| Program Services | $2,504,296 | ProgramServicesAmt |
| Management And General | $381,202 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $781,327 | TotalAmt |
| Program Services | $678,106 | ProgramServicesAmt |
| Management And General | $103,221 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| HAF FEE | $971,612 | $893,883 | $77,729 |
| DUES & SUB. | $276,422 | $239,904 | $36,518 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $160,818 | TotalAmt |
| Program Services | $68,614 | ProgramServicesAmt |
| Management And General | $92,204 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,543,237 | TotalAmt |
| Program Services | $47,328,982 | ProgramServicesAmt |
| Management And General | $7,214,255 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,166,869 | BOYAmt |
| EOY | $1,214,815 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,469,525 | BOYAmt |
| EOY | $8,111,892 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $519,551 | BOYAmt |
| EOY | $372,058 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $852,954 | BOYAmt |
| EOY | $862,921 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $444,178 | BOYAmt |
| EOY | $315,659 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $82,349,519 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $57,022,436 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,839,716 | BOYAmt |
| EOY | $25,327,083 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,792,161 | BOYAmt |
| EOY | $13,959,090 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,248,517 | BOYAmt |
| EOY | $4,273,363 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $264,457 | BOYAmt |
| EOY | $1,713,946 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $63,597,928 | BOYAmt |
| EOY | $56,150,827 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,128,517 | BOYAmt |
| EOY | $6,541,592 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,275,701 | BOYAmt |
| EOY | $20,564,009 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,853,148 | BOYAmt |
| EOY | $1,873,844 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,054,885 | BOYAmt |
| EOY | $9,803,644 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,312,251 | BOYAmt |
| EOY | $38,783,089 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,328,373 | BOYAmt |
| EOY | $16,495,051 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $957,304 | BOYAmt |
| EOY | $872,687 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,285,677 | BOYAmt |
| EOY | $17,367,738 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $63,597,928 | BOYAmt |
| EOY | $56,150,827 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$7,173,250 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$660,072 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$84,617 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $876 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $876 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | PAY MEMBERSHIP DUES TO TRADE ORGANIZATIONS OF WHICH A PORTION OF THE DUES ARE USED FOR LOBBY EXPENSES BY THE TRADE ORGANIZATIONS. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,244,594 | OtherCostOrOtherBasisAmt |
| Book Value | $1,244,594 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $55,186,967 | OtherCostOrOtherBasisAmt |
| Depreciation | $35,598,239 | DepreciationAmt |
| Book Value | $19,588,728 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $25,779,425 | OtherCostOrOtherBasisAmt |
| Depreciation | $21,424,197 | DepreciationAmt |
| Book Value | $4,355,228 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $138,533 | OtherCostOrOtherBasisAmt |
| Book Value | $138,533 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $25,327,083 | TotalBookValueLandBuildingsAmt |
Financial Derivatives FinancialDerivativesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | $3,329,548 | BookValueAmt |
| Method Valuation | C | MethodValuationCd |
Closely Held Equity Interests CloselyHeldEquityInterestsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | $943,815 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $4,273,363 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| LINE OF CREDIT | $6,991,723 |
| DERIVIATIVE LIABILITY | $2,811,921 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $9,803,644 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $46,566,199 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$660,072 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$660,072 | RevenueNotReportedAmt |
| Revenue Subtotal | $47,226,271 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $208,534 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | -$64,818 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $143,716 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $47,369,987 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $54,399,521 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $64,818 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $64,818 | ExpensesNotReportedAmt |
| Expenses Subtotal | $54,334,703 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $208,534 | InvestmentExpensesNotIncld2Amt |
| Expenses Not Rpt Fincl Stmt | $208,534 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $54,543,237 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE SYSTEM AND RECOGNIZE A TAX LIABILITY IF THE SYSTEM HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE SYSTEM, AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2015 AND 2014, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. AS SUCH, THE SYSTEM IS GENERALLY EXEMPT FROM INCOME TAXES. HOWEVER, THE SYSTEM IS REQUIRED TO FILE FEDERAL FORM 990 - RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX WHICH IS AN INFORMATIONAL RETURN ONLY. THE SYSTEM IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, AS OF THE DATE THE FINANCIAL STATEMENTS WERE ISSUED, THERE WERE NOT AUDITS FOR ANY TAX PERIODS IN PROGRESS. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | LOSS ON FIXED ASSETS -4,772. RENT EXPENSES -60,046. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | LOSS ON FIXED ASSETS 4,772. RENT EXPENSES 60,046. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | 0 | FinancialAssistanceBudgetInd |
| 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 | $940,884 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $940,884 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01730 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,845,754 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,341,587 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $11,504,167 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.21090 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,786,638 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,341,587 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $12,445,051 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.22820 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 8 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $6,970 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,970 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 8 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $6,970 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,970 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 8 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $18,793,608 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,341,587 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $12,452,021 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.22830 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 22 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $82,086 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $82,086 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 22 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $82,086 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $82,086 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $7,036,282 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,244,411 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $12,068,996 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$2,824,585 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | 0 | 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 | FAYETTE REGIONAL HOSPITAL SYSTEM | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1941 VIRGINIA AVE | AddressLine1Txt |
| City | CONNERSVILLE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47331 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | HTTP://WWW.FAYETTEREGIONAL.ORG | WebsiteAddressTxt |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAYETTE MEMORIAL HOSPITAL ASSOCIATION | 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 | WWW.FAYETTEREGIONAL.ORG/PORTALS/O/PDF/FRHS_CHNA_FINAL.PDF | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 12 | 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 | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | 0 | AppFinancialAsstExplnInd |
| Includes Publicity Measures | 0 | IncludesPublicityMeasuresInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FAYETTE MEMORIAL HOSPITAL ASSOCIATION | PART V, SECTION B, LINE 5: FAYETTE REGIONAL HEALTH SYSTEM HELPED ORGANIZE A STEERING COMMITTEE COMPRISED OF COMMUNITY REPRESENTATIVES INCLUDING BUSINESS OWNERS, LOCAL OFFICIALS, HEALTHCARE PROVIDERS, MINORITY LEADERS, CLERGY, STUDENT REPRESENTATIVES, AND OTHER INTERESTED PARTIES. A 37-QUESTION SURVEY WAS DEVELOPED AND WIDELY DISSEMINATED TO THE RESIDENTS IN THE HOSPITAL'S SERVICE AREA VIA THE HOSPITAL'S WEBSITE, FACE-TO-FACE POLLING AT CONNERSVILLE WAL-MART AND COUNTY FARMERS' MARKET, AND MADE OPENLY AVAILABLE ON SURVEYMONKEY.COM. |
| FAYETTE MEMORIAL HOSPITAL ASSOCIATION | PART V, SECTION B, LINE 7D: THE CHNA CAN BE FOUND ON THE HOSPITAL'S WEBSITE: HTTP://WWW.FAYETTEREGIONAL.ORG/PORTALS/0/PDF/FRHS_CHNA_FINAL.PDF |
| FAYETTE MEMORIAL HOSPITAL ASSOCIATION | PART V, SECTION B, LINE 22D: THE HOSPITAL PROVIDES A DISCOUNT ON CHARGE MASTER RATES BASED ON THE FEDERAL POVERTY GUIDELINES FOR INDIVIDUALS THAT ARE ELIGIBLE FOR FINANCIAL ASSISTANCE. |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | THE HOSPITAL HAS A SLIDING SCALE BASED ON THE FEDERAL POVERTY GUIDELINES WITH FREE CARE TO INDIVIDUALS WHO HAVE INCOME BETWEEN 100% AND 133% OF POVERTY AND PROVIDE DISCOUNTED CARE UP TO INCOME OF 300% OF POVERTY. THE LARGEST NUMBER OF THE ORGANIZATION'S PATIENTS MEET THE FEDERAL POVERTY GUIDELINES FOR DISCOUNTED CARE AROUND 200% DEPENDING ON THE HOUSEHOLD SIZE. |
| PART I, LINE 6A: | ORGANIZATION'S COMMUNITY BENEFIT REPORT IS AVAILABLE UPON REQUEST. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | FRHS EMPLOYEES PARTICIPATE IN COMMUNITY BUILDING ACTIVITIES TO PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES. |
| PART III, LINE 4: | FOOTNOTE TO ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSES CAN BE FOUND IN THE AUDITED FINANCIAL STATEMENTS ATTACHED ON PAGE 8 "PATIENT ACCOUNTS RECEIVABLE AND, NET PATIENT SERVICE REVENUE AND, PAGE 9 "ALLOWANCE FOR DOUBTFUL ACCOUNTS". PART III, LINE 3: RATIONAL FOR INCLUDING OTHER BAD DEBT AMOUNT IN COMMUNITY BENEFIT: NONE HAS BEEN INCLUDED. THE HOSPITAL HAS A DETAILED CHARITY CARE POLICY WHICH STATES THAT TO PARTICIPATE IN CHARITY CARE CANDIDATES MUST COOPERATE FULLY. IN ADDITION THE HOSPITAL EDUCATES PATIENTS WITH LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THIS REASON THE ORGANIZATION BELIEVES THAT IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE. |
| PART III, LINE 8: | THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED SEPTEMBER 30, 2015 REPORT: HOSPITAL STATEMENT OF REIMBURSABLE COST. |
| PART VI, LINE 2: | THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES THROUGH ONGOING COMMUNICATION WITH LOCAL COMMUNITY LEADERS AND ORIGINATIONS. THE HOSPITAL TEAM MEMBERS REGULARLY PARTICIPATE IN COMMUNITY EVENTS AND LOCAL CIVIC ORGANIZATIONS INCLUDING ROTARY, KIWANIS, AND CHAMBER OF COMMERCE. COMMUNITY NEEDS ARE DISSEMINATED THROUGH THESE LOCAL COMMUNITY ORGANIZATIONS AND EVENTS PROVIDING THE HOSPITAL WITH FEEDBACK REGARDING THE NEEDS OF THE COMMUNITY. IN ADDITION THE HOSPITAL COMPLETES AND SUBMITS ANNUALLY A COMMUNITY BENEFIT PLAN TO THE INDIANA STATE DEPARTMENT OF HEALTH WHICH ADDRESSES THE GOALS SET TO FOCUS ON THE NEEDS OF THE COMMUNITY.FRHS RECOGNIZES FIVE PRIMARY AREAS OF CONCERN FACING ITS COMMUNITY AS THE FRHS EMPHASIS IN THE IMPLEMENTATION OF THE COMMUNITY BENEFIT PLAN: 1. CITIZENS WHO ARE MEDICALLY UNDERSERVED. 2. ISSUES THAT IMPACT ADOLESCENTS INCLUDING EDUCATION, PREGNANCY AND GENERAL BEHAVIORAL CONCEPTS SPECIFIC TO THIS AGE GROUP. 3. CHILDHOOD GROWTH AND DEVELOPMENT, AS WELL AS ABUSE AND NEGLECT PREVENTION. 4. HEALTH ISSUES THAT REQUIRE INCREASED AWARENESS IN THE GENERAL COMMUNITY POPULATION. 5. CHALLENGES IMPACTING THE AREA WHICH DIRECTLY RELATE TO THE COMMUNITY'S ABILITY TO OBTAIN COMPREHENSIVE MEDICAL CARE. |
| PART VI, LINE 3: | ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS DISCUSSED WITH PATIENTS OR GUARANTORS TO INFORM AND EDUCATE PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE. CHARITY CARE APPLICATIONS AND PAMPHLETS DETAILING BILLING PROCEDURES AND CONTACT INFORMATION FOR THE BILLING OFFICE ARE MADE AVAILABLE TO PATIENTS. ANY QUESTIONS REGARDING THE ORGANIZATION'S WRITTEN CHARITY CARE POLICY CAN BE DIRECTED AND ANSWERED BY A MEMBER OF THE PATIENT ACCOUNTS' PERSONNEL. PATIENT ACCOUNTS' PERSONNEL WILL NOTIFY INDIVIDUALS WITH APPROVED APPLICATIONS QUALIFYING FOR REDUCED LIABILITY UNDER THE CHARITY CARE POLICY. FRHS STAFFS A FULL TIME REPRESENTATIVE FROM CLAIMAID CONSULTING 5 DAYS A WEEK TO ASSIST COMMUNITY MEMBERS WITH ELIGIBILITY FOR ASSISTANCE FOR PROGRAMS SUCH AS MEDICAID, HIP, AND OTHER PRIVATE ASSISTANCE PROGRAMS. |
| PART VI, LINE 4: | FRHS'S MAIN AREAS OF SERVICE ARE FAYETTE, FRANKLIN AND UNION COUNTIES SERVING AN APPROXIMATE POPULATION OF 54,000. FAYETTE COUNTY HAS RANKED IN THE TOP TWO COUNTIES FOR UNEMPLOYMENT IN THE PAST SEVERAL YEARS AND HAS A HIGH NUMBER OF PRIVATE PAY INDIVIDUALS. UNION COUNTY AND FRANKLIN COUNTY HAVE LITTLE TO NO INDUSTRY.PART VI, LINE 5: DURING THE FISCAL YEAR FRHS HAS DEMONSTRATED CONTINUED COMMUNITY STEWARDSHIP THROUGH THE ATTAINMENT OF MANY GOALS THAT ADDRESS THE NEEDS OF OUR COMMUNITY. WE CONTINUE TO STRIVE FOR EXCELLENCE IN THE CONTRIBUTIONS AND SERVICES THAT WE PROVIDE TO AREA CITIZENS. DETAILS FOR FURTHERING FRHS'S EXEMPT PURPOSE FOR **MEDICALLY UNDERSERVED CITIZEN: THE FRANKLIN COUNTY COMMUNITY HAS CONTINUED TO BENEFIT FROM THE SERVICES AT THE BROOKVILLE HEALTHPLEX FACILITY WITH LABORATORY AND RADIOLOGY SERVICES. SUSTAINED CARDIOLOGY AND ONCOLOGY SERVICES WITH THE FRHS CARE CENTERS ENABLE PATIENTS TO BE SEEN LOCALLY FOR MORE ACCESSIBLE CARE WITH LESS TRAVEL, TIME AND EXPENSE. THE ST VINCENT CARDIOLOGY GROUP CONTINUES TO ADDRESS THE NEED FOR LOCAL SERVICES FOR OUR CARDIAC PATIENTS, DECREASING THE COST OF COMMUTING. RADIATION ONCOLOGY WAS ADDED TO OUR CANCER CENTER TO DECREASE COMMUTE DEMANDS ON PATIENTS THAT REQUIRE THIS TREATMENT. AN IMMEDIATE CARE FACILITY HAS REMAINED OPEN IN CONNERSVILLE TO ASSIST PATIENTS TO BETTER ACCESS CARE WITHOUT EXPENSIVE TRAVEL AND TRANSPORTATION ARRANGEMENTS FOR THOSE WITHOUT VEHICLES. THIS SERVICE DECREASES PATIENT COSTS AS IT IS NOT AS EXPENSIVE AS A VISIT TO THE EMERGENCY DEPARTMENT. LABORATORY AND RADIOLOGY SERVICES FURTHER HELP PATIENTS TO REMAIN LOCAL FOR TESTING.SPONSORSHIP OF THE ANNUAL COMMUNITY HEALTH FAIRS IN FAYETTE, UNION AND FRANKLIN COUNTIES WITH EXTENSIVE REPRESENTATION OF FRHS SERVICES BY STAFF HAS CONTINUED. A WIDE ARRAY OF SCREENINGS OFFERED INCLUDED BLOOD PRESSURE, BLOOD SUGAR, CHOLESTEROL AND BONE DENSITY. TEAM MEMBERS WERE AVAILABLE TO HELP PARTICIPANTS UTILIZE HEALTH RISK SURVEYS AS WELL AS TO EDUCATE THEM ON A VARIETY OF HEALTH ISSUES. ALL ATTEMPTS ARE MADE TO OFFER FREE HEALTH AIDES SUCH AS PILL DISPENSERS, NUTRITIONAL GUIDES FOR FAST FOOD RESTAURANTS, ETCETERA. TWO CARDIAC SCORING PROCEDURES, FEMALE WELLNESS EXAM, AND CHOLESTEROL SCREENING CERTIFICATES WERE AMONG THE BOOTH PRIZES GIVEN AWAY AT THE EVENT. THERE WAS AN FRHS PRESENCE IN COMMUNITY HEALTH FAIRS IN 2013 OFFERED BY STAFF INCLUDING TWO IN AN INDUSTRIAL SETTING AT ROOTS BLOWER & SAPA FOR EASY ACCESS FOR THEIR EMPLOYEES. AS IN THE PAST YEAR, STAFF WAS INVOLVED WITH A HEALTH FAIR AT THE FRANKLIN COUNTY LIBRARY THAT ADDRESSED HEALTH NEEDS IN THAT COMMUNITY.MULTIPLE VOLUNTEERS WERE INVOLVED IN FOOD PANTRIES AND MINISTRIES TO ASSIST LOW INCOME INDIVIDUALS WITH NUTRITIONAL AID WHICH IMPACT THEIR GENERAL HEALTH. AN FRHS FOOD DRIVE IS HELD IN FEBRUARY TO ASSIST WITH THE POST-HOLIDAY NEED FOR FOOD. THIS SERVICE CANNOT BE UNDERVALUED AT AN ECONOMIC TIME WHEN MANY FAMILIES HAVE BASIC NUTRITIONAL NEEDS THAT ARE NOT BEING MET IN A MORE TRADITIONAL FASHION. FRHS STAFF HAS HAD A LONG TERM COMMITMENT TO PARTICIPATE IN THE ANGEL FOOD MINISTRIES PROGRAM IN THE SERVICE AREA. FUND RAISING FOR CHARITABLE ORGANIZATIONS INVOLVED IN EDUCATIONAL ASSISTANCE THROUGH SCHOLARSHIP PROGRAMS WAS CONTINUED BY FRHS STAFF. PARTICIPATION IN THE FAYETTE AND FRANKLIN COUNTY RELAY FOR LIFE CANCER SOCIETY EVENTS RAISED FUNDS TO ENABLE CARE/SERVICES FOR ONCOLOGY PATIENTS AND SURVIVORS OF CANCER. ADDITIONALLY, FRHS ASSISTED FURTHER THROUGH ANNOUNCEMENTS FOR THE RELAY AND A MONETARY GIFT. MANY FRHS TEAM MEMBERS AND LEADERSHIP STAFF CONTRIBUTED TIME TO WALK DURING THE 24 HOUR EVENT. THERE WAS ALSO PARTICIPATION IN THE STATE SUSAN B KOMEN WALK IN INDIANAPOLIS. AN FRHS TEAM MEMBER IS ON THE CANCER SOCIETY BOARD AND ATTENDS MONTHLY MEETINGS. FINANCIAL DONATIONS WERE PROVIDED FOR ACTIVITIES INCLUDING THE DONUT DAYS AND JEANS DAYS TO RAISE FUNDS. A BREAST CANCER AWARENESS TABLE WAS AVAILABLE IN THE FRHS ATRIUM TO EDUCATE PATIENTS AND STAFF. FRANKLIN AND FAYETTE COUNTY CANCER SOCIETIES BOTH RECEIVED A DONATION FROM FRHS. BREAST CANCER AWARENESS IN PARTICULAR WAS SUPPORTED IN 2013 WITH THE PINK PJ PARTY FOR BREAST CANCER AWARENESS THAT INCLUDED A FASHION SHOW. SEVERAL COMMUNITY SERVICE GROUPS INCLUDING PSI IOTA XI, TRI KAPPA, AND ETA PI KAPPA WERE ASSISTED WITH PROGRAMS AND PROJECTS THAT DIRECTLY IMPROVED THE MEDICAL OUTCOME FOR COMMUNITY MEMBERS WHILE ALSO INCREASING HEALTH EDUCATION. MANY HOURS WERE DONATED BY FRHS STAFF TO THE LOCAL HOPE PREGNANCY CRISES CENTER AS WELL AS THE HOUSE OF RUTH SHELTER FOR PROGRAMS AND PROJECTS TO HELP MEET THE NEEDS OF THIS POPULATION. THERE WAS A SILENT AUCTION THIS YEAR THAT STAFF SUPPORTED. A LOCAL GOLF TOURNEY AND THE ANNUAL GALA EVENT HAVE RAISED FUNDS TO PROVIDE ADDITIONAL HEALTH SERVICES TO THE COMMUNITY AS WELL AS TO UPDATE FACILITIES. AREA 9 AGENCY ON AGING WAS SUPPORTED MONETARILY FOR THE ANNUAL PICNIC AS WELL AS THE VOLUNTEER LUNCH FOR THE PLANNING PROCESS. **ADOLESCENT POPULATION ISSUES: THE WHITEWATER CARE PAVILION OFFERS COMPREHENSIVE BEHAVIORAL HEALTH SERVICES FOR ADOLESCENTS INCLUDING RESIDENTIAL, ACUTE INPATIENT CARE AND OUTPATIENT THERAPY OPTIONS. FRHS ENCOURAGED YOUTH TO BE ACTIVE AND HEALTH CONSCIOUS THROUGH COACHING AND SEVERAL SPONSORSHIPS FOR YOUTH SPORTS GROUPS INCLUDING BASKETBALL, GYMNASTICS, WRESTLING, FRANKLIN COUNTY BOYS BASEBALL, CONNERSVILLE PARKS AND RECREATION PROGRAM, CAST SWIMMING, CHEERLEADING AND A 5K RUN. MANY LOCAL YOUTH GROUPS AND INDIVIDUAL CHILDREN WERE ASSISTED BY FRHS STAFF THROUGH ACTIVITIES SUCH AS 4H FAIR, BOYS AND GIRLS CLUB, AND BIG BROTHERS/BIG SISTERS. BOY SCOUTS AND GIRL SCOUTS WERE ALSO SUPPORTED. SEVERAL SPORTS PHYSICALS FOR LOCAL HIGH SCHOOL AND ELEMENTARY YOUTH WERE SPONSORED AND STAFFED BY FRHS TEAM MEMBERS, ENABLING THEM TO PARTICIPATE IN SCHOOL SPORTS PROGRAMS AND WERE COMPLETED BY FRHS PHYSICIANS. AS WELL, TEAM MEMBER PROVIDED BLOOD PRESSURE CHECKS AT COMMUNITY BASKETBALL GAMES. PROM AND AFTER PROM WERE SPONSORED BY FRHS DONATIONS. ST GABRIEL'S AMERICAN HERITAGE GIRLS (WHICH IS SIMILAR TO GIRL SCOUTS) WAS SUPPORTED BY A STAFF MEMBER BY VOLUNTEERING AS A GROUP LEADER. ADDITIONALLY, OVER 50 HOURS WERE DONATED TO SUPPORT OTHER SCHOOL AND CHURCH EVENTS AT ST GABRIEL'S SCHOOL. JUNIOR ACHIEVEMENT BANQUET WAS SUPPORTED BY FRHS. FRHS PURCHASED THE SCORE BOARD FOR THE BABE RUTH LEAGUE BALLPARK FOR LOCAL BASEBALL LEAGUES FOR AREA YOUTH. STAFF MEMBER DONATED TIME ON THE ADVISORY BOARD FOR THE WHITE WATER TECH CAREER CENTER AND VOLUNTEERED AT THE LINK FUNDRAISER. OVER 100 HOURS WERE ALSO DONATED BY FRHS STAFF FOR AN AFTER SCHOOL PROGRAM THROUGH THE LINK PROGRAM. HEALTH CARE PROFESSIONALS SPOKE AT LOCAL CLASSES, AND PARTICIPATED IN FUNDRAISING FOR SCHOLARSHIPS. FOOD, CLOTHING, AND SHELTER PROVISIONS ARE PROVIDED IN COOPERATION WITH COMMUNITY CHURCHES, MISSIONS, SORORITY ACTIVITIES, AND SCHOOL CORPORATION PROJECTS. FRHS STAFF DONATED TIME TO THE LOCAL HOPE PREGNANCY CARE CENTER FOR PROGRAMS AND PROJECTS TO HELP MEET THE NEEDS OF THIS POPULATION. A BABY FORMULA PROGRAM THROUGH THE HOPE PREGNANCY CENTER IS AVAILABLE FOR TEEN MOTHERS FOR THEIR BABY'S NUTRITIONAL NEEDS. DONATIONS WERE OFFERED TO THE CONNERSVILLE HIGH SCHOOL ATHLETICS AND BAND PROGRAMS INCLUDING THE CROSS COUNTRY TEAM. |
| PART VI, LINE 5: | **CONTINUE OF ADOLESCENT POPULATION** FRHS STAFF ASSISTED WITH TICKET SALES FOR THE FRANKLIN COUNTY SPRING PLAY. THERE CONTINUED TO BE STRONG PARTICIPATION IN THE FAYETTE CO. 4H FAIR BY PURCHASING LIVESTOCK FROM TEAM MEMBERS CHILDREN THAT PARTICIPATE IN THESE PROGRAMS AS WELL AS SPONSORSHIP IN FRANKLIN COUNTY 4H FAIR ACTIVITIES.**CHILDHOOD ISSUES: CHRISTMAS GIVING TO THE DIVISION OF FAMILY AND CHILDREN INITIATIVE WHERE DEPARTMENTS SPONSOR NEEDY CHILDREN AT THE HOLIDAY WITH SHOES, CLOTHING, BOOKS AND TOYS WAS AGAIN SUPPORTED BY FRHS DEPARTMENT STAFF. THE DEPARTMENTS SUPPORT CHILDREN ACTIVITIES SUCH AS CHURCH HOLIDAY PROGRAMS, THE 4H FAIR, GIRL SCOUTS, BOY SCOUTS AND CUB SCOUTS. FRHS STAFF MEMBER HANDED OUT BACKPACKS WITH SCHOOL SUPPLIES AT THE PARK ROAD CHRISTIAN CENTER. 97 HOURS WERE DONATED TO THE SAMARITAN'S PURSE OPERATION CHRISTMAS CHILD THROUGH WORK AS A CHURCH AND COMMUNITY RELATIONS VOLUNTEER AS WELL AS PACKING BOXES. TEAM MEMBERS VOLUNTEERED HOURS FOR A VARIETY OF DIVISION FOR FAMILY AND CHILDREN ACTIVITIES INCLUDING A GIFT DRIVE AT CHRISTMAS, A COAT DRIVE, A BOOK DRIVE AND A FOOD DRIVE TO BENEFIT FAMILIES IN OUR AREA. ENJOYMENT COMBINED WITH CHARITY IN THE COMMUNITY PROGRAMS THAT INCLUDE THE BIKE RODEO SAFETY EVENT AND THE THOMAS THE TRAIN ACTIVITY WHICH BENEFITED THE HOUSE OF RUTH SHELTER LOCALLY. A DONATION TO THE UNITED YOUTH PROJECT WAS OFFERED. **INCREASING HEALTHCARE-RELATED ISSUES AWARENESS AND EDUCATION: SPEAKING ENGAGEMENTS WERE DONATED BY STAFF ON A VARIETY OF HEALTH ISSUES AT LOCAL SCHOOL, EVENTS AND COMMUNITY GROUPS. FRHS HAS COORDINATED LIVING THROUGH GRIEF AND LIVING THROUGH CANCER GROUPS FOR TEN YEARS TO COUNSEL AND SUPPORT FAMILIES THROUGH DIFFICULT FAMILY SITUATIONS. SMOKING CESSATION PROGRAM IS AVAILABLE THROUGH THE FRHS HEALTH WORKS DEPARTMENT. FRHS HOME HEALTH OFFERS BLOOD PRESSURE AND BLOOD GLUCOSE CLINICS AT VARIOUS SITES IN FRANKLIN, FAYETTE AND UNION COUNTY. A TEAM MEMBER IS ON THE LOCAL PROLIFE COMMITTEE AND STAFF HAVE PARTICIPATED IN THE LIFE CHAIN EVENT IN THE COMMUNITY. NUTRITIONAL PROGRAMS AT THE FAYETTE COUNTY COURTHOUSE, IVY TECH, AND SEVERAL OTHER COMMUNITY CENTERS WERE PRESENTED IN THE PAST YEAR. ALSO, STAFF PREPARED A PROGRAM FOR THE DIABETES SUPPORT GROUP. A STAFF MEMBER DONATED OVER 100 HOURS WORKING AT THE LORD'S KITCHEN BY SHOPPING, COOKING, SERVING AND CLEANING UP AT THIS LOCAL SOUP KITCHEN FOR THE NEEDY. ANOTHER STAFF MEMBER DONATED OVER 200 HOURS WITH THE COMMUNITY SHARING PROGRAM HANDING OUT FOOD AT THE FAYETTE COUNTY ANNEX BUILDING. CPR AND FIRST AID ARE TAUGHT BY AN FRHS VOLUNTEER AT NURSING HOMES AND A LOCAL BUSINESS. TEAM MEMBER WAS THE OUTPATIENT CLINICAL INSTRUCTOR FOR THE DPT STUDENTS. FRHS STAFF HAVE PARTICIPATED AND CONTRIBUTED TO THE WALK FOR ALZHEIMER'S, WALK FOR AUTISM, WALK A MILE IN HER SHOES (DOMESTIC VIOLENCE AWARENESS) AND THE HOME RUN 5K RUN FOR THE HIGH SCHOOL.**OTHER AREAS OF PARTICIPATION BEYOND THE PREVIOUSLY STATED GOALS INCLUDE: THE FRHS FOUNDATION IS A CAUSE THAT FRHS STAFF SUPPORTS ANNUALLY THROUGH A VARIETY OF FUNCTIONS SUCH AS THE GOLF OUTING. OVER 80 HOURS WERE DONATED BY STAFF. OVER 1000 HOURS WERE DONATED BY FRHS THROUGH PARTICIPATION IN LOCAL MINISTRIES INCLUDING VBS, CHURCH ACTIVITIES, FOOD DRIVES AND PANTRIES, AND CHRISTMAS PROGRAMS FOR THE NEEDY INDIVIDUALS IN OUR COMMUNITIES. MANY STAFF MEMBERS VOLUNTEERED TIME AND SERVICES FOR A LOCAL FUNDRAISER FOR THE SON OF A TEAM MEMBER, TO ASSIST HIS FAMILY WITH EXPENSES DURING HIS ILLNESS. TEAM MEMBER IS THE CHAPLAIN AND TREASURER FOR THE LADIES AUXILIARY AT THE EAGLES CLUB. CONTRIBUTED FINANCIALLY TO THE CONNERSVILLE AND FRANKLIN COUNTY CHAMBER OF COMMERCE, KIWANIS, JAYCEES, OPTIMIST CLUB, CONNERSVILLE FOP, BICENTENNIAL COMMITTEE, AND VONDA BISHOP MINISTRIES CHARITY. DONATION TO THE CAMBRIDGE CITY FIRE DEPT FOR THE WESTERN WAYNE FIREMAN 5K RUN. BLOOD WAS DONATED BY STAFF MEMBERS FOR THE BLOOD DRIVE SPONSORED BY FRHS. CONNERSVILLE IS CELEBRATING ITS BICENTENNIAL IN 2013. A STAFF MEMBER IS ON THAT COMMITTEE TO PLAN THIS EVENT. A FINANCIAL DONATION IS ALSO INCLUDED IN THE FRHS SUPPORT OF THIS UPCOMING COMMUNITY CELEBRATION. WE CONTINUE TO SEARCH FOR NEW AVENUES TO INCREASE THE AWARENESS AND HEALTH STATUS OF THE CITIZENS OF OUR MULTI COUNTY AREA. |
| PART VI, LINE 6: | NOT APPLICABLE. ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | IN |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAYETTE COUNTY SCHOOLS | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1941 VIRGINIA AVE | AddressLine1Txt |
| City | CONNERSVILLE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47331 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRC Section | N/A | IRCSectionDesc |
| Non Cash Assistance | $59,587 | NonCashAssistanceAmt |
| Valuation Method Used | COST OF SERVICES | ValuationMethodUsedDesc |
| Non Cash Assistance | ATHLETIC TRAINER SERVICES | NonCashAssistanceDesc |
| Purpose Of Grant | DONATED ATHLETIC TRAINER SERVICES | PurposeOfGrantTxt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | ASSISTANCE IS PROVIDED TO PUBLIC CHARITIES FOR GENERAL SUPPORT. THE ORGANIZATION DOES NOT MONITOR THE USE OF THESE FUNDS BY THESE PUBLIC CHARITIES. IN ADDITION THE ORGANIZATION MAKES SCHOLARSHIPS AND STUDENT LOANS AVAILABLE TO ELIGIBLE PERSONS TO FURTHER HEALTHCARE IN THE COMMUNITY. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RYAN MINNICH MD | ||||||||||||||
| MEMBER & PHYSICIAN | $287,917 | $0 | $0 | $0 | $4,500 | $0 | $0 | $0 | $1,936 | $0 | $294,353 | $0 | $0 | $0 |
| MICHAEL ROWE MD | ||||||||||||||
| CHIEF OF STAFF | $357,378 | $0 | $0 | $0 | $12,000 | $0 | $7,800 | $0 | $3,805 | $0 | $380,983 | $0 | $0 | $0 |
| RANDALL WHITE | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $253,703 | $0 | $0 | $0 | $0 | $0 | $7,611 | $0 | $8,503 | $0 | $269,817 | $0 | $0 | $0 |
| BETH WAMPLER | ||||||||||||||
| VP OF PATIENT CARE SVCS | $152,711 | $0 | $0 | $0 | $0 | $0 | $4,581 | $0 | $5,674 | $0 | $162,966 | $0 | $0 | $0 |
| DENNIS KNOEPFLER MD | ||||||||||||||
| PHYSICIAN | $433,294 | $0 | $0 | $0 | $0 | $0 | $7,800 | $0 | $6,278 | $0 | $447,372 | $0 | $0 | $0 |
| SHIV KAPOOR MD | ||||||||||||||
| PHYSICIAN | $389,432 | $0 | $0 | $0 | $0 | $0 | $7,800 | $0 | $7,881 | $0 | $405,113 | $0 | $0 | $0 |
| WILLIAM NESBITT MD | ||||||||||||||
| PHYSICIAN | $367,323 | $0 | $0 | $0 | $0 | $0 | $7,800 | $0 | $613 | $0 | $375,736 | $0 | $0 | $0 |
| PETRONIO ILAGAN MD | ||||||||||||||
| PHYSICIAN | $302,721 | $0 | $0 | $0 | $0 | $0 | $7,800 | $0 | $8,093 | $0 | $318,614 | $0 | $0 | $0 |
| JOHN LANDRY MD | ||||||||||||||
| PHYSICIAN | $298,407 | $0 | $0 | $0 | $0 | $0 | $7,800 | $0 | $8,314 | $0 | $314,521 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 7 | FormAndLineReferenceDesc |
| Explanation | PERFORMANCE INCENTIVE PAY IS A GOAL-BASED NON-FIXED PAYMENT THAT IS DIRECTLY TIED TO THE PERFORMANCE OF THE INDIVIDUAL IN ACHIEVING PERSONAL AND ORGANIZATIONAL GOALS. THE PROGRAM IS GOVERNED BY THE BOARD OF TRUSTEES AND DELEGATED TO THE EXECUTIVE COMMITTEE OF THE BOARD TO BE REVIEWED AND APPROVED. PAYOUTS ARE BASED ON EACH INDIVIDUAL'S PERFORMANCE AGAINST PRE-DEFINED GOALS AND OBJECTIVES ALIGNED WITH THE OVERALL MISSION, VISION, AND STRATEGIC GOALS OF THE ORGANIZATION AND THE PROFITABILITY OF FRHS FOR THE FISCAL YEAR. IF THE HOSPITAL MEETS OR EXCEEDS BUDGET WITH RESPECT TO EXCESS REVENUE OVER EXPENSES EXCLUDING ANY INTEREST INCOME, EACH EMPLOYEE WILL RECEIVE ON WEEK'S PAY BASED UPON AN AVERAGE NUMBER OF REGULAR SCHEDULED HOURS WORKED PER WEEK. | 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 | INDIANA FINANCE AUTHORITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 351602316 | BondIssuerEIN |
| Bond Issued | 2015-03-23 | BondIssuedDt |
| Issue Price | $20,443,000 | IssuePriceAmt |
| Purpose | SEE PART VI | 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 | $711,692 | RetiredAmt |
| Total Proceeds | $20,443,000 | TotalProceedsAmt |
| Other Spent Proceeds | $20,443,000 | OtherSpentProceedsAmt |
| Current Refunding | Yes (1) | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | 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 | Yes (1) | MgmtContractBondFincdPropInd |
| Engage Bond Counsel Contracts | Yes (1) | EngageBondCounselContractsInd |
| 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 | Yes (1) | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | Yes (1) | 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 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCH K, PART I, LINE A, COLUMN (F), DESCRIPTION OF PURPOSE: | FormAndLineReferenceDesc |
| Explanation | THE 2015 RE-ISSUANCE OF INDIANA FINANCE AUTHORITY HEALTH FACILITY REVENUE AND REFUNDING BONDS, SERIES 2013, USED TO COVER THE COST OF ISSUING THE BONDS; REFUND ALL OF THE OUTSTANDING INDIANA HEALTH FACILITY FINANCING AUTHORITY VARIABLE RATE DEMAND REVENUE BONDS, SERIES 2002A AND 2002B ISSUED 2/28/2002 AND 7/3/2002, RESPECTIVELY; AND FINANCE ASSETS FOR CONSTRUCTION OF A NEW 12-BED GERIATRIC/PSYCHOLOGY UNIT IN CONNERSVILLE, INDIANA. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE PROCESS OF REVIEWING THE FORM 990 ENTAILS A DETAILED REVIEW OF THE FORM 990 BY THE ORGANIZATION'S CFO AND CONTROLLER. THE GOVERNING BODY REVIEWS AND APPROVES THE FORM 990 INCLUDING REQUESTED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, AND ARE PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANNUAL INFORMATION ABOUT THE CONFLICT OF INTEREST AND DISCLOSURE ARE PROVIDED TO MEMBERS OF THE BOARD OF TRUSTEES, CHIEF EXECUTIVE OFFICER, ADMINISTRATIVE STAFF, ALL DEPARTMENT MANAGERS, INDIVIDUALS WITH INFLUENCE OVER PURCHASING, AND INDIVIDUALS WITH CONTRACTS TO FAYETTE REGIONAL HOSPITAL SYSTEM. ANNUAL QUESTIONNAIRES ARE TO BE COMPLETED BY EACH MEMBER OF THE BOARD OF TRUSTEES AND THE EXECUTIVE TEAM, THEN REVIEWED AND NOTED IN THE BOARD MINUTES. IN ADDITION, ANY INDIVIDUAL ASSOCIATED WITH FAYETTE REGIONAL HEALTH SYSTEM IS TO DECLARE SITUATIONS OF ACTUAL OR POTENTIAL CONFLICTS OF INTEREST AS THEY ARISE, IN WRITING, AND IN SUFFICIENT DETAIL. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE PROCESS FOR DETERMINING COMPENSATION FOR THE CEO IS GOVERNED BY THE BOARD OF TRUSTEES AND DELEGATED TO THE EXECUTIVE COMMITTEE OF THE BOARD TO REVIEW AND APPROVE ANNUALLY. IN ADDITION, ALL EMPLOYMENT CONTRACTS AND AMENDMENTS FOR THE CEO WILL BE REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD AND CO-SIGNED BY THE CHAIR OF THE BOARD OF TRUSTEES AND THE SECRETARY OF THE BOARD. THE PROCESS FOR DETERMINING COMPENSATION FOR OTHER OFFICERS/KEY EMPLOYEES IS REVIEWED ANNUALLY BY THE EXECUTIVE COMMITTEE AND CEO. THE SECRETARY OF THE BOARD OF TRUSTEES IS RESPONSIBLE FOR RECORDING IN THE MINUTES THE DELIBERATION AND DECISIONS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 8,568,733. MANAGEMENT AND GENERAL EXPENSES 1,304,327. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,873,060. |
| FORM 990, PART XI, LINE 9: | CHANGE IN TEMPORARILY RESTRICTED NET ASSETS LOSS ON DEBT EXTINGUISHMENT CHANGE IN TEMPORARILY RESTRICTED NE -84,617. |
| PART XI, LINE 2C | THE AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT; AND NO PROCESSES HAVE CHANGED FROM PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAYETTE MEMORIAL HOSPITAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1941 VIRGINIA AVENUE | AddressLine1Txt |
| City | CONNERSVILLE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 47331 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311010071 | EIN |
| Primary Activities | TO BENEFIT FAYETTE REGIONAL HOSPITAL SYSTEM | PrimaryActivitiesTxt |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 11A, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAYETTE REGIONAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | Yes (1) | 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 | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| FAYETTE MEMORIAL HOSPITAL FOUNDATION | ||
| C | $22,256 | FAIR MARKET VALUE |
| FAYETTE MEMORIAL HOSPITAL FOUNDATION | ||
| L | $141,480 | COST OF SERVICES |