STONEWALL JACKSON MEMORIAL HOSPITAL COMPANY: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- STONEWALL JACKSON MEMORIAL HOSPITAL COMPANY (EIN 55-0422958)
- Tax period
- 2014-10-01 to 2015-09-30
- Filed
- 2016-08-15
- IRS object ID
- 201622289349306232
- 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 G
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-08-15T16:57:59-05:00 | 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 | 550422958 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Stonewall Jackson Memorial Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STON | BusinessNameControlTxt |
| Phone | 3042698059 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 230 Hospital Plaza | AddressLine1Txt |
| City | WESTON | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26452 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Avah Stalnaker | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 3042698059 | PhoneNum |
| Signature | 2016-08-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Tessa W Carr | PreparerPersonNm |
| PTIN | P01291277 | PTIN |
| Phone | 3043460441 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-09-27 15:27:22Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Avah L Stalnaker | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 230 Hospital Plaza | AddressLine1Txt |
| City | WESTON | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26452 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $70,995,766 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.stonewallhospital.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1959 | FormationYr |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Activity Or Mission | It is the mission of Stonewall Jackson Memorial Hospital to provide excellent care to all we serve. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 591 | TotalEmployeeCnt |
| Total Volunteers | 35 | TotalVolunteersCnt |
| Total Gross UBI | $5,999 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $4,999 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $136,130 | PYContributionsGrantsAmt |
| CY Contributions Grants | $104,137 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $46,451,333 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $45,424,033 | CYProgramServiceRevenueAmt |
| PY Investment Income | $3,510,911 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,614,998 | CYInvestmentIncomeAmt |
| PY Other Revenue | $262,761 | PYOtherRevenueAmt |
| CY Other Revenue | $469,539 | CYOtherRevenueAmt |
| PY Total Revenue | $50,361,135 | PYTotalRevenueAmt |
| CY Total Revenue | $47,612,707 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $26,500 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $30,626 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $25,267,557 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $27,648,093 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $20,920,592 | PYOtherExpensesAmt |
| CY Other Expenses | $20,966,158 | CYOtherExpensesAmt |
| PY Total Expenses | $46,214,649 | PYTotalExpensesAmt |
| CY Total Expenses | $48,644,877 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,146,486 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,032,170 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $71,202,442 | TotalAssetsBOYAmt |
| Total Assets EOY | $67,911,425 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,748,860 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,621,658 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $64,453,582 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $60,289,767 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | It is the mission of Stonewall Jackson Memorial Hospital to provide excellent care to all we serve. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $36,858,002 | ExpenseAmt |
| Revenue | $45,858,069 | RevenueAmt |
| Desc | Stonewall Jackson Memorial Hospital provides acute medical and outpatient services to residents of Weston, West Virginia and surrounding communities which covers 10 different counties. Services included 7,091 days of inpatient care, 92,406 outpatient visits, 16,713 emergency room visits, 1,371 ambulatory surgery visits, 5,458 Home Health visits and 62,482 Physician Clinic visits. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $11,161 | ExpenseAmt |
| Grant | $11,026 | GrantAmt |
| Desc | Annual Blood Screening: Stonewall Jackson Memorial Hospital provides all supplies and staff to operate the program. A portion of the excess revenue is forwarded to the local Rotary Club to promote charitable services. Other programs include: scoliosis screening at county elementary and middle schools, health fairs at the local senior citizens center, free sports physicals to middle and high school students, Children's Safety Day to promote healthy choices to children under 12 years of age, events for free osteoporosis screenings, events for free Dermascans to screen for skin cancer, Weston Walk-run to promote exercise as a way to improve cardiac health, free women's health screening for breast and cervical cancer, free vein screenings and free hearing screenings. Revenue and expenses are included in Line 4a above. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $24,085 | ExpenseAmt |
| Grant | $19,600 | GrantAmt |
| Revenue | $29,016 | RevenueAmt |
| Desc | William Adler Scholarship Fund - Stonewall Jackson Memorial Hospital sponsored program to provide scholarships to local graduating high school seniors who are pursuing a career in the health care field. It is hoped that this program will encourage more students to seek health care professions and lesson the health care staffing shortage. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $36,893,248 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | 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 | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 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 | 140 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 591 | 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 | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | 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 | WV | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Crystal Frazier | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3042698050 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 230 Hospital Plaza | AddressLine1Txt |
| City | Weston | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 264528558 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| John Law | ||||||||
| President | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Joseph Snead | ||||||||
| Vice-President | 22.50 | Yes (X) | Yes (X) | $189,346 | $0 | $9,471 | ||
| R Gerald Wood | ||||||||
| Secretary | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Denver Turner | ||||||||
| Treasurer | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| J Robert Bennett | ||||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Robin Poling | ||||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| John W Wyllie III | ||||||||
| Director | 37.50 | Yes (X) | $448,978 | $0 | $21,054 | |||
| David Gallien | ||||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Michael Hager | ||||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| Avah Stalnaker | ||||||||
| CEO | 22.50 | Yes (X) | $278,059 | $0 | $21,054 | |||
| Delphia Arbogast | ||||||||
| CFO | 37.50 | Yes (X) | $127,729 | $0 | $26,481 | |||
| Kevin Stalnaker | ||||||||
| Assistant CEO | 37.50 | $151,044 | $0 | $28,671 | Yes (X) | |||
| Ronald Pearson | ||||||||
| Physician | 37.50 | $442,600 | $0 | $13,000 | Yes (X) | |||
| Doyle Sickles | ||||||||
| Physician | 40.00 | $537,816 | $0 | $33,035 | Yes (X) | |||
| Virgil W McMillion | ||||||||
| Physician | 62.80 | $518,758 | $0 | $33,035 | Yes (X) | |||
| Shafic Sraj | ||||||||
| Physician | 40.00 | $524,720 | $0 | $33,035 | Yes (X) | |||
| Michael Gregory | ||||||||
| Physician | 62.80 | $436,800 | $0 | $33,035 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,655,850 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $251,871 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 33 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Sodexo | |||||
| PO Box 936522 | Atlanta | GA | 503536922 | Maintenance/Dietary | $438,401 |
| Laboratory Corporation | |||||
| PO Box 12140 | Burlington | NC | 27216 | Laboratory Services | $290,452 |
| Onward Healthcare | |||||
| PO Box 27421 | New York | NY | 100877421 | Nurse Staffing | $203,554 |
| CPS | |||||
| PO Box 1000 | Memphis | TN | 38148 | Pharmacy Consulting | $195,067 |
| Atlanticon | |||||
| PO Box 621 | Fairborn | OH | 45324 | Consulting | $178,557 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 10 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $18,731 | FundraisingAmt |
| Government Grants | $7,000 | GovernmentGrantsAmt |
| All Other Contributions | $78,406 | AllOtherContributionsAmt |
| Total Contributions | $104,137 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Patient Services | Desc |
| Business | 622110 | BusinessCd |
| Total Revenue Column | $45,424,033 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $45,424,033 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $45,424,033 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,108,651 | TotalRevenueColumnAmt |
| Exclusion | $1,108,651 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $49,634 | RealAmt |
| Personal | $7,200 | PersonalAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $88,815 | RealAmt |
| Personal | $1,201 | PersonalAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$39,181 | RealAmt |
| Personal | $5,999 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$33,182 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $5,999 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$39,181 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $23,777,244 | SecuritiesAmt |
| Other | $6,500 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $23,270,633 | SecuritiesAmt |
| Other | $6,764 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $506,611 | SecuritiesAmt |
| Other | -$264 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $506,347 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$264 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $506,611 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $55,051 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $18,731 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $15,646 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $39,405 | TotalRevenueColumnAmt |
| Exclusion | $39,405 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| EHR Incentive Income | 900099 | $219,591 | $219,591 |
| Cafeteria/Vending sales | 722310 | $195,962 | $195,962 |
| Purchase discounts | 900099 | $34,881 | $34,881 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,882 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12,882 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $463,316 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $47,612,707 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $45,887,085 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $5,999 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,615,486 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,026 | TotalAmt |
| Program Services | $11,026 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,600 | TotalAmt |
| Program Services | $19,600 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,332,151 | TotalAmt |
| Program Services | $941,830 | ProgramServicesAmt |
| Management And General | $390,321 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,919,061 | TotalAmt |
| Program Services | $15,496,776 | ProgramServicesAmt |
| Management And General | $6,422,285 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $709,349 | TotalAmt |
| Program Services | $501,510 | ProgramServicesAmt |
| Management And General | $207,839 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,270,889 | TotalAmt |
| Program Services | $1,605,519 | ProgramServicesAmt |
| Management And General | $665,370 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,416,643 | TotalAmt |
| Program Services | $1,001,567 | ProgramServicesAmt |
| Management And General | $415,076 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $150,644 | TotalAmt |
| Management And General | $150,644 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $149,023 | TotalAmt |
| Management And General | $149,023 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $341,236 | TotalAmt |
| Management And General | $341,236 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,320,785 | TotalAmt |
| Program Services | $1,649,687 | ProgramServicesAmt |
| Management And General | $671,098 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $157,027 | TotalAmt |
| Program Services | $111,018 | ProgramServicesAmt |
| Management And General | $46,009 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,842,615 | TotalAmt |
| Program Services | $1,300,966 | ProgramServicesAmt |
| Management And General | $541,649 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $149,960 | TotalAmt |
| Program Services | $106,022 | ProgramServicesAmt |
| Management And General | $43,938 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,120,742 | TotalAmt |
| Program Services | $792,365 | ProgramServicesAmt |
| Management And General | $328,377 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,249 | TotalAmt |
| Program Services | $69,462 | ProgramServicesAmt |
| Management And General | $28,787 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,825 | TotalAmt |
| Program Services | $14,723 | ProgramServicesAmt |
| Management And General | $6,102 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,290,401 | TotalAmt |
| Program Services | $1,619,314 | ProgramServicesAmt |
| Management And General | $671,087 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $455,301 | TotalAmt |
| Program Services | $321,898 | ProgramServicesAmt |
| Management And General | $133,403 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical supplies | $8,035,584 | $8,035,584 | |
| Repairs and maintenance | $1,323,539 | $935,742 | $387,797 |
| Bad debts | $972,045 | $972,045 | |
| Charity Care Expenses | $550,823 | $550,823 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $987,359 | TotalAmt |
| Program Services | $835,771 | ProgramServicesAmt |
| Management And General | $151,588 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,644,877 | TotalAmt |
| Program Services | $36,893,248 | ProgramServicesAmt |
| Management And General | $11,751,629 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $197,202 | BOYAmt |
| EOY | $544,631 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,048,278 | BOYAmt |
| EOY | $9,554,723 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,810,199 | BOYAmt |
| EOY | $7,320,151 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $791,698 | BOYAmt |
| EOY | $1,195,535 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $382,460 | BOYAmt |
| EOY | $377,623 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $37,915,482 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $26,928,300 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,745,543 | BOYAmt |
| EOY | $10,987,182 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,960,423 | BOYAmt |
| EOY | $36,329,225 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $67,668 | BOYAmt |
| EOY | $67,668 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,198,971 | BOYAmt |
| EOY | $1,534,687 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $71,202,442 | BOYAmt |
| EOY | $67,911,425 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,592,132 | BOYAmt |
| EOY | $6,348,984 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,254 | BOYAmt |
| EOY | $37,254 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,099,474 | BOYAmt |
| EOY | $631,901 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $603,519 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,748,860 | BOYAmt |
| EOY | $7,621,658 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $64,453,582 | BOYAmt |
| EOY | $60,289,767 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $64,453,582 | BOYAmt |
| EOY | $60,289,767 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $71,202,442 | BOYAmt |
| EOY | $67,911,425 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$1,032,170 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$3,131,645 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $646,015 | OtherCostOrOtherBasisAmt |
| Book Value | $646,015 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,407,350 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,320,826 | DepreciationAmt |
| Book Value | $3,086,524 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $22,315,143 | OtherCostOrOtherBasisAmt |
| Depreciation | $16,607,474 | DepreciationAmt |
| Book Value | $5,707,669 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,546,974 | OtherCostOrOtherBasisAmt |
| Book Value | $1,546,974 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $10,987,182 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Due to Medicare | Desc |
| Amt | $603,519 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $603,519 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $45,686,628 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $1,201 | OtherRevenueAmt |
| Revenue Not Reported | $1,201 | RevenueNotReportedAmt |
| Revenue Subtotal | $45,685,427 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,927,279 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,927,279 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $47,612,706 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $46,718,798 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $1,201 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $1,201 | ExpensesNotReportedAmt |
| Expenses Subtotal | $46,717,597 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,927,279 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,927,279 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $48,644,876 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part XI, Line 2d - Other Adjustments: | Rental expense netted with rental income on 990 1,201. |
| Part XI, Line 4b - Other Adjustments: | Investment expenses netted with revenue on the financial statements 341,236. Bad debt and Charity expense netted with revenue on the financial statements 1,522,868. Expenses netted with donation revenue on the financial statements 23,775. Net fundraising revenue netted with expenses on financial statements 39,400. |
| Part XII, Line 2d - Other Adjustments: | Rental expense netted with rental income on 990 1,201. |
| Part XII, Line 4b - Other Adjustments: | Investment expenses netted with revenue on the financial statements 341,236. Bad debt expense netted with revenue on the financial statements 1,522,868. Expenses netted with donation revenue on the financial statements 23,775. Net fundraising revenue netted with expenses on financial statements 39,400. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Charity Golf Tournament | Event1Nm |
| Gross Receipts Event1 | $29,017 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $18,731 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $10,286 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $310 | CashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $4,175 | RentFacilityCostsEvent1Amt |
| Event2 | Rotary Blood Screening | Event2Nm |
| Gross Receipts Event2 | $44,765 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $44,765 | GrossRevenueEvent2Amt |
| Other Direct Expenses Event2 | $11,161 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $73,782 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $18,731 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $55,051 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $310 | CashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $4,175 | RentFcltyCostsTotalEventsAmt |
| Oth Direct Expnss Total Events | $11,161 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $15,646 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $39,405 | NetIncomeSummaryAmt |
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 | 0 | FPGReferenceFreeCareInd |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $233,794 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $233,794 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00490 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,281,028 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,576,689 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,704,339 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05670 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,514,822 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,576,689 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,938,133 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06160 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,740 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,740 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,740 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,740 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,518,562 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,576,689 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,941,873 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06170 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $412,580 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $7,934,373 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,190,397 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$256,024 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Stonewall Jackson Memorial Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 230 Hospital Plaza | AddressLine1Txt |
| City | Weston | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26452 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Stonewall Jackson Memorial 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 |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.stonewalljacksonhospital.com | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| 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 |
| 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 Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Stonewall Jackson Memorial Hospital | Part V, Section B, Line 5: The Hospital took into account input from representatives from health department, schools, local businesses and town Mayor. |
| Stonewall Jackson Memorial Hospital | Part V, Section B, Line 11: Action has been taken on the top 5 Community Needs identified in the Community Health Needs Assessment. The remaining items were not addressed due to low community need. |
| Stonewall Jackson Memorial Hospital | Part V, Section B, Line 22d: Charges are the same for all payers and private pay but private pay patients are given a 20% discount off of charges if the bill is paid within 30 days of the statement date. The Hospital's Financial Assistance Policy allows for 100% Write-Off of charges for patients whose family income is below 150% of the FPL and Partial Charity Care with a discount between 60% and 95% for patients who have family income between 150% and 260% of the FPL. |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | WV food stamp eligibility guidelines are used. We also evaluate the patient's assets and the amount of medical debt. We have signs posted at Registration, around and in the Emergency Department and in all physician clinics. We send letters to patients who are not paying their bills and give the application to private pay inpatients. We also tell the patients during telephone conversations if the patient indicates he/she is not able to pay the bill or pay all of the bill. |
| 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 unreimbursed cost of Medicaid was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions. |
| Part I, Line 7, Column (f): | The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 972,045. |
| Part II, Community Building Activities: | We recruit physicians to this area based entirely on what services the patients need. Our goal is to be able to provide physicians who can address these needs in the community. |
| Part III, Line 2: | The cost of 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 collectability. Management also reviews troubled, aged accounts to determine collection potential. Patient accounts receivable are written off when deemed uncollectible. Recoveries of accounts previously written off are recorded as a reduction to bad debt expense when received. Interest is not charged on patient accounts receivable. |
| Part III, Line 9b: | Our collections policy applies to all patients regardless of financial class or any other classification. During our collections process, if the patient indicates they do not have the ability to pay their bill, the credit staff offers exoneration. |
| Part VI, Line 2: | We completed the community needs assessment at the end of fiscal year 2012. The next one will not be completed until the end of fiscal year 2015. |
| Part VI, Line 3: | We have signs posted at Registration, around and in the Emergency Department and in all physician clinics. We send letters to patients who are not paying their bills. We give the application to Private Pay inpatients. We tell the patients when during telephone conversations if the patient indicates he/she is not able to pay the bill or pay all of the bill. |
| Part VI, Line 4: | Stonewall Jackson Memorial Hospital serves a relatively large rural population of about 65,000 people with an average household income of $32,000. 30% of the population is disabled. Approximately 30% are Medicaid Eligible or are uninsured. We are the largest hospital in our service area, which includes two other hospitals, one being a Critical Access Hospital. We are located in a federally-designated medically underserved area. |
| Part VI, Line 5: | Stonewall Jackson Memorial Hospital (SJMH) is a 70 bed rural acute hospital located in Lewis county West Virginia. SJMH is the only hospital located in the county as such it is solely responsible for the healthcare of this rural community. SJMH provides 24 hours Emergency Room and Obstetrics services and provides care regardless of the patient's ability to pay. The majority of the governing body is comprised of community members. Medical privileges are offered to all qualified physicians in the community and SJMH has worked diligently to provide other physician services by expanding the services they provide.SJMH continues to make capital improvement to the facility and expand patient care services to meet the needs of the community. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Rotary Club of Weston | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 222 | AddressLine1Txt |
| City | Weston | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26452 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 550371556 | RecipientEIN |
| IRC Section | 501(c)(4) | IRCSectionDesc |
| Cash Grant | $11,026 | CashGrantAmt |
| Purpose Of Grant | To help the Rotary support various children's programs in Lewis County. | PurposeOfGrantTxt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | Nursing School Scholarships for recent high school graduates. | GrantTypeTxt |
| Recipient | 18 | RecipientCnt |
| Cash Grant | $19,600 | CashGrantAmt |
| Valuation Method Used | FMV - Cash | ValuationMethodUsedDesc |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Joseph Snead | ||||||||||||||
| Vice-President | $189,346 | $0 | $0 | $0 | $0 | $0 | $9,471 | $0 | $1,580 | $0 | $200,397 | $0 | $0 | $0 |
| John W Wyllie III | ||||||||||||||
| Director | $424,209 | $0 | $24,769 | $0 | $0 | $0 | $13,250 | $0 | $9,974 | $0 | $472,202 | $0 | $0 | $0 |
| Avah Stalnaker | ||||||||||||||
| CEO | $267,956 | $0 | $0 | $0 | $10,103 | $0 | $13,250 | $0 | $10,147 | $0 | $301,456 | $0 | $0 | $0 |
| Delphia Arbogast | ||||||||||||||
| CFO | $127,729 | $0 | $0 | $0 | $0 | $0 | $6,445 | $0 | $21,230 | $0 | $155,404 | $0 | $0 | $0 |
| Kevin Stalnaker | ||||||||||||||
| Assistant CEO | $151,044 | $0 | $0 | $0 | $0 | $0 | $8,636 | $0 | $21,464 | $0 | $181,144 | $0 | $0 | $0 |
| Ronald Pearson | ||||||||||||||
| Physician | $442,600 | $0 | $0 | $0 | $0 | $0 | $13,000 | $0 | $0 | $0 | $455,600 | $0 | $0 | $0 |
| Doyle Sickles | ||||||||||||||
| Physician | $537,816 | $0 | $0 | $0 | $0 | $0 | $13,000 | $0 | $22,378 | $0 | $573,194 | $0 | $0 | $0 |
| Virgil W McMillion | ||||||||||||||
| Physician | $518,758 | $0 | $0 | $0 | $0 | $0 | $13,000 | $0 | $22,378 | $0 | $554,136 | $0 | $0 | $0 |
| Shafic Sraj | ||||||||||||||
| Physician | $488,720 | $0 | $36,000 | $0 | $0 | $0 | $13,000 | $0 | $22,378 | $0 | $560,098 | $0 | $0 | $0 |
| Michael Gregory | ||||||||||||||
| Physician | $436,800 | $0 | $0 | $0 | $0 | $0 | $13,000 | $0 | $22,378 | $0 | $472,178 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 3 | Management duties customarily are performed under the direct supervision of officers, directors, trustees or key employees, but the Hospital has contracted out the management duties of the Maintenance department. The manager of the Maintenance department (also considered a department head) is employed by the Maintenance company. All other Maintenance staff are employees of the Hospital. The Hospital contracts out the management duties of the Pharmacy department. The manager of the Pharmacy department (also considered a department head) is employed by the Pharmacy company. All other Pharmacy staff are employees of the Hospital. The Hospital contracts out the management duties of the Dietary department. The manager of the Dietary department (also considered a department head) is employed by the Dietary company. The certified Dietary Manager and the Dietitian are also the employees of the Dietary company. All other Dietary staff are employees of the Hospital. |
| Form 990, Part VI, Section B, line 11 | The process the Hospital uses to review their 990 before filing with the IRS is the Assistant CEO is responsible for reviewing the form 990 for completeness and accuracy. A completed copy is provided for the board. It is then signed and submitted to the IRS. |
| Form 990, Part VI, Section B, line 12c | All board members disclose possible conflicts of interest prior to appointment and periodically throughout their terms as trustees. |
| Form 990, Part VI, Section B, line 15 | The Hospital obtains salary survey data. Performance evaluations are done on each of these personnel & financial conditions are considered. |
| Form 990, Part VI, Section C, line 19 | The Hospital places a publication in the local newspaper stating the governing documents, conflicts of interest policy and financial statements are available upon request. The policies and procedures are on the Stonewall Jackson website. |
Schedule R IRS990ScheduleR
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Stonewall Home Oxygen Therapy Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 Market Place Mall Suite 8 | AddressLine1Txt |
| City | Weston | CityNm |
| State Abbreviation | WV | StateAbbreviationCd |
| ZIP | 26452 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550754278 | EIN |
| Primary Activities | Oxygen Therapy Services | PrimaryActivitiesTxt |
| Legal Domicile State | WV | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | $17,279 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $346,475 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Stonewall Home Oxygen Therapy Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | A | TransactionTypeTxt |
| Involved | $7,200 | InvolvedAmt |
| Method Of Amount Determination | FMV - Cash | MethodOfAmountDeterminationTxt |