GUTHRIE TOWANDA MEMORIAL HOSPITAL: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- GUTHRIE TOWANDA MEMORIAL HOSPITAL (EIN 24-0786657)
- Tax period
- 2013-07-01 to 2014-06-30
- Filed
- 2015-05-13
- IRS object ID
- 201511339349300906
- Schema version
- 2013v4.0
- 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 J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-05-13T07:14:11-05:00 | ReturnTs |
| Tax Period End | 2014-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390859910 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER TILLY VIRCHOW KRAUSE LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1650 MARKET STREET SUITE 4500 | AddressLine1 |
| City | PHILADELPHIA | City |
| State | PA | State |
| ZIP Code | 19103 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 240786657 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE MEMORIAL HOSPITAL INC OF TOWANDA PA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MEMO | BusinessNameControlTxt |
| Phone | 5702652191 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 91 HOSPITAL DRIVE | AddressLine1 |
| City | TOWANDA | City |
| State | PA | State |
| ZIP Code | 188489703 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | WILLIAM ROHRBACH | PersonNm |
| Person Title | CFO/SECRETARY | PersonTitleTxt |
| Phone | 5702652191 | PhoneNum |
| Signature | 2015-05-06 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JULIUS C GREEN CPA JD | PreparerPersonNm |
| PTIN | P00350393 | PTIN |
| Phone | 2159720701 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | WILLIAM ROHRBACH | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 91 HOSPITAL DRIVE | AddressLine1 |
| City | TOWANDA | City |
| State | PA | State |
| ZIP Code | 188489703 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $38,881,533 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MEMORIALHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1946 | FormationYr |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | TO OPERATE AN ACUTE CARE HOSPITAL AND LONG TERM CARE FACILITY IN TOWANDA, PENNSYLVANIA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 27 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 25 | VotingMembersIndependentCnt |
| Total Employee | 606 | TotalEmployeeCnt |
| Total Volunteers | 14 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,191,418 | PYContributionsGrantsAmt |
| CY Contributions Grants | $595,843 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $39,841,474 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $36,441,457 | CYProgramServiceRevenueAmt |
| PY Investment Income | $391,326 | PYInvestmentIncomeAmt |
| CY Investment Income | $140,531 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,146,490 | PYOtherRevenueAmt |
| CY Other Revenue | $1,575,186 | CYOtherRevenueAmt |
| PY Total Revenue | $44,570,708 | PYTotalRevenueAmt |
| CY Total Revenue | $38,753,017 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $23,158,649 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $21,771,275 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $19,255,320 | PYOtherExpensesAmt |
| CY Other Expenses | $17,944,145 | CYOtherExpensesAmt |
| PY Total Expenses | $42,413,969 | PYTotalExpensesAmt |
| CY Total Expenses | $39,715,420 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,156,739 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$962,403 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $46,825,694 | TotalAssetsBOYAmt |
| Total Assets EOY | $50,052,242 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $20,401,495 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $23,623,035 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $26,424,199 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $26,429,207 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF MEMORIAL HOSPITAL, INC., A NONPROFIT ORGANIZATION, IS TO PROVIDE SUPERIOR QUALITY HEALTH CARE SERVICES IN A CARING, EFFICIENT, AND FINANCIALLY RESPONSIBLE MANNER THAT WILL IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $37,208,769 | ExpenseAmt |
| Revenue | $36,595,553 | RevenueAmt |
| Desc | MEMORIAL HOSPITAL, INC. OF TOWANDA, PA IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL AND LONG TERM CARE FACILITY LOCATED IN TOWANDA, PA. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, EMERGENCY CARE, LONG-TERM CARE AND HOME HEALTH SERVICES TO RESIDENTS OF TOWANDA, PA AND SURROUNDING COMMUNITIES. OUR DOCTORS CONTINUOUSLY WORK WITH OUR OWN QUALIFIED SPECIALISTS AND MANY OTHERS WITHIN THE BRADFORD AND SULLIVAN COUNTY MEDICAL COMMUNITY AS WELL AS OUTSIDE OF THIS AREA TO PROVIDE ACCESS TO QUALITY SPECIALTY CARE.WE ROUTINELY WORK WITH SPECIALISTS IN SAYRE, PA; ELMIRA, NY; BINGHAMTON, NY; WILLIAMSPORT, PA; SCRANTON, PA; DANVILLE, PA; AND PHILADELPHIA, PA, TO MEET OUR PATIENTS' HEALTHCARE NEEDS.IN FEBRUARY 2008, COMMUNITY HEALTH ASSOCIATES, LLC, A SINGLE MEMBER LLC OWNED SOLELY BY MEMORIAL HOSPITAL, INC. WAS ESTABLISHED. THE PURPOSE OF COMMUNITY HEALTH ASSOCIATES, LLC IS TO EMPLOY PHYSICIANS TO ASSIST THE HOSPITAL WITH MEETING ITS MISSION AND TO IMPROVE THE RECRUITING AND RETENTION OF PHYSICIANS IN THE AREA.IN THE YEAR ENDING JUNE 30, 2014, THE HOSPITAL ADMITTED 1,194 PATIENTS AND HAD A TOTAL OF 56,759 PATIENT DAYS. TOTAL PATIENT DAYS WERE COMPRISED OF 4,349 ACUTE CARE; 86 NURSERY; 28,376 PERSONAL CARE HOME, AND 23,948 SKILLED NURSING. WE CONDUCTED 5,071 HOME HEALTH VISITS AND RECEIVED 55,591 OTHER OUTPATIENT VISITS. THE MATERNITY CENTER DELIVERED 42 NEWBORNS. THE ER SAW 9,714 VISITS DURING THE YEAR. DURING THE FISCAL YEAR JUNE 30, 2014, THE HOSPITAL PROVIDED APPROXIMATELY $219,000 IN CHARITY CARE (COST BASIS) TO THE COMMUNITIES IT SERVES. MEMORIAL HOSPITAL IS DIRECTED BY A BOARD OF COMMUNITY LEADERS KNOWN AS TRUSTEES AND IS SUPPORTED BY THE SERVICE OF DOZENS OF VOLUNTEERS INCLUDING A VERY ACTIVE AUXILIARY.MANY OF MEMORIAL HOSPITAL'S ACTIVE MEDICAL STAFF PHYSICIANS ARE BOARD CERTIFIED IN THEIR RESPECTIVE SPECIALTIES, REFLECTING A DEDICATION AND COMMITMENT TO PROVIDE THE HIGHEST QUALITY OF CARE TO MEMORIAL HOSPITAL'S PATIENTS. ALL THREE LEADERSHIP GROUPS OF THE HOSPITAL - THE BOARD OF TRUSTEES, MEDICAL STAFF AND ADMINISTRATION - CONTINUOUSLY WORK TOGETHER TO IDENTIFY AND DIRECT THE PRIORITIES OF THE HOSPITAL THROUGH THE DEVELOPMENT AND IMPLEMENTATION OF STRATEGIC PLANS WITHIN THE SCOPE OF OUR MISSION. FROM EMERGENCY SERVICES TO OUR MATERNITY CENTER, FROM TOP-NOTCH RADIOLOGY DIAGNOSTICS TO LONG-TERM CARE, FROM HOME HEALTH TO OUTPATIENT THERAPIES, WE ARE HERE FOR FAMILIES AND INDIVIDUALS IN OUR COMMUNITIES. WE ARE COMMITTED TO MEETING THE HEALTH CARE NEEDS OF OUR RESIDENTS AND WILL DO OUR BEST TO MEET AND EXCEED THEIR EXPECTATIONS.MEMORIAL HOSPITAL, INC. PROVIDES HEALTH CARE TO RESIDENTS IN THE BRADFORD AND SULLIVAN COUNTY AREAS. THE HOSPITAL PROVIDES A WIDE RANGE OF SERVICES TO PATIENTS WITHOUT REGARD TO THE INDIVIDUAL'S ABILITY TO PAY. THE HOSPITAL'S EMERGENCY DEPARTMENT IS AVAILABLE ON A 7 DAY A WEEK, 24 HOUR A DAY BASIS FOR THE EMERGENT, AS WELL AS NON-EMERGENT, NEEDS OF THOSE THAT SEEK CARE. THE HOSPITAL HAS A HOSPITAL-BASED SKILLED NURSING FACILITY THAT CARES FOR A VERY HIGH PERCENTAGE OF MEDICAL ASSISTANCE RESIDENTS, AS WELL AS SOME MEDICARE RESIDENTS. | Desc |
| Total Program Service Expenses | $37,208,769 | 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 | Yes (1) | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | 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 | 27 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 606 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 27 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 25 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | 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 | PA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILLIAM ROHRBACH | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5702682207 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 91 HOSPITAL DRIVE | AddressLine1 |
| City | TOWANDA | City |
| State | PA | State |
| ZIP Code | 18848 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (33 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| JOHN L SCHOONOVER III | ||||||||
| CHAIRMAN | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JAMES PARKS | ||||||||
| VICE-CHAIRMAN | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | 2.00 | |
| DAVID PACKARD | ||||||||
| TREASURER | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | 2.00 | |
| ROBERT FERRARIO | ||||||||
| SECRETARY | 5.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | 2.00 | |
| WILLIAM ROHRBACH | ||||||||
| CFO/ASST SECRETARY | 40.00 | Yes (X) | Yes (X) | $192,229 | $0 | $17,333 | 2.00 | |
| MARGUERITE SHANER | ||||||||
| AUXILIARY PRESIDENT | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| MARIANNE ADDISON | ||||||||
| TRUSTEE | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| DONALD BRENNAN | ||||||||
| TRUSTEE | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| PETER BRODERICK | ||||||||
| TRUSTEE | 5.00 | Yes (X) | $0 | $0 | $0 | 2.00 | ||
| JOSEPH CAMA MD | ||||||||
| TRUSTEE | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| RAY DEPAOLA | ||||||||
| TRUSTEE | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| HANK DUNN | ||||||||
| TRUSTEE | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| BRIAN EMICK | ||||||||
| TRUSTEE | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| MARK GANNON | ||||||||
| TRUSTEE | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| STACY L GARRITY | ||||||||
| TRUSTEE | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| STEVE GOBBLE | ||||||||
| TRUSTEE | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| LEWIS HOPE | ||||||||
| TRUSTEE | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| LARRY HUBER | ||||||||
| TRUSTEE | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| MARJORY KREISCHER | ||||||||
| TRUSTEE | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| LEO LAMBERT | ||||||||
| TRUSTEE | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| MARTIN MIKAYA MD | ||||||||
| TRUSTEE | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| JODY PLACE | ||||||||
| TRUSTEE | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| ERIC R ROWE | ||||||||
| TRUSTEE | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| GERALD E SHAFFER | ||||||||
| TRUSTEE | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| TOM THOMPSON | ||||||||
| TRUSTEE | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| BARBARA YANAK OD | ||||||||
| TRUSTEE | 5.00 | Yes (X) | $0 | $0 | $0 | |||
| LISA CERAOLO MD | ||||||||
| TRUSTEE/VP MEDICAL STAFF | 40.00 | Yes (X) | $183,958 | $0 | $11,460 | |||
| GARY A BAKER | ||||||||
| PRESIDENT/CEO | 40.00 | Yes (X) | $0 | $0 | $0 | 2.00 | ||
| MARC ALPERT | ||||||||
| GENERAL SURGEON | 40.00 | $278,845 | $0 | $16,364 | Yes (X) | |||
| WINGROVE JARVIS | ||||||||
| ORTHOPEDIC SURGEON | 40.00 | $251,104 | $0 | $0 | Yes (X) | |||
| TIMOTHY POWELL | ||||||||
| OB/GYN | 40.00 | $214,338 | $0 | $13,248 | Yes (X) | |||
| LARRY MCCULLOUGH | ||||||||
| OB/GYN | 40.00 | $195,860 | $0 | $17,725 | Yes (X) | |||
| TIMOTHY DENNEN | ||||||||
| FAMILY PRACTICE PHYSICIAN | 40.00 | $183,866 | $0 | $12,543 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,500,200 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $88,673 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 17 | 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/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| A PICKETT CONSTRUCTION | |||||
| 128 W VAUGHN ST | KINGSTON | PA | 187043812 | CONSTRUCTION | $3,909,750 |
| TEAM CARE PC | |||||
| 2031 ORANGE HILL ROAD | ATHENS | PA | 18810 | EMERGENCY PHYSICIAN SERVICES | $1,049,375 |
| GULFSTREAM ANESTHESIA CONSULTANTS | |||||
| PO BOX 212110 ROYAL | PALM BEACH | FL | 33421 | ANESTHESIA SERVICES | $559,438 |
| QUORUM HEALTH RESOURCES | |||||
| 105 CONTINENTAL PLACE | BRENTWOOD | TN | 370271018 | HOSPITAL MANAGEMENT SERVICES | $534,798 |
| MORRISON MANAGEMENT SPECIALIST | |||||
| PO BOX 102289 | ATLANTA | GA | 303682289 | DIETARY MANAGEMENT SERVICES | $263,471 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 20 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $173,746 | RelatedOrganizationsAmt |
| All Other Contributions | $422,097 | AllOtherContributionsAmt |
| Total Contributions | $595,843 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SVC REV | Desc |
| Business | 621990 | BusinessCd |
| Total Revenue Column | $36,441,457 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $36,441,457 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $36,441,457 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $153,929 | TotalRevenueColumnAmt |
| Exclusion | $153,929 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $120,141 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $99,532 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $20,609 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,609 | TotalRevenueColumnAmt |
| Exclusion | $20,609 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $15,586 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $28,984 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$13,398 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$13,398 | TotalRevenueColumnAmt |
| Exclusion | -$13,398 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| MEANINGFUL USE | 900099 | $1,118,691 | $1,118,691 | |
| OTHER PATIENT SERVICES | 621990 | $154,096 | $154,096 | |
| CAFETERIA/VENDING | 722210 | $116,915 | $116,915 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $164,875 | TotalRevenueColumnAmt |
| Exclusion | $164,875 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,554,577 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $38,753,017 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $36,595,553 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,561,621 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $493,050 | TotalAmt |
| Management And General | $493,050 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,326,686 | TotalAmt |
| Program Services | $16,750,890 | ProgramServicesAmt |
| Management And General | $575,796 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $316,071 | TotalAmt |
| Program Services | $305,027 | ProgramServicesAmt |
| Management And General | $11,044 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,360,885 | TotalAmt |
| Program Services | $2,240,430 | ProgramServicesAmt |
| Management And General | $120,455 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,274,583 | TotalAmt |
| Program Services | $1,198,108 | ProgramServicesAmt |
| Management And General | $76,475 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $568,147 | TotalAmt |
| Program Services | $378,867 | ProgramServicesAmt |
| Management And General | $189,280 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $129,770 | TotalAmt |
| Management And General | $129,770 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $92,552 | TotalAmt |
| Management And General | $92,552 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,499 | TotalAmt |
| Management And General | $3,499 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,048,230 | TotalAmt |
| Program Services | $4,589,693 | ProgramServicesAmt |
| Management And General | $458,537 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,074 | TotalAmt |
| Program Services | $26,713 | ProgramServicesAmt |
| Management And General | $22,361 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,001,120 | TotalAmt |
| Program Services | $1,860,972 | ProgramServicesAmt |
| Management And General | $140,148 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $881,291 | TotalAmt |
| Program Services | $862,204 | ProgramServicesAmt |
| Management And General | $19,087 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $173,403 | TotalAmt |
| Program Services | $167,077 | ProgramServicesAmt |
| Management And General | $6,326 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,580 | TotalAmt |
| Program Services | $31,580 | ProgramServicesAmt |
| Management And General | $4,000 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $360,184 | TotalAmt |
| Program Services | $360,184 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,767,679 | TotalAmt |
| Program Services | $1,767,679 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $800,702 | TotalAmt |
| Program Services | $800,702 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT EXPENSE | $3,359,460 | $3,359,460 | |
| MEDICAL SUPPLIES | $1,413,419 | $1,413,419 | |
| DIETARY | $512,886 | $496,129 | $16,757 |
| REPAIRS & MAINTENANCE | $332,782 | $326,116 | $6,666 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $414,367 | TotalAmt |
| Program Services | $273,519 | ProgramServicesAmt |
| Management And General | $140,848 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,715,420 | TotalAmt |
| Program Services | $37,208,769 | ProgramServicesAmt |
| Management And General | $2,506,651 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,339 | BOYAmt |
| EOY | $1,188 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $71,723 | BOYAmt |
| EOY | $543,757 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,083,792 | BOYAmt |
| EOY | $5,052,002 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $491,522 | BOYAmt |
| EOY | $480,112 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $495,461 | BOYAmt |
| EOY | $711,539 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $53,492,422 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $27,668,015 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,640,805 | BOYAmt |
| EOY | $25,824,407 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $69,966 | BOYAmt |
| EOY | $72,495 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $956,626 | BOYAmt |
| EOY | $1,025,070 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,014,460 | BOYAmt |
| EOY | $16,341,672 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,825,694 | BOYAmt |
| EOY | $50,052,242 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,120,005 | BOYAmt |
| EOY | $2,359,723 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,380,083 | BOYAmt |
| EOY | $13,327,283 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $153,435 | BOYAmt |
| EOY | $131,933 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,747,972 | BOYAmt |
| EOY | $7,804,096 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,401,495 | BOYAmt |
| EOY | $23,623,035 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,994,242 | BOYAmt |
| EOY | $25,936,611 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $364,957 | BOYAmt |
| EOY | $427,596 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $65,000 | BOYAmt |
| EOY | $65,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,424,199 | BOYAmt |
| EOY | $26,429,207 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,825,694 | BOYAmt |
| EOY | $50,052,242 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$962,403 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $6,304 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $961,107 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule 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 | $3,499 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $3,499 | 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 | THE MEMORIAL HOSPITAL, INC. OF TOWANDA, PA INCURS LOBBYING EXPENSES ONLY AS A PORTION OF THEIR HAP DUES APPLICABLE TO THE YEAR ENDED 6/30/14. THESE EXPENSES ARE APPROX. 26.27% OF DUES FOR THE YEAR. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | Yes (1) | AgentTrusteeEtcInd |
| Beginning Balance | $14,195 | BeginningBalanceAmt |
| Additions During Year | $160,607 | AdditionsDuringYearAmt |
| Distributions During Year | $161,801 | DistributionsDuringYearAmt |
| Ending Balance | $13,001 | EndingBalanceAmt |
| Incl Escrow Custodial Acct Liab | 0 | InclEscrowCustodialAcctLiabInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $338,564 | OtherCostOrOtherBasisAmt |
| Book Value | $338,564 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $32,822,932 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,688,932 | DepreciationAmt |
| Book Value | $22,134,000 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $19,610,366 | OtherCostOrOtherBasisAmt |
| Depreciation | $16,486,902 | DepreciationAmt |
| Book Value | $3,123,464 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $720,560 | OtherCostOrOtherBasisAmt |
| Depreciation | $492,181 | DepreciationAmt |
| Book Value | $228,379 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $25,824,407 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DEFERRED FINANCING COSTS, NET | $102,481 |
| BENEFICIAL INTEREST IN ASSETS HELD BY MEMORIAL HOSPITAL FDN | $15,892,085 |
| OTHER CURRENT ASSETS | $127,202 |
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | $219,904 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $16,341,672 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| AMTS W/H FROM EMPLOYEES FOR TAXES, ETC. | $89,736 |
| BLUE CROSS ADVANCE | $184,441 |
| AMOUNTS DUE TO AFFILIATES | $6,476,664 |
| ESTIMATED MED MALPRACTICE CLAIMS LIAB | $1,053,255 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $7,804,096 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $36,473,898 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $6,304 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$2,398,353 | OtherRevenueAmt |
| Revenue Not Reported | -$2,392,049 | RevenueNotReportedAmt |
| Revenue Subtotal | $38,865,947 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$112,930 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$112,930 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $38,753,017 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $36,468,890 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $112,930 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $112,930 | ExpensesNotReportedAmt |
| Expenses Subtotal | $36,355,960 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $3,359,460 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $3,359,460 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $39,715,420 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART IV, LINE 1B: | THE HOSPITAL MAINTAINS A SEPARATE ACCOUNT WITH SKILLED NURSING FACILITY RESIDENT FUNDS OF WHICH WE ARE THE REPRESENTATIVE PAYEE. FUNDS ARE USED TO PAY PATIENTS' BILLS AND PERSONAL EXPENSES. |
| PART X, LINE 2: | THE ORGANIZATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD IS MET. MANAGEMENT DETERMINED THAT THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2014 AND 2013. THE ORGANIZATION'S POLICY IS TO RECOGNIZE INTEREST RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST EXPENSE AND PENALTIES IN OPERATING EXPENSES. THE ORGANIZATION'S FEDERAL INCOME TAX RETURNS FOR YEARS ENDED PRIOR TO JUNE 30, 2011 NO LONGER REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS NETTED ON FINANCIAL STATEMENTS -3,359,460. CHANGE IN INTEREST IN MEMORIAL HOSPITAL FOUNDATION 1,054,273. PENSION LIABILITY ADJUSTMENT 2,520,643. CHANGE IN TEMPORARILY RESTRICTED INTEREST IN MEMORIAL HOSPITAL FOUNDATION 62,639. LOSS ON PENSION SETTLEMENT -2,520,643. ASSETS ACQUIRED OVER LIABILITIES -155,805. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | RENTAL EXPENSES -99,532. LOSS ON DISPOSAL OF EQUIPMENT -13,398. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | LOSS ON DISPOSAL OF EQUIPMENT 13,398. RENTAL EXPENSES 99,532. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS NETTED ON FINANCIAL STATEMENTS 3,359,460. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| 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 | $219,196 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $219,196 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00600 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,079,012 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,939,463 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,139,549 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05880 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,298,208 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,939,463 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,358,745 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06480 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $38,050 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $38,050 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,919,296 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,561,878 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,357,418 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06480 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,957,346 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,561,878 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,395,468 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06580 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,255,554 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,501,341 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,754,213 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13060 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $984,433 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $147,665 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,527,435 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,772,560 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$245,125 | 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 | THE MEMORIAL HOSP INC OF TOWANDA PA | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 91 HOSPITAL DRIVE | AddressLine1 |
| City | TOWANDA | City |
| State | PA | State |
| ZIP Code | 18848 | ZIPCode |
| 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 | THE MEMORIAL HOSPITAL INC OF TOWANDA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| 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 Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE SUPPLEMENTAL INFORMATION | OwnWebsiteURLTxt |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| All Needs Addressed | 0 | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (1) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (1) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Posted On Website | Yes (X) | PostedOnWebsiteInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| 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 |
| Medicare Rates | Yes (X) | MedicareRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| THE MEMORIAL HOSPITAL, INC. OF TOWANDA | PART V, SECTION B, LINE 3: A TOTAL OF 19 INDIVIDUALS ATTENDED A STRATEGIC PLANNING SESSION ON MAY 16, 2013. THESE INDIVIDUALS REPRESENTED A VARIETY OF PUBLIC AGENCIES AND ORGANIZATIONS, INCLUDING LEADERSHIP OF MEMORIAL HOSPITAL, BRADFORD COUNTY ACTION, STATE HEALTH DEPARTMENT, STATE REPRESENTATIVE, SULLIVAN COUNTY COMMISSIONER, TOWANDA SCHOOL DISTRICT, AND AAA. |
| THE MEMORIAL HOSPITAL, INC. OF TOWANDA | PART V, SECTION B, LINE 5D: THE REPORT WAS PROVIDED TO PARTICIPATING ORGANIZATIONS AND ATTENDEES. |
| THE MEMORIAL HOSPITAL, INC. OF TOWANDA | PART V, SECTION B, LINE 7: THE FOLLOWING NEEDS WERE NOT ADDRESSED DUE TO RESOURCES NOT AVAILABLE AT MEMORIAL HOSPITAL OR THEY WERE BEING ADDRESSED BY ANOTHER ORGANIZATION: MENTAL HEALTH AND SUBSTANCE ABUSE, FOOD BOURNE ILLNESSES, ACCIDENTS AND INJURIES (MOTOR VEHICLE), ACCESS TO CARE, TRANSPORTATION, ORAL AND DENTAL CARE, PRE-NATAL CARE, CHILDREN IN POVERTY (SULLIVAN COUNTY). |
| PART V, SECTION B, LINE 5A | HTTP://WWW.MEMORIALHOSPITAL.ORG/NEW/IMAGES/CHNA_IMPLEMENTATION_STRATEGY.PDF |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | THE RATIO OF COST TO CHARGES WAS COMPUTED USING PATIENT CHARGES AND PATIENT COST EXCLUDING RELATED BAD DEBT COSTS COUNTED ELSEWHERE IN THE COMMUNITY BENEFIT NUMBERS. THE NUMBERS USED IN THE CALCULATION OF THE RATIO WERE OBTAINED FROM THE MEDICARE COST REPORT FOR THE RELATED PERIOD. THIS RATIO IS USED IN THE CALCULATION OF CHARITY CARE, MEDICAID, OTHER MEANS-TESTED GOVERNMENT PROGRAMS AND SUBSIDIZED HEALTH SERVICES. FOR THE REMAINING LINES, DIRECT EXPENSES WERE IDENTIFIED BY PROGRAM BASED ON PROGRAM RECORDS. |
| PART I, LN 7 COL(F): | THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25 COLUMN (A) BUT SUBTRACTED OUT FOR PURPOSES OF CALCULATING THE PERCENTAGE ON SCH H, PART I, LINE 7, COLUMN (F) IS $3,359,460. |
| PART III, LINE 2: | TOTAL RATIO OF COST TO CHARGES (BAD DEBT EXPENSE WAS BACKED OUT TO CALCULATE THE RATIO) WAS USED TO CALCULATE BAD DEBT EXPENSE. |
| PART III, LINE 3: | MEMORIAL HOSPITAL OF TOWANDA PROVIDES CARE TO ALL PATIENTS WHO NEED IT, REGARDLESS OF THEIR ABILITY TO PAY. THIS IS PART OF THE HOSPITAL'S MISSION. THE HOSPITAL ESTIMATES THAT 15% OF THE BAD DEBT EXPENSE AT COST IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY THAT HAVE NOT FILLED OUT THE PROPER FORMS OR PROVIDED THE PROPER INFORMATION TO QUALIFY FOR THE PROGRAM. |
| PART III, LINE 4: | PATIENT ACCOUNTS RECEIVABLE ARE REPORTED AT NET REALIZABLE VALUE. ACCOUNTS ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE BASED UPON MANAGEMENTS ASSESSMENT OF INDIVIDUAL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS ANDPROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUAL AMOUNTS DUE AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICHINDICATES THAT MANY PATIENTS ARE UNABLE TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE BILLED RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. |
| PART III, LINE 8: | MEDICARE ALLOWABLE COST AMOUNT DETERMINED FROM MEDICARE COST REPORT. SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT, AS THE HOSPITAL PROVIDES CARE TO ALL PATIENTS IN NEED REGARDLESS OF THEIR ABILITY TO PAY. |
| PART III, LINE 9B: | IF UPON REGISTRATION, PATIENT IS DETERMINED TO HAVE NO INSURANCE AND QUALIFIES FOR FINANCIAL ASSISTANCE THEY ARE ASKED TO PROVIDE COPIES OF A W-2, PAY STUB, OR INCOME TAX RETURN TO COMPLETE OUR CHARITY CARE APPLICATION. DETERMINATION IS MADE BASED ON INFORMATION RECEIVED AND FINANCIAL GUIDELINES BEFORE UNDERTAKING COLLECTION EFFORTS. |
| PART VI, LINE 2: | MEMORIAL HOSPITAL CONDUCTS ITS OWN HEALTH CARE ASSESSMENT ON AN ONGOING BASIS FOR THE HOSPITAL'S PRIMARY (ZIP CODES: 18837, 18854, 18815, 18853, 18814, 18848, 18832, 18833, 18614, 16947, 16926, 17743, 17724 AND 17735) AND SECONDARY (16914, 18817, 18840, 18831, 18850, 18851, 18829, 18845, 18818, 18828, 18839, 18801, 18843, 18846, 18616 AND 18632) SERVICE AREA. THE HOSPITAL USES ITS BOARD OF TRUSTEES, PHYSICIANS ON STAFF, EMPLOYEES AND COMMUNITY MEMBERS TO IDENTIFY NEEDS BASED ON INFORMATION OBTAINED BY THESE INDIVIDUALS OR GROUPS. BASED ON WHAT IS OBTAINED, THE HOSPITAL CAN THEN DETERMINE WHAT HEALTHCARE SERVICES SHOULD BE CONSIDERED TO BE OFFERED IN THE COMMUNITY. |
| PART VI, LINE 3: | INFORMATION IS PROVIDED THROUGHOUT THE HOSPITAL REGARDING THE CHARITY CARE PROGRAM. TELEPHONE CALLS ARE MADE TO ALL SELF PAY PATIENTS AS WELL AS SEEING THEM PERSONALLY IF THEY HAPPEN TO BE AN INPATIENT OF THE HOSPITAL. EVERY INTAKE AREA OF THE HOSPITAL HAS INFORMATION REGARDING THE FINANCIAL ASSISTANCE THE HOSPITAL CAN PROVIDE AND THE CONTACT INFORMATION FOR THE HOSPITAL'S FINANCIAL COUNSELOR IS MADE AVAILABLE. ALL NEW HIRED EMPLOYEES IN INTAKE AREAS ARE TRAINED IN THE FINANCIAL ASSISTANCE POLICIES AS PART OF THEIR ORIENTATION PROCESS. A NOTICE FOR FINANCIAL AID IS POSTED ON THE HOSPITAL'S WEB SITE FOR THOSE SEEKING THE INFORMATION VIA THE WEB. IN THE EVENT AN INTERPRETER IS NEEDED TO ASSIST A PATIENT WHO DOES NOT SPEAK ENGLISH, ONE CAN BE PROVIDED. |
| PART VI, LINE 4: | MEMORIAL HOSPITAL SERVES A RURAL PORTION OF BRADFORD AND SULLIVAN COUNTIES IN NORTHEAST PA. THE TOTAL POPULATION FOR BOTH COUNTIES IS APPROXIMATELY 67,000. THE HOSPITAL SERVES A HIGH PERCENTAGE OF MEDICAL ASSISTANCE PATIENTS AND IS ELIGIBLE FOR DSH REIMBURSEMENT AS A RESULT. ACCORDING TO THE PENNSYLVANIA HEALTH CARE COST CONTAINMENT COUNCIL (PHC4), MEMORIAL HOSPITAL HAD A 17.66% SHARE OF NET PATIENT REVENUE COMING FROM MEDICAL ASSISTANCE PATIENTS. THE AVERAGE FOR THE REGION MEMORIAL HOSPITAL IS LOCATED IN IS 7.87%. MEMORIAL HOSPITAL ALSO HAD, ACCORDING TO PHC4, AN UNCOMPENSATED CARE PERCENTAGE OF 5.31% WITH THE REGION AVERAGE BEING 2.90%. THE HOSPITAL'S 24 HOUR EMERGENCY ROOM CARES FOR MANY PATIENTS SEEKING PRIMARY CARE WHO DO NOT HAVE AN EXISTING PRIMARY CARE PHYSICIAN. WITHIN BRADFORD AND SULLIVAN COUNTIES THERE ARE AREAS DESIGNATED AS MEDICALLY UNDERSERVED, WITH THE HOSPITAL CARING FOR MANY PATIENTS WITHIN THOSE AREAS. |
| PART VI, LINE 5: | MEMORIAL HOSPITAL IS GOVERNED BY A 27 MEMBER VOLUNTEER BOARD OF TRUSTEES WITH THE MAJORITY OF THOSE TRUSTEES RESIDING IN THE HOSPITAL'S PRIMARY SERVICE AREA. THE CFO AND AN EMPLOYED PHYSICIAN ARE MEMBERS OF THE BOARD OF TRUSTEES. THE REMAINING 25 MEMBERS ARE COMMUNITY MEMBERS OF THE AREAS THE HOSPITAL SERVES THAT ARE NEITHER EMPLOYEES, CONTRACTORS OF THE ORGANIZATION, OR FAMILY MEMBERS THEREOF. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY WHO SEEK THOSE PRIVILEGES. ANY SURPLUS FUNDS GENERATED BY THE HOSPITAL ARE USED FOR FUNDING IMPROVEMENTS IN PATIENT CARE. THE HOSPITAL'S 24 HOUR EMERGENCY ROOM TREATS ALL PATIENTS WHO PRESENT REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL PARTICIPATES WITH ALL GOVERNMENT SPONSORED HEALTH CARE PROGRAMS AND OFFERS FINANCIAL ASSISTANCE TO PATIENTS WHO SEEK ASSISTANCE AND MEET THE GUIDELINES. |
| PART VI, LINE 6: | MEMORIAL HOSPITAL IS SUPPORTED BY THE MEMORIAL HOSPITAL FOUNDATION, WHICH WAS ESTABLISHED IN 2003 TO FOSTER AND SUPPORT SPECIFIC PROJECTS AND PROGRAMS TO IMPROVE THE HOSPITAL'S SERVICES TO ITS PATIENTS. THE MISSION OF THE MEMORIAL HOSPITAL FOUNDATION IS TO GENERATE RESOURCES FOR THE SUSTAINABILITY AND ADVANCEMENT OF HEALTHCARE IN THE COMMUNITIES IT HAS THE PRIVILEGE OF SERVING. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| WILLIAM ROHRBACH | ||||||||||||||
| CFO/ASST SECRETARY | $161,435 | $0 | $30,794 | $0 | $0 | $0 | $5,800 | $0 | $11,533 | $0 | $209,562 | $0 | $0 | $0 |
| LISA CERAOLO MD | ||||||||||||||
| TRUSTEE/VP MEDICAL STAFF | $183,958 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $11,460 | $0 | $195,418 | $0 | $0 | $0 |
| MARC ALPERT | ||||||||||||||
| GENERAL SURGEON | $278,845 | $0 | $0 | $0 | $0 | $0 | $4,904 | $0 | $11,460 | $0 | $295,209 | $0 | $0 | $0 |
| WINGROVE JARVIS | ||||||||||||||
| ORTHOPEDIC SURGEON | $251,104 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $251,104 | $0 | $0 | $0 |
| TIMOTHY POWELL | ||||||||||||||
| OB/GYN | $214,338 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $13,248 | $0 | $227,586 | $0 | $0 | $0 |
| LARRY MCCULLOUGH | ||||||||||||||
| OB/GYN | $195,860 | $0 | $0 | $0 | $0 | $0 | $5,964 | $0 | $11,761 | $0 | $213,585 | $0 | $0 | $0 |
| TIMOTHY DENNEN | ||||||||||||||
| FAMILY PRACTICE PHYSICIAN | $183,866 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $12,543 | $0 | $196,409 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|
| MUNICIPAL HOSPITAL AUTHORITY OF THE TOWNSHIP OF NORTH TOWANDA | |||||||
| A | 232308413 | 2012-10-05 | $10,000,000 | SEE PART VI | 0 | 0 | 0 |
| MUNICIPAL HOSPITAL AUTHORITY OF THE TOWNSHIP OF NORTH TOWANDA | |||||||
| B | 232308413 | 2004-10-19 | $9,800,000 | CONSTRUCTION, RENOVATION AND REFINANCING | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Other Spent ProceedsOtherSpentProceedsAmt | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|---|
| A | $774,564 | $10,000,000 | $112,309 | $5,279,697 | $4,607,994 | Yes (1) | 0 | Yes (1) | Yes (1) |
| B | $5,698,153 | $9,800,000 | $4,621,214 | $5,178,786 | Yes (1) | 0 | Yes (1) | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Private Bus Concerning UBIPrivateBusConcerningUBIPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | 0 |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | Yes (1) | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 |
| B | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 | 0 |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | 0 |
| B | 0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE K, PART I, COLUMN F: | BOND ISSUE A: PURPOSE OF BOND: TO PAY OFF REMAINING PORTION OF 2005 NOTE PAYABLE, CONSTRUCTION OF CAPITAL PROJECTS AND EQUIPMENT. |
| SCHEDULE K, PART V PROCEDURES TO UNDERTAKE CORRECTIVE ACTION: | ALTHOUGH THE ORGANIZATION DOES NOT CURRENTLY HAVE SUCH PROCEDURES DOCUMENTED IN WRITING, IT DOES FOLLOW SUCH PROCEDURES AND IS IN THE PROCESS OF ADOPTING A FORMAL, WRITTEN POLICY. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | JAMES PARKS (VICE-CHAIRMAN) IS THE BROTHER-IN-LAW OF ROBERT FERRARIO (SECRETARY). |
| FORM 990, PART VI, SECTION A, LINE 3 | MEMORIAL HOSPITAL HAS A MANAGEMENT CONTRACT WITH QUORUM HEALTH RESOURCES. GARY BAKER, PRESIDENT/CEO, IS EMPLOYED BY QUORUM HEALTH RESOURCES. GARY'S CALENDAR YEAR 2013 COMPENSATION WAS $264,751. |
| FORM 990, PART VI, SECTION B, LINE 11 | REVIEWED IN DETAIL BY MANAGEMENT WITH THE HELP OF BAKER TILLY. A COPY OF THE RETURN WAS EMAILED TO THE MEMBERS OF THE FINANCE COMMITTEE OF THE BOARD OF TRUSTEES FOR THEIR REVIEW BEFORE FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | OUR TRUSTEES, MEDICAL STAFF AND MANAGEMENT STAFF ALL ARE REQUIRED TO DISCLOSE CONFLICTS OF INTEREST THROUGH A FORMAL PROCESS OF REVIEWING THE POLICY & DISCLOSING & SIGNING A STATEMENT. THEY ARE ENCOURAGED TO PARTICIPATE IN DISCUSSION, BUT WILL ABSTAIN DURING VOTES. CONFLICT OF INTEREST STATEMENTS BY MANAGEMENT STAFF ARE REVIEWED BY THE VICE PRESIDENT OF HUMAN RESOURCES. TRUSTEE AND MEDICAL STAFF CONFLICT OF INTEREST DISCLOSURES ARE REVIEWED BY THE VICE PRESIDENT OF ADMINISTRATIVE AND MEDICAL STAFF AFFAIRS. DISCIPLINARY ACTIONS RESULTING FROM INADEQUATE DISCLOSURE ARE DETERMINED ON A CASE BY CASE MANNER AND COULD RESULT IN TERMINATION OF EMPLOYMENT. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION COMMITTEE REVIEWS AND APPROVES THE SALARIES OF THE CEO, CFO AND VP'S. MEMBERS OF THE BOARD, AS WELL AS THE VP OF THE MANAGEMENT COMPANY, ARE INVOLVED IN SETTING COMPENSATION. SURVEYS ARE USED TO COMPARE THE SALARIES TO MAINTAIN APPROPRIATENESS OF WAGES. REVIEW AND APPROVAL IS DOCUMENTED IN COMMITTEE MINUTES. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND/OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | MEDICAL SERVICES FEES: PROGRAM SERVICE EXPENSES 3,393,890. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,393,890. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 1,195,803. MANAGEMENT AND GENERAL EXPENSES 458,537. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,654,340. |
| FORM 990, PART XI, LINE 9: | PENSION LIABILITY ADJUSTMENT 2,520,643. CHANGE IN INTEREST IN MEMORIAL HOSPITAL FOUNDATION 1,054,273. CHANGE IN TEMPORARILY RESTRICTED INTEREST IN MEMORIAL HOSPITAL FOUNDATION 62,639. ASSETS ACQUIRED OVER LIABILITIES -155,805. LOSS ON PENSION SETTLEMENT -2,520,643. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HEALTH ASSOCIATES LLC | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 91 HOSPITAL DRIVE | AddressLine1 |
| City | TOWANDA | City |
| State | PA | State |
| ZIP Code | 18848 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 262096228 | EIN |
| Primary Activities | EMPLOYS PHYSICIANS FOR THE HOSPITAL | PrimaryActivitiesTxt |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Total Income | $1,889,978 | TotalIncomeAmt |
| End Of Year Assets | $5,597,350 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE MEMORIAL HOSPITAL INC OF TOWANDA | BusinessNameLine1 |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE MEMORIAL HOSPITAL FOUNDATION | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 91 HOSPITAL DRIVE | AddressLine1 |
| City | TOWANDA | City |
| State | PA | State |
| ZIP Code | 188489703 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 651160811 | EIN |
| Primary Activities | SUPPORTS THE ACTIVITIES AND PURPOSES OF THE HOSPITAL | PrimaryActivitiesTxt |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | 11A | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE MEMORIAL HOSPITAL INC OF TOWANDA | BusinessNameLine1 |
| 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 | Yes (1) | 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 | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | 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 (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| THE MEMORIAL HOSPITAL FOUNDATION | ||
| C | $173,746 | CASH |
| THE MEMORIAL HOSPITAL FOUNDATION | ||
| D | $9,433,509 | CASH |