PETERSBURG MEDICAL CENTER: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- PETERSBURG MEDICAL CENTER (EIN 92-6001607)
- Tax period
- 2013-07-01 to 2014-06-30
- Filed
- 2015-05-14
- IRS object ID
- 201541349349304484
- 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 D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-05-14T13:03:39-05:00 | ReturnTs |
| Tax Period End | 2014-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BDO USA LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3601 C STREET STE 600 | AddressLine1 |
| City | ANCHORAGE | City |
| State | AK | State |
| ZIP Code | 99503 | 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 | 926001607 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PETERSBURG MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % ELIZABETH WOODYARD | InCareOfNm |
| Business Name Control | PETE | BusinessNameControlTxt |
| Phone | 9077724291 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 589 | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | PETERSBURG | City |
| State | AK | State |
| ZIP Code | 99833 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ELIZABETH WOODYARD | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 9077724291 | PhoneNum |
| Signature | 2015-05-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Key E Getty CPA | PreparerPersonNm |
| PTIN | P00121200 | PTIN |
| Phone | 9077724291 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ELIZABETH WOODYARD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 589 | AddressLine1 |
| City | Petersburg | City |
| State | AK | State |
| ZIP Code | 99833 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $15,944,497 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.pmcak.org | WebsiteAddressTxt |
| Type Of Organization Other | Yes (X) | TypeOfOrganizationOtherInd |
| Other Organization Dsc | COMP | OtherOrganizationDsc |
| Formation | 1993 | FormationYr |
| Legal Domicile State | AK | LegalDomicileStateCd |
| Activity Or Mission | OUR MISSION IS TO PROVIDE EXCELLENT HEALTHCARE AND TO PROMOTE WELLNESS IN OUR COMMUNITY | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 142 | TotalEmployeeCnt |
| Total Volunteers | 15 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $1,098,094 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,659,679 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $12,948,321 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $11,867,845 | CYProgramServiceRevenueAmt |
| PY Investment Income | $97,972 | PYInvestmentIncomeAmt |
| CY Investment Income | $253,593 | CYInvestmentIncomeAmt |
| PY Other Revenue | $130,899 | PYOtherRevenueAmt |
| CY Other Revenue | $142,285 | CYOtherRevenueAmt |
| PY Total Revenue | $14,275,286 | PYTotalRevenueAmt |
| CY Total Revenue | $13,923,402 | 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 | $8,925,363 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,212,669 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $8,650 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,651,493 | PYOtherExpensesAmt |
| CY Other Expenses | $4,828,482 | CYOtherExpensesAmt |
| PY Total Expenses | $13,576,856 | PYTotalExpensesAmt |
| CY Total Expenses | $14,041,151 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $698,430 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$117,749 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $13,725,987 | TotalAssetsBOYAmt |
| Total Assets EOY | $13,533,451 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,844,115 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,603,657 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $10,881,872 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $10,929,794 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | OUR MISSION IS TO PROVIDE EXCELLENT HEALTHCARE AND TO PROMOTE WELLNESS IN OUR COMMUNITY. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $2,307,871 | ExpenseAmt |
| Revenue | $2,609,080 | RevenueAmt |
| Desc | NURSING SERVICES PROVIDED IN ACUTE CARE, INTENSIVE CARE, SWINGBED, EMERGENCY ROOM, OPERATING ROOM AND HOME HEALTH SAVINGS. THESE SERVICES ARE PROVIDED IN A SEMI-REMOTE RURAL AREA OF ALASKA. ACCESS TO THE AREA IS BY AIR OR WATER ONLY. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,717,361 | ExpenseAmt |
| Revenue | $4,457,799 | RevenueAmt |
| Desc | OTHER HEALTHCARE SERVICES. THESE SERVICES ARE PROVIDED IN A SEMI-REMOTE AREA OF RURAL ALASKA. ACCESS TO THE AREA IS BY AIR OR WATER ONLY. THE SERVICES INCLUDE LABORATORY, IMAGING, AND PHYSICAL THERAPY. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,248,141 | ExpenseAmt |
| Revenue | $1,910,293 | RevenueAmt |
| Desc | CLINIC. WE PROVIDE CLINIC SERVICES TO SEMI-REMOTE AREAS OF ALASKA ACCESSIBLE BY AIR OR WATER ONLY. NURSING HOME. WE PROVIDE NURSING HOME SERVICES IN A SEMI-REMOTE AREA OF RURAL ALASKA. ACCESSIBLE BY AIR OR WATER ONLY. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,911,553 | ExpenseAmt |
| Revenue | $2,890,675 | RevenueAmt |
| Desc | LONG TERM CARE | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $1,911,553 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $2,890,675 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $9,184,926 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 62 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 142 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | false | ConflictOfInterestPolicyInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | false | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ELIZABETH WOODYARD | PersonNm |
| Phone | 9077724291 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 589 | AddressLine1 |
| City | PETERSBURG | City |
| State | AK | State |
| ZIP Code | 99833 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| TOM ABBOTT | |||||||
| PRESIDENT | 4.0 | Yes (X) | Yes (X) | ||||
| JEANETTE NESS | |||||||
| SECRETARY | 2.0 | Yes (X) | Yes (X) | ||||
| KRIS KISSINGER | |||||||
| BOARD MEMBER | 2.0 | Yes (X) | |||||
| TIM KOENEMAN | |||||||
| VICE PRESIDENT | 2.0 | Yes (X) | Yes (X) | ||||
| DARLENE WHITEHORN | |||||||
| SECRETARY | 2.0 | Yes (X) | Yes (X) | ||||
| ROCIO TEJERA | |||||||
| BOARD MEMBER | 2.0 | Yes (X) | |||||
| STEVEN SAMUELSON | |||||||
| BOARD MEMBER | 2.0 | Yes (X) | |||||
| Elizabeth Woodyard | |||||||
| CHIEF EXECUTIVE OFFICER | 40.0 | Yes (X) | $200,013 | $0 | $14,002 | ||
| JENNIFER BRYNER | |||||||
| DIRECTOR OF NURSING | 40.0 | $124,123 | $0 | $42,202 | Yes (X) | ||
| Alice Hulebak | |||||||
| Physician | 40.0 | $150,510 | $0 | $21,072 | Yes (X) | ||
| Jennifer Hyer | |||||||
| Physician | 40.0 | $182,214 | $0 | $30,977 | Yes (X) | ||
| MARK TUCCILLO | |||||||
| PHYSICIAN | 40.0 | $210,127 | $0 | $52,532 | Yes (X) | ||
| KRISTOFOR SARGENT | |||||||
| PHYSICIAN | 40.0 | $174,486 | $55,336 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,041,473 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $216,121 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| INNOVATIVE EMPLOYEE SOLUTIONS | |||||
| 9665 GRANITE RIDGE 420 | SAN DIEGO | CA | 92123 | TRAVELER NURSES | $191,695 |
| DELTA HEALTHCARE PLACEMENT | |||||
| PO BOX 202940 | DALLAS | TX | 753202056 | RECRUITMENT | $253,210 |
| HEALTHCARE RESOURCE GROUP | |||||
| 800 12610 E MIRABEAU PKY | SPOKANE | WA | 99216 | INTERIM FISCAL SERVI | $185,413 |
| PARKER SMITH FEEK | |||||
| PO BOX 84232 | SEATTLE | WA | 98124 | INSURANCE | $160,332 |
| COMPHEALTH | |||||
| 9910 LONG POINT ROAD | HOUSTIN | TX | 77080 | CONTRACT STAFFING | $160,662 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,659,679 | GovernmentGrantsAmt |
| Total Contributions | $1,659,679 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICES | Desc |
| Business | 624100 | BusinessCd |
| Total Revenue Column | $11,867,845 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,867,845 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $11,867,845 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $47,962 | TotalRevenueColumnAmt |
| Exclusion | $47,962 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $18,490 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $18,490 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,490 | TotalRevenueColumnAmt |
| Exclusion | $18,490 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,226,726 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,021,095 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $205,631 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $205,631 | TotalRevenueColumnAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| OTHER OPERATING REVENUE | 900099 | $123,148 | $123,148 |
| OTHER NON-OPERTING REVENUE | 900099 | $647 | $647 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $123,795 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,923,402 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,867,845 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $190,247 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $383,937 | TotalAmt |
| Program Services | $169,923 | ProgramServicesAmt |
| Management And General | $214,014 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,828,732 | TotalAmt |
| Program Services | $6,647,992 | ProgramServicesAmt |
| Management And General | $2,180,740 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,650 | TotalAmt |
| Fundraising | $8,650 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $878,803 | TotalAmt |
| Management And General | $878,803 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,045 | TotalAmt |
| Management And General | $57,045 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| NURSING SERVICES | $844,599 | $701,840 | $142,759 |
| ADMINISTRATIVE AND FISCAL SER | $1,117,905 | $1,117,905 | |
| MAINTENANCE | $256,309 | $256,309 | |
| PHYSICIANS | $1,316,761 | $1,316,761 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $348,410 | TotalAmt |
| Program Services | $348,410 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,041,151 | TotalAmt |
| Program Services | $9,184,926 | ProgramServicesAmt |
| Management And General | $4,847,575 | ManagementAndGeneralAmt |
| Fundraising | $8,650 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $95,032 | BOYAmt |
| EOY | $2,588,879 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,268 | BOYAmt |
| EOY | $2,709 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,720,658 | BOYAmt |
| EOY | $2,812,850 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $188,835 | BOYAmt |
| EOY | $206,904 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $90,790 | BOYAmt |
| EOY | $101,861 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $18,875,365 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $13,947,391 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,474,055 | BOYAmt |
| EOY | $4,927,974 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,035,851 | BOYAmt |
| EOY | $2,846,069 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $113,498 | BOYAmt |
| EOY | $46,205 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,725,987 | BOYAmt |
| EOY | $13,533,451 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,218,060 | BOYAmt |
| EOY | $2,223,905 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,398,367 | BOYAmt |
| EOY | $176,500 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $227,688 | BOYAmt |
| EOY | $203,252 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,844,115 | BOYAmt |
| EOY | $2,603,657 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Does Not Follow SFAS117 | Yes (X) | OrgDoesNotFollowSFAS117Ind |
Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,691,170 | BOYAmt |
| EOY | $6,306,163 | EOYAmt |
Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,190,702 | BOYAmt |
| EOY | $4,623,631 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,881,872 | BOYAmt |
| EOY | $10,929,794 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,725,987 | BOYAmt |
| EOY | $13,533,451 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$117,749 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $165,671 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | 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 (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Governmental Unit | Yes (X) | GovernmentalUnitInd |
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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $347,944 | OtherCostOrOtherBasisAmt |
| Book Value | $347,944 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $12,402,414 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,626,423 | DepreciationAmt |
| Book Value | $2,775,991 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $125,327 | OtherCostOrOtherBasisAmt |
| Depreciation | $111,290 | DepreciationAmt |
| Book Value | $14,037 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $5,999,680 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,209,678 | DepreciationAmt |
| Book Value | $1,790,002 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,927,974 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| PAYABLE TO FOUNDATION | $29,204 |
| CAPITAL LEASE | $174,048 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $203,252 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $14,080,423 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $165,671 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$8,650 | OtherRevenueAmt |
| Revenue Not Reported | $157,021 | RevenueNotReportedAmt |
| Revenue Subtotal | $13,923,402 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $13,923,402 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $14,032,501 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $14,032,501 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $8,650 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $8,650 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $14,041,151 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule D, Part XI, Line 2d | Investment fees netted against revenue originally for $8,650 relcassed to expenses. |
| Schedule D, Part XII, Line 4b | Investment fees netted against revenue originally for $8,650 relcassed to expenses. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 175. | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | false | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $36,061 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $36,601 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00250 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $36,061 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $36,601 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00250 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $36,061 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $36,601 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00250 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,211,344 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $3,703,054 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,781,508 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$78,454 | 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 (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NONE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | PETERSBURG MEDICAL CENTER | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 103 FRAM ST PO BOX 589 | AddressLine1 |
| City | PETERSBURG | City |
| State | AK | State |
| ZIP Code | 99833 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Other | NURSING HOME OUTPATIENT CLINIC | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PETERSBURG MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | false | CHNAReportWidelyAvailableInd |
| All Needs Addressed | false | AllNeedsAddressedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (true) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 100 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (true) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 175. | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Medicaid Medicare | Yes (X) | MedicaidMedicareInd |
| State Regulation | Yes (X) | StateRegulationInd |
| Residency | Yes (X) | ResidencyInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| Attached To Invoice | Yes (X) | AttachedToInvoiceInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | Yes (true) | GrossChargesInd |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | THE % OF FINANCIAL ASSISTANCE IS THE AMOUNT OF FINANCIAL ASSISTANCE AT COST $36,061 DIVIDED BY TOTAL EXPENSES OF $14,032,501. |
| PART III, LINE 2: | THE AMOOUNT OF BAD DEBT EXPENSE IS THE NET DOLLAR AMOUNT OF PATIENT CHARGES TURNED OVER TO COLLECTION AGENCIES DURING THE YEAR. |
| PART III, LINE 4: | THERE IS NO FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS DESCRIBING BAD DEBT EXPENSE. |
| PART III, LINE 8: | MEDICARE REVENUES EXCEED MEDICARE EXPENSES - THERE IS NO SHORTFALL. MEDICARE COSTS AND EXPENSES ARE FROM THE COST REPORT. |
| PART III, LINE 9B: | IF A PATIENT STATES OR IMPLIES HAVING A LIMITED MEANS TO PAY, BUSINESS OFFICE STAFF SPECIFICALLY NOTIFY THEM OF THE CHARITY POLICY. |
| PART V, LINE 12H: | AD ADDITIONAL FACTOR USED TO DETERMINE AMOUNTS CHARGED TO PATIENTS UNDER THE FINANCIAL ASSISTANCE POLICY IS FAMILY SIZE. |
| PART V, LINE 20D AND 22: | ALL PATIENTS ARE CHARGED THE GROSS CHARGE ESTABLISHED IN THE CHARGEMASTER. IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSITANCE POLICY, THE CHARGES ARE REDUCED TO THE AMOUNTS PERMITTED BY THE POLICY. |
| PART VI, LINE 2: NEEDS ASSESSMENT | The organization's board maintains an awareness of the health care needs of the community and attempts to provide for those needs while remaining financially viable. |
| PART VI, LINE 3: PATIENT EDUCATION OF ELIBIBILITY FOR ASSITANCE | The organization's staff informs any patient for whom they become aware of possible elgibility for financial assistance of the existance of such assistance. The same applies to possible federal and state assistance. applies to possible federal and state assistance. |
| PART VI, LINE 4: COMMUNITY INFORMATION | The organization operates on an island off the southeast coast of Alaska. The island is accessed only by air or water. The core population is 3,000. The primary industry is fishing. A once thriving timber industry has now ceased to exist. |
| PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH | The organization operates under the direction of a board of locally elected citizens. The board is not compensated. They serve because they want to have the best possible health services within the community given the limited resources. |
| PART V, LINE 3: | A steering committee oversaw the community health needs assessment. That committee, in addition to three members of the Petersburg Medical Center staff, included representatives from Petersburg Mental Health, Petersburg Fire and Emergency Services, the Petersburg Indian Association, Petersburg Public Health, the Petersburg Ministerial Association, the Petersburg School District, and the City of Petersburg. Key informant interviews were conducted with diverse members of the community asked a standardized set of questions. Those key informants were a businessman, a fisherman, a healthcare employee, a high school student, an elder, and a person with a chronic disability. Additionally, a community round table where all members of the community were invited was a part of the assessment. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | Yes (true) | SubstantiationRequiredInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Elizabeth Woodyard | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $200,013 | $0 | $0 | $0 | $0 | $0 | $10,001 | $0 | $4,001 | $0 | $214,015 | $0 | $0 | $0 |
| JENNIFER BRYNER | ||||||||||||||
| DIRECTOR OF NURSING | $124,123 | $0 | $0 | $0 | $0 | $0 | $27,307 | $0 | $14,895 | $0 | $166,325 | $0 | $0 | $0 |
| Alice Hulebak | ||||||||||||||
| Physician | $150,510 | $0 | $0 | $0 | $0 | $0 | $7,526 | $0 | $13,546 | $0 | $171,582 | $0 | $0 | $0 |
| Jennifer Hyer | ||||||||||||||
| Physician | $182,214 | $0 | $0 | $0 | $0 | $0 | $9,111 | $0 | $21,866 | $0 | $213,191 | $0 | $0 | $0 |
| MARK TUCCILLO | ||||||||||||||
| PHYSICIAN | $210,127 | $0 | $0 | $0 | $0 | $0 | $46,228 | $0 | $6,304 | $0 | $262,659 | $0 | $0 | $0 |
| KRISTOFOR SARGENT | ||||||||||||||
| PHYSICIAN | $174,486 | $38,387 | $16,949 | $229,822 | ||||||||||
Schedule L IRS990ScheduleL
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $0 | TotalBalanceDueAmt |
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | elizabeth hart | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | spouse of board president | RelationshipDescriptionTxt |
| Transaction | $90,088 | TransactionAmt |
| Transaction | wages | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCH L, PART IV: | FormAndLineReferenceDesc |
| Explanation | (A) NAME OF PERSON: ELIZABETH HART (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: SPOUSE OF BOARD PRESIDENT | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART I, ITEM K, OTHER ORGANIZATION TYPE: | COMPONENT UNIT OT PETERSBURG BOROUGH, AK |
| FORM 990, PART III, LINE 4D, OTHER PROGRAM SERVICES | NURSING HOME. WE PROVIDE NURSING HOME SERVICES IN A SEMI REMOTE AREA OF RURAL ALASKA. ACCESS TO THE AREA IS BY AIR OR WATER ONLY. EXPENSES $2,307,871. INCLUDING GRANTS OF $0. REVENUE $2,611,745. |
| FORM 990, PART VI, SECTION B, LINE 11: | THE CHIEF FINANCIAL OFFICER AND THE CHIEF EXECUTIVE OFFICER WILL EACH REVIEW THE COMPLETED RETURN SEPARATELY AND THEN RESOLVE ANY ISSUES WHICH ARISE PRIOR TO FILING THE RETURN. |
| FORM 990, PART VI, SECTION B, LINE 15: | THE CHIEF EXECUTIVE OFFICERS SALARY IS DETERMINED BY THE BOARD OF DIRECTORS AFTER REVIEWING SALARIES FOR SIMILAR POSITIONS IN COMPARABLE ORGANIZATIONS OF THE HEALTHCARE INDUSTRY. A SALARY HISTORY OF THE POSITION IS PART OF THE REVIEW. THE COMPENSATION REVIEW IS MADE IN CONJUNCTION WITH THE CEOS ANNUAL EVALUATION. |
| FORM 990, PART VI, SECTION C, LINE 19: | PETERSBURG MEDICAL CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PETERSBURG MEDICAL CENTER FND | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 589 | AddressLine1 |
| City | PETERSBURG | City |
| State | AK | State |
| ZIP Code | 99833 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 920134279 | EIN |
| Primary Activities | SEE PAGE 5 | PrimaryActivitiesTxt |
| Legal Domicile State | AK | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | 509(A)(3) | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PETERSBURG | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (true) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE R, PART II, LINE1: | FormAndLineReferenceDesc |
| Explanation | A: PETERSBURG MEDICAL CENTER, PO BOX 589, PETERSBURG, AK 99833, 92-0134279 B: CARRY OUT FUNDRAISING & CHARITABLE ACTIVITIES FOR PETERSBURG MEDICAL CENTER C: AK D: 501(C)(3) E: 509(A)(3) F: PETERSBURG G: YES | ExplanationTxt |