NEWMAN MEMORIAL HOSPITAL INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- NEWMAN MEMORIAL HOSPITAL INC (EIN 73-0570773)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-14
- IRS object ID
- 201403189349301920
- Schema version
- 2013v3.1
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-14T09:06:23-06:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6120 S Yale 1400 | AddressLine1 |
| City | Tulsa | City |
| State | OK | State |
| ZIP Code | 741364223 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 730570773 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NEWMAN MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % NEWMAN MEMORIAL HOSPITAL | InCareOfNm |
| Business Name Control | NEWM | BusinessNameControlTxt |
| Phone | 5809382551 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 905 SOUTH MAIN | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | SHATTUCK | City |
| State | OK | State |
| ZIP Code | 73858 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEFFREY D SHELTON | PersonNm |
| Person Title | OFFICER | PersonTitleTxt |
| Phone | 5809382551 | PhoneNum |
| Signature | 2014-11-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Anne M Adams | PreparerPersonNm |
| PTIN | P00887943 | PTIN |
| Phone | 5809382551 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JEFFREY D SHELTON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 905 SOUTH MAIN | AddressLine1 |
| City | SHATTUCK | City |
| State | OK | State |
| ZIP Code | 73858 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $10,542,348 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.NEWMANMEMORIALHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1907 | FormationYr |
| Legal Domicile State | OK | LegalDomicileStateCd |
| Activity Or Mission | NEWMAN MEMORIAL HOSPITAL'S MISSION IS TO SERVE THE COMMUNITY BY PROVIDING HEALTHCARE SERVICE AND HEALTHCARE EDUCATION. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 121 | TotalEmployeeCnt |
| Total Volunteers | 14 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $1,719,966 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,624,639 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $9,537,601 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $7,796,793 | CYProgramServiceRevenueAmt |
| PY Investment Income | $12,640 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,600 | CYInvestmentIncomeAmt |
| PY Other Revenue | $175,484 | PYOtherRevenueAmt |
| CY Other Revenue | $1,119,316 | CYOtherRevenueAmt |
| PY Total Revenue | $11,445,691 | PYTotalRevenueAmt |
| CY Total Revenue | $10,542,348 | 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 | $4,592,553 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $4,015,760 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,973,749 | PYOtherExpensesAmt |
| CY Other Expenses | $7,196,818 | CYOtherExpensesAmt |
| PY Total Expenses | $11,566,302 | PYTotalExpensesAmt |
| CY Total Expenses | $11,212,578 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$120,611 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$670,230 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $14,067,988 | TotalAssetsBOYAmt |
| Total Assets EOY | $14,244,579 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $7,039,682 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,909,038 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $7,028,306 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $6,335,541 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | PROVIDE THE COMMUNITY WITH HEALTHCARE SERVICE AND HEALTHCHARE EDUCATION. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $8,220,073 | ExpenseAmt |
| Revenue | $8,886,024 | RevenueAmt |
| Desc | Newman Memorial Hospital provides quality medical healthcare regardless of race, creed, sex, national origin, disability, age, or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of Newman Memorial Hospital, it is recognized that not all individuals possess the ability to purchase essential medical services. Our mission is to serve the community with respect to providing healthcare services and healthcare education. Therefore, in keeping with this hospital's commitment to serve all members of its community: free care and/or subsidized care, care provided to persons covered by governmental programs at below cost, health activities and programs to support the community will be considered where the need and/or an individual's inability to pay coexists. These activities include wellness programs, community education programs, special programs for the elderly, disabled, medically underserved, and a variety of broad community support activities. Newman Memorial Hospital serviced 455 inpatients and provided over 4,000 home health visits during 2013. In addition, Newman Memorial Hospital provided emergency room care for over 2,555 patients. Newman Memorial Hospital provides care to persons covered by governmental programs at below cost. Recognizing its mission to the community, services are provided to Medicare and Medicaid patients. To the extent reimbursement is below cost, Newman Memorial Hospital recognizes these amounts as charity care in meeting its mission to the entire community. Charity care is also provided through many reduced price services and free programs offered throughout the year based upon activities and services which Newman Memorial Hospital believes will serve a bona fide community health need. These include: - Provided additional charity care to the community of $313,912 during 2013. - Being called upon to speak before community organizations on a variety of healthcare topics. - Providing assistance to educators through our work with student nurses. - Providing meeting facilities for the Ministerial Alliance. Facilities are used for this purpose once a month. - During 2013 the Newman Hospital Auxiliary contributed over 3,800 volunteer hours toward the purpose of servicing the health care of the community. - Provided nursing scholarship to area students. - Provided free finger blood stick sugars and blood pressure checks to area senior citizens centers. - Provided over 250 WIC service visits for the area. - Provided influenza clinics in the four surrounding towns which served over 190 people. - Provided over 217 immunizations at the hospital. - Provided over 217 immunizations at the hospital. | Desc |
| Total Program Service Expenses | $8,220,073 | 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 | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | 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 | false | 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 | 26 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 121 | 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 | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | 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 | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OK | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | NEWMAN MEMORIAL HOSPITAL | PersonNm |
| Phone | 5809382551 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 905 SOUTH MAIN | AddressLine1 |
| City | SHATTUCK | City |
| State | OK | State |
| ZIP Code | 73858 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| MATTHEW SCOTT OD | ||||||
| PRESIDENT | 0.5 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| GREG HUENERGARDT | ||||||
| VICE PRESIDENT/PRESIDENT | 0.5 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| ANGELA PRATHER | ||||||
| SECRETARY | 0.5 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| DANNA STUART MD | ||||||
| DIRECTOR | 0.5 | Yes (X) | $0 | $0 | $0 | |
| BRENDA HUENERGARDT MD | ||||||
| DIRECTOR | 0.5 | Yes (X) | $0 | $0 | $0 | |
| DAVID DERSCH | ||||||
| DIRECTOR | 0.5 | Yes (X) | $0 | $0 | $0 | |
| TODD COOK | ||||||
| DIRECTOR | 0.5 | Yes (X) | $0 | $0 | $0 | |
| THERESA WHEELER | ||||||
| DIRECTOR | 0.5 | Yes (X) | $0 | $0 | $0 | |
| TED MILLER | ||||||
| VICE PRESIDENT | 0.5 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| RICHARD ROYAL | ||||||
| DIRECTOR | 0.5 | Yes (X) | $0 | $0 | $0 | |
| KYLE NONDORF | ||||||
| DIRECTOR | 0.5 | Yes (X) | $0 | $0 | $0 | |
| BRIDGET COSBY | ||||||
| DIRECTOR | 0.5 | Yes (X) | $0 | $0 | $0 | |
| RHONDA WAYLAND | ||||||
| DIRECTOR | 0.5 | Yes (X) | $0 | $0 | $0 | |
| KEVIN O'BRIEN | ||||||
| COO | 50.0 | Yes (X) | $134,584 | $0 | $6,475 | |
| DENISA KETTERMAN | ||||||
| CNO | 40.0 | Yes (X) | $53,477 | $0 | $2,755 | |
| JEFFREY SHELTON | ||||||
| CEO | 50.0 | Yes (X) | $105,587 | $0 | $2,823 | |
| RILEY CASPER | ||||||
| DIRECTOR OF NURSING | 50.0 | Yes (X) | $51,492 | $0 | $782 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $345,140 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $12,835 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (true) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ANESTHESIA LLC | |||||
| PO BOX 429 | SHATTUCK | OK | 73858 | ANESTHESIA | $353,000 |
| ACCOUNTABLE HEALTHCARE | |||||
| PO BOX 203820 | DALLAS | TX | 75320 | NURSING SERVICES | $168,244 |
| CONCORD MEDICAL GROUP | |||||
| 3004 50TH STREET SUITE D | LUBBOCK | TX | 79413 | ER PHYSICIANS | $425,428 |
| ST ANTHONY HOSPITAL | |||||
| PO BOX 205 | OKLAHOMA CITY | OK | 73101 | CLINICAL RESOURCES | $118,517 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,600,553 | GovernmentGrantsAmt |
| All Other Contributions | $24,086 | AllOtherContributionsAmt |
| Total Contributions | $1,624,639 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE | Desc |
| Business | 621300 | BusinessCd |
| Total Revenue Column | $7,796,793 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $7,796,793 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $7,796,793 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,600 | TotalRevenueColumnAmt |
| Exclusion | $1,600 | 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 | $30,085 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $30,085 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $30,085 | TotalRevenueColumnAmt |
| Exclusion | $30,085 | ExclusionAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | 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 (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| MEDICAL RECORD SALES | 900099 | $979,619 | $979,619 |
| CAFETERIA MEALS | 722210 | $48,187 | $48,187 |
| VENDING SALES | 900099 | $3,033 | $3,033 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $58,392 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $58,392 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,089,231 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,542,348 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,886,024 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $31,685 | 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 | $357,974 | TotalAmt |
| Management And General | $357,974 | 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 | $3,059,945 | TotalAmt |
| Program Services | $2,397,390 | ProgramServicesAmt |
| Management And General | $662,555 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,349 | TotalAmt |
| Program Services | $22,994 | ProgramServicesAmt |
| Management And General | $6,355 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $325,576 | TotalAmt |
| Program Services | $255,081 | ProgramServicesAmt |
| Management And General | $70,495 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $242,916 | TotalAmt |
| Program Services | $190,319 | ProgramServicesAmt |
| Management And General | $52,597 | ManagementAndGeneralAmt |
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 | $17,843 | TotalAmt |
| Management And General | $17,843 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,604 | TotalAmt |
| Management And General | $75,604 | ManagementAndGeneralAmt |
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 | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,300 | TotalAmt |
| Program Services | $8,057 | ProgramServicesAmt |
| Management And General | $16,243 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,705 | TotalAmt |
| Program Services | $39,726 | ProgramServicesAmt |
| Management And General | $10,979 | ManagementAndGeneralAmt |
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 | $200,206 | TotalAmt |
| Management And General | $200,206 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,289 | TotalAmt |
| Program Services | $53,503 | ProgramServicesAmt |
| Management And General | $14,786 | ManagementAndGeneralAmt |
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 | $281,942 | TotalAmt |
| Management And General | $281,942 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $810,812 | TotalAmt |
| Management And General | $810,812 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $184,639 | TotalAmt |
| Program Services | $184,639 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT EXPENSE | $1,767,560 | $1,767,560 | |
| CONTRACTUAL SALARIES | $1,825,219 | $1,825,219 | |
| SUPPLIES | $923,253 | $723,346 | $199,907 |
| EQUIPMENT RENTAL & MAINTENANCE | $497,656 | $389,901 | $107,755 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $468,790 | TotalAmt |
| Program Services | $362,338 | ProgramServicesAmt |
| Management And General | $106,452 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,212,578 | TotalAmt |
| Program Services | $8,220,073 | ProgramServicesAmt |
| Management And General | $2,992,505 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,675,452 | BOYAmt |
| EOY | $1,796,131 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $406,687 | BOYAmt |
| EOY | $407,913 | 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 | $1,613,393 | BOYAmt |
| EOY | $1,321,469 | 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 | $191,977 | BOYAmt |
| EOY | $172,498 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $155,100 | BOYAmt |
| EOY | $106,842 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $23,013,546 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $12,573,820 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,025,379 | BOYAmt |
| EOY | $10,439,726 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | 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 | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,067,988 | BOYAmt |
| EOY | $14,244,579 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $816,796 | BOYAmt |
| EOY | $832,354 | 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 | $6,222,886 | BOYAmt |
| EOY | $7,076,684 | 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 | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,039,682 | BOYAmt |
| EOY | $7,909,038 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,448,262 | BOYAmt |
| EOY | $5,651,904 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $580,044 | BOYAmt |
| EOY | $683,637 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,028,306 | BOYAmt |
| EOY | $6,335,541 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,067,988 | BOYAmt |
| EOY | $14,244,579 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$670,230 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | -$22,535 | PriorPeriodAdjustmentsAmt |
| 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| 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) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| 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) |
|---|---|---|
| Other Cost Or Other Basis | $41,025 | OtherCostOrOtherBasisAmt |
| Book Value | $41,025 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,249,170 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,167,543 | DepreciationAmt |
| Book Value | $5,081,627 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,684,606 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,406,277 | DepreciationAmt |
| Book Value | $5,278,329 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $38,745 | OtherCostOrOtherBasisAmt |
| Book Value | $38,745 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $10,439,726 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $10,542,348 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $10,542,348 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $10,542,348 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $11,212,578 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $11,212,578 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $11,212,578 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule D, Part XIII | FormAndLineReferenceDesc |
| Explanation | As a govenmental entity, the Hospital is generally exempt from federal and state income taxes under Section 115 of the Internal Revenue Code and a similar provision of state law. However, the Hospital is subject to federal income tax on any unrelated business taxable income. | ExplanationTxt |
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 |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 180. | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| 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 | $269,136 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $269,136 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02400 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $592,020 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $287,916 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $304,104 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02710 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $861,156 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $287,916 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $573,240 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05110 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $861,156 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $287,916 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $573,240 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05110 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,767,560 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $1,423,241 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $2,314,852 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$891,611 | 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 | NA | 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 | NEWMAN MEMORIAL HOSPITAL | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 905 SOUTH MAIN | AddressLine1 |
| City | SHATTUCK | City |
| State | OK | State |
| ZIP Code | 73858 | 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 | NEWMAN MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.newmanmemorial.org | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Develop Community Wide Plan | Yes (X) | DevelopCommunityWidePlanInd |
| Exec Community Wide Plan | Yes (X) | ExecCommunityWidePlanInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| 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 | 180. | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (true) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 300. | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| 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 |
| Posted On Website | Yes (X) | PostedOnWebsiteInd |
| Attached To Invoice | Yes (X) | AttachedToInvoiceInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Provided On Admission | Yes (X) | ProvidedOnAdmissionInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Collection Activities | false | 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 (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part V, Section B, Line 3 | A survey was designated to gauge hospital usage, satisfaction and community health needs. The surveys were distributed at the hospital and during the first community meeting on August 21, 2013. Community members present at the hospital each took a survey. THE HOSPITAL ALSO HOSTED FOUR COMMUNITY MEETINGS FROM AUGUST 21, 2013 THRU OCTOBER 24, 2013. THESE MEETINGS WERE ATTENDED BY COMMUNITY MEMBERS AND THOSE WITH SPECIALIZED KNOWLEDGE IN PUBLIC HEALTH. THE MEETINGS ALLOWED THOSE IN ATTENDANCE TO DISCUSS THE HEALTH NEEDS OF THE HOSPITAL'S COMMUNITY. |
| Schedule H, Part V, Line 7 | THERE WERE SEVERAL HEALTH NEEDS IDENTIFIED THRU THE SURVEY PROCESS AND THE COMMUNITY MEETINGS. WHILE ALL OF THESE NEEDS ARE LISTED IN THE CHNA, THE TOP HEALTH NEEDS WERE SPECIFICALLY IDENTIFIED WITH SPECIFIC EXAMPLES. THE IMPLEMENTATION STRATEGY ADDRESSES THE TOP HEALTH NEEDS OF THE COMMUNITY. |
| Schedule H, Part V, Section B, Line 6a | The implementation strategy can be found on the hospital's website at www.newmanmemorial.org in the community health needs assessment. |
| SCHEDULE H, PART V, LINE 20D | 100% OF BILLED CHARGES ARE WRITTEN OFF FROM 0-180%; 90% OF CHARGES ARE WRITTEN OFF FROM 181%-200%; 80% FROM 201-220%; 221-300% IS CASE BY CASE DEPENDING ON THE FINANCIAL STATUS OF THE PATIENT, ASSETS, ETC. |
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART III, LINE 4A | The Hospital has agreements with third-party payers that provide for payments to the Hospital at amounts different from its established rates. Net patient service revenue is reported at the estimated net realizable amounts from patients, third-party payers and others for services rendered and includes estimated retroactive revenue adjustments and a provision for uncollectible accounts. Retroactive adjustments are considered in the recognition of revenue on an estimated basis in the period the related services are rendered and such estimated amounts are revised in future periods as adjustments become known. |
| SCHEDULE H, PART III, LINE 4B | THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS DUE FROM PATIENTS, THIRD-PARTY AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. |
| SCHEDULE H, PART III, LINE 8 and 8a | THE ORGANIZATION USES MEDICARE COST REPORT METHODOLOGY TO DETERMINE THE AMOUNT REPORTED ON LINE 6. THE SHORTFALL ON LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE THE SERVICES WERE PROVIDED WITHOUT PAYMENT TO PATIENTS. |
| SCHEDULE H, PART III, LINE 9B | THE HOSPITAL NOTIFIES PATIENTS OF THE CHARITY CARE POLICY WHEN THEY ARE ATTEMPTING TO COLLECT PAYMENT FOR THE SERVICES OR SETTING UP PAYMENT ARRANGEMENTS. |
| SCHEDULE H, PART VI, LINE 2 | THE MEDICAL STAFF, HOSPITAL BOARD AND MANAGEMENT OF THE HOSPITAL DECIDE COMMUNITY NEEDS BASED UPON WHAT THEY READ AND SEE IN OTHER COMMUNITIES OR INPUT FROM PEOPLE IN THE COMMUNITY. |
| SCHEDULE H, PART VI, LINE 3 | ALL INPATIENTS THAT ARE ADMITTED TO THE HOSPITAL RECEIVE AN INFORMATION PACKET ABOUT SERVICES AND PROGRAMS THE HOSPITAL OFFERS. ONE BROCHURE IS AN APPLICATION FOR CHARITY CARE FOR PATIENTS TO FILL OUT. THE COLLECTION CLERK ALSO CONTACTS ALL SELF-PAY PATIENTS TO SET UP PAYMENT ARRANGEMENTS. IF THE PATIENT FEELS THEY CAN NOT PAY, THEY ARE ADVISED OF THE HOSPITAL CHARITY CARE AND APPLICATIONS ARE MAILED AT THAT TIME. |
| SCHEDULE H, PART VI, LINE 4 | THE HOSPITAL PROVIDES COMPETENT HIGH-QUALITY SERVICES MEETING THE PREVENTATIVE, ACUTE, EMERGENCY, AMBULATORY, REHABILITATIVE AND HOME HEALTH CARE NEEDS OF ALL INDIVIDUALS RESIDING IN THE IMMEDIATE AND ADJACENT COMMUNITIES. NO INDIVIDUAL WILL BE DEPRIVED OF EMERGENCY OR CRITICAL CARE BECAUSE OF THEIR INABILITY TO PAY; HOWEVER, EVERY EFFORT WILL BE MADE TO COLLECT FUNDS OWED TO THE HOSPITAL FOR ELECTIVE CARE SINCE THE ABILITY TO CONTINUE TO PROVIDE AND IMPROVE SERVICES TO THE COMMUNITIES SERVED DEPENDS ON FINANCIAL STABILITY. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DENISA KETTERMAN | PersonNm |
| Title | CNO | TitleTxt |
| Base Compensation Filing Org | $53,477 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $2,755 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $56,232 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SEE PART V 1 | PersonNm |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART IV | FormAndLineReferenceDesc |
| Explanation | 1. NAME: KASANDRA WATSON; FAMILY MEMBER OF COO - KEVIN O'BRIEN; AMOUNT OF TRANSACTION: $19,708; TRANSACTION: EMPLOYMENT, NO SHARING OF ORGANIZATION REVENUES. 2. NAME: JIMMY KETTERMAN; FAMILY MEMBER OF CNO - DENISA KETTERMAN; AMOUNT OF TRANSACTION: $353,000; TRANSACTION: CONTRACT LABOR, NO SHARING OF ORGANIZATION REVENUES. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, LINE 12C | A CONFLICT OF INTEREST POLICY IS REQUIRED TO BE COMPLETED BY ALL BOARD MEMBERS ANNUALLY. |
| FORM 990, PART VI, LINE 15 | IN SEPTEMBER 2013, THE EXECUTIVE COMMITTEE MET AND DETERMINED THE COMPENSATION OF THE CEO OF THE HOSPITAL. THE MEETING WAS DOCUMENTED IN THE BOARD OF DIRECTORS' MEETING MINUTES. |
| FORM 990, PART VI, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAIALBLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART VI, LINE 11 | THE 990 WAS PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND REVIEWED INTERNALLY BY MANAGEMENT. THE RETURN WAS THEN REVIEWED AND APPROVED BY THE BOARD PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, LINE 2 | THE FOLLOWING RELATIONSHIPS EXIST BETWEEN OFFICERS, DIRECTORS, TRUSTEES, AND OTHER KEY EMPLOYEES: DAVID DERSCH AND DANNA STUART FAMILY RELATIONSHIP. GREG HUENERGARDT AND BRENDA HUENERGARDT FAMILY RELATIONSHIP. |