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STONEWALL JACKSON MEMORIAL HOSPITAL COMPANY: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
STONEWALL JACKSON MEMORIAL HOSPITAL COMPANY (EIN 55-0422958)
Tax period
2012-10-01 to 2013-09-30
Filed
2014-06-16
IRS object ID
201411679349300011
Schema version
2012v2.1
Note
A later return for the same period supersedes this one.
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

FieldValueIRS element (for citing)
Timestamp2014-06-16T08:58:18-05:00Timestamp
Tax Period End Date2013-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN550486667EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Arnett Foster Toothman PLLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1P O Box 2629AddressLine1
CityCharlestonCity
StateWVState
ZIP Code25329ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN550422958EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Stonewall Jackson Memorial Hospital CompanyBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSTONNameControl
Phone3042698059Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1230 Hospital PlazaAddressLine1
CityWestonCity
StateWVState
ZIP Code26452ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDodie ArbogastName
TitleCFOTitle
Phone3042698059Phone
Date Signed2014-05-29DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDale CarpenterName
PTINP00189642PTIN
Phone3043460441Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Amended ReturnXAmendedReturn
Name Of Principal Officer PersonAvah L StalnakerNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1230 Hospital PlazaAddressLine1
CityWestonCity
StateWVState
ZIP Code26452ZIPCode
FieldValueIRS element (for citing)
Gross Receipts65670584GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.stonewallhospital.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1959YearFormation
State Legal DomicileWVStateLegalDomicile
Activity Or Mission DescriptionIt is the mission of Stonewall Jackson Memorial Hospital to provide excellent care to all we serve.ActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees624TotalNbrEmployees
Total Nbr Volunteers28TotalNbrVolunteers
Total Gross UBI7200TotalGrossUBI
Net Unrelated Business Txbl Income6200NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year82859ContributionsGrantsPriorYear
Contributions Grants Current Year117598ContributionsGrantsCurrentYear
Program Service Revenue Prior Year44112962ProgramServiceRevenuePriorYear
Program Service Revenue CY44302989ProgramServiceRevenueCY
Investment Income Prior Year-438688InvestmentIncomePriorYear
Investment Income Current Year2115789InvestmentIncomeCurrentYear
Other Revenue Prior Year2105522OtherRevenuePriorYear
Other Revenue Current Year847812OtherRevenueCurrentYear
Total Revenue Prior Year45862655TotalRevenuePriorYear
Total Revenue Current Year47384188TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year31886GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY25450GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year25017884SalariesEtcPriorYear
Salaries Etc Current Year25604524SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year20032437OtherExpensePriorYear
Other Expenses Current Year22094204OtherExpensesCurrentYear
Total Expenses Prior Year45082207TotalExpensesPriorYear
Total Expenses Current Year47724178TotalExpensesCurrentYear
Revenues Less Expenses Prior Year780448RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-339990RevenuesLessExpensesCY
Total Assets BOY64514533TotalAssetsBOY
Total Assets EOY67994521TotalAssetsEOY
Total Liabilities BOY7412873TotalLiabilitiesBOY
Total Liabilities EOY8168224TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY57101660NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY59826297NetAssetsOrFundBalancesEOY
Mission DescriptionIt is the mission of Stonewall Jackson Memorial Hospital to provide excellent care to all we serve.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense37772068Expense
Revenue44258638Revenue
DescriptionStonewall Jackson Memorial Hospital provides Acute medical and outpatient services to residents of Weston, West Virginia and surrounding communities which covers 10 different counties. Services included 8,769 days of inpatient care, 82,145 outpatient visits, 15,767 emergency room visits, 1,530 ambulatory surgery visits, 6,187 Home Health visits and 51,811 Physician Clinic visits.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense15073Expense
Grants3450Grants
Revenue17707Revenue
DescriptionAnnual Blood Screening: Stonewall Jackson Memorial Hospital provides all supplies and staff to operate the program. Profits are shared with the local Rotary Club to promote charitable services. Other programs include: scoliosis screening at county elementary and middle schools, health fairs at the local senior citizens center, free sports physicals to middle and high school students, Children's Safety Day to promote healthy choices to children under 12 years of age, events for free osteoporosis screenings, events for free Dermascans to screen for skin cancer, Weston Walk-run to promote exercise as a way to improve cardiac health, free women's health screening for breast and cervical cancer, and free hearing screenings.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense30397Expense
Grants22000Grants
Revenue26644Revenue
DescriptionWilliam Adler Scholarship Fund - Stonewall Jackson Memorial Hospital sponsored program to provide scholarships to local graduating high school seniors who are pursuing a career in the health care field. It is hoped that this program will encourage more students to seek health care professions and lesson the health care staffing shortage.Description
FieldValueIRS element (for citing)
Total Program Service Expense37817538TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096145NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees624NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Dodie ArbogastBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3042698050TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1230 Hospital PlazaAddressLine1
CityWestonCity
StateWVState
ZIP Code264528558ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (16 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
John Law
President1.00X000
Joseph Snead
Vice-President37.50X231276028036
R Gerald Wood
Secretary1.00X000
Denver Turner
Treasurer1.00X000
Jean Bennett
Director1.00X000
J Robert Bennett
Director1.00X000
Robin Poling
Director1.00X000
John W Wyllie
Director37.50X399085018834
David Gallien
Director1.00X000
Avah Stalnaker
CEO37.50264906018834X
Delphia Arbogast
CFO37.50122460022547X
Peter Edgerton
Physician37.50423455018834X
Doyle Sickles
Physician37.50447027028785X
Ronald Pearson
Physician37.50431400012500X
Virgil W McMillion
Physician37.50401670028785X
Shafic Sraj
Physician37.50396835028785X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3118114TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation205940TotalOtherCompensation
Number Individuals GT100 K28NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Staff Care Inc
PO Box 281923AtlantaGA303841923ER Physician Coverage313924
Laboratory Corporation
PO Box 12140BurlingtonNC27216Laboratory Services256795
Reliable Builders
PO Box 122BuckhannonWV26201Construction242847
CPS
PO Box 1000MemphisTN38148Pharmacy Consulting230671
Sodexo
PO Box 936522AtlantaGA503536922Maintenance198073
FieldValueIRS element (for citing)
Number Of Contractors GT100 K8NumberOfContractorsGT100K
Fundraising Events24025FundraisingEvents
All Other Contributions93573AllOtherContributions
Total Contributions117598TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPatient ServicesDescription
Business Code622110BusinessCode
Total Revenue Column44302989TotalRevenueColumn
Related Or Exempt Function Income44302989RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue44302989TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1028989TotalRevenueColumn
Exclusion$1,028,989ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real38759Real
Personal7200Personal

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real88852Real
Personal0Personal

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-50093Real
Personal7200Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-42893TotalRevenueColumn
Unrelated Business Revenue7200UnrelatedBusinessRevenue
Exclusion-$50,093ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities19261315Securities
Other3009Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities18176075Securities
Other1449Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities1085240Securities
Other1560Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1086800TotalRevenueColumn
Exclusion$1,086,800ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events20326GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events24025CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses20020FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column306TotalRevenueColumn
Exclusion$306ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
Sales tax refund900099419365$419,365
Cafeteria sales722310176987$176,987
Electronic health records revenue900099101750$101,750

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column192297TotalRevenueColumn
Exclusion$192,297ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue890399TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column47384188TotalRevenueColumn
Related Or Exempt Function Income44302989RelatedOrExemptFunctionIncome
Unrelated Business Revenue7200UnrelatedBusinessRevenue
Exclusion$2,956,401ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total3450Total
Program Services3450ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total22000Total
Program Services22000ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1099582Total
Program Services798516ProgramServices
Management And General301066ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total20749318Total
Program Services15068155ProgramServices
Management And General5681163ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total749167Total
Program Services544045ProgramServices
Management And General205122ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1632935Total
Program Services1185837ProgramServices
Management And General447098ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1373522Total
Program Services997452ProgramServices
Management And General376070ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total78256Total
Management And General78256ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total101818Total
Management And General101818ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total249184Total
Management And General249184ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1811214Total
Program Services1315304ProgramServices
Management And General495910ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total199866Total
Program Services145143ProgramServices
Management And General54723ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1638432Total
Program Services1189829ProgramServices
Management And General448603ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total135680Total
Program Services98531ProgramServices
Management And General37149ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total950999Total
Program Services690615ProgramServices
Management And General260384ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total69829Total
Program Services50710ProgramServices
Management And General19119ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total76100Total
Program Services55264ProgramServices
Management And General20836ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2174789Total
Program Services1579332ProgramServices
Management And General595457ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total210433Total
Program Services152816ProgramServices
Management And General57617ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Medical supplies67560406756040
Bad debts52386845238684
Repairs and maintenance1149144834508314636
Medicaid provider tax491799491799

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total761937Total
Program Services599508ProgramServices
Management And General162429ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total47724178Total
Program Services37817538ProgramServices
Management And General9906640ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY149289BOY
EOY48788EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1606486BOY
EOY10991643EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY7261430BOY
EOY6867022EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1051146BOY
EOY788779EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY301932BOY
EOY296128EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis34315651LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec22368689LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY10789711BOY
EOY11946962EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY41517511BOY
EOY35242542EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY195934BOY
EOY67668EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1641094BOY
EOY1744989EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY64514533BOY
EOY67994521EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY5778236BOY
EOY6306619EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY92210BOY
EOY87254EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1199213BOY
EOY1774351EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY343214BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY7412873BOY
EOY8168224EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY57101660BOY
EOY59826297EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY57101660BOY
EOY59826297EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY64514533BOY
EOY67994521EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-339990ReconcilationRevenueExpenses
Reconciliation Unrealized Invest3064627ReconciliationUnrealizedInvest
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis646015OtherCostOrOtherBasis
Book Value646015BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis12405754OtherCostOrOtherBasis
Depreciation9517843Depreciation
Book Value2887911BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis20251091OtherCostOrOtherBasis
Depreciation12850846Depreciation
Book Value7400245BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1012791OtherCostOrOtherBasis
Book Value1012791BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings11946962TotalOfBookValueLandBuildings
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt41436685TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal41436685RevenueSubtotal
Other Revenues Not Included5947503OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt5947503RevenueNotRptdOnFinStmt
Total Revenue Per Form99047384188TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt41776675TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal41776675ExpensesSubtotal
Other Expenses Not Included5947503OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt5947503ExpensesNotRptdOnFinStmt
Total Expenses Per Form99047724178TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Description of Uncertain Tax Positions Under FIN 48:Part X, Line 2:The organization had no uncertain tax positions under Fin 48 as reported in the financial statements.
Part XI, Line 4b - Other Adjustments:Investment expenses netted with revenue on the financial statements 249,184. Bad debt expense netted with revenue on the financial statements 5,238,684. Expenses netted with donation revenue on the financial statements 14,820. Grant expenses netted with grant revenue on the financial statements 25,450. Sales tax refund netted with expense on financial statements 419,365.
Part XII, Line 4b - Other Adjustments:Investment expenses netted with revenue on the financial statements 249,184. Bad debt expense netted with revenue on the financial statements 5,238,684. Grant expenses netted with grant revenue on the financial statements 25,450. Expenses netted with donation revenue on the financial statements 14,820. Sales tax refund netted with expense on financial statements 419,365.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1Charity Golf TournamentNameOfEvent1
Gross Receipts Event126644GrossReceiptsEvent1
Charitable Contributions Event117941CharitableContributionsEvent1
Gross Revenue Event18703GrossRevenueEvent1
Cash Prizes Event1900CashPrizesEvent1
Rent Facility Costs Event17090RentFacilityCostsEvent1
Food And Beverage Event1176FoodAndBeverageEvent1
Other Direct Expenses Event1231OtherDirectExpensesEvent1
Name Of Event2Rotary Blood ScreeningNameOfEvent2
Gross Receipts Event217707GrossReceiptsEvent2
Charitable Contributions Event26084CharitableContributionsEvent2
Gross Revenue Event211623GrossRevenueEvent2
Other Direct Expenses Event211623OtherDirectExpensesEvent2
Gross Receipts Total44351GrossReceiptsTotal
Charitable Contributions Total24025CharitableContributionsTotal
Gross Revenue Total Events20326GrossRevenueTotalEvents
Cash Prizes Total Events900CashPrizesTotalEvents
Rent Facility Costs Total Events7090RentFacilityCostsTotalEvents
Food And Beverage Total Events176FoodAndBeverageTotalEvents
Other Direct Expenses Total Events11854OtherDirectExpensesTotalEvents
Direct Expense Summary Events20020DirectExpenseSummaryEvents
Net Income Summary306NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care0FPGReferenceFreeCare
FPG Reference Discounted Care0FPGReferenceDiscountedCare
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report0AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense921035TotalCommunityBenefitExpense
Net Community Benefit Expense921035NetCommunityBenefitExpense
Percent Of Total Expense0.02170PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense8080564TotalCommunityBenefitExpense
Direct Offsetting Revenue5881241DirectOffsettingRevenue
Net Community Benefit Expense2199323NetCommunityBenefitExpense
Percent Of Total Expense0.05180PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense9001599TotalCommunityBenefitExpense
Direct Offsetting Revenue5881241DirectOffsettingRevenue
Net Community Benefit Expense3120358NetCommunityBenefitExpense
Percent Of Total Expense0.07350PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs15NumberOfActivitiesOrPrograms
Persons Served3000PersonsServed
Total Community Benefit Expense12100TotalCommunityBenefitExpense
Net Community Benefit Expense12100NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served22PersonsServed
Total Community Benefit Expense30397TotalCommunityBenefitExpense
Direct Offsetting Revenue26644DirectOffsettingRevenue
Net Community Benefit Expense3753NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense7483TotalCommunityBenefitExpense
Net Community Benefit Expense7483NetCommunityBenefitExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs16NumberOfActivitiesOrPrograms
Persons Served3022PersonsServed
Total Community Benefit Expense49980TotalCommunityBenefitExpense
Direct Offsetting Revenue26644DirectOffsettingRevenue
Net Community Benefit Expense23336NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs16NumberOfActivitiesOrPrograms
Persons Served3022PersonsServed
Total Community Benefit Expense9051579TotalCommunityBenefitExpense
Direct Offsetting Revenue5907885DirectOffsettingRevenue
Net Community Benefit Expense3143694NetCommunityBenefitExpense
Percent Of Total Expense0.07410PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense166426TotalCommunityBuildingExpense
Net Community Building Expense166426NetCommunityBuildingExpense
Percent Of Total Expense0.00390PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense166426TotalCommunityBuildingExpense
Net Community Building Expense166426NetCommunityBuildingExpense
Percent Of Total Expense0.00390PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$2,334,881BadDebtExpenseAmount
Amount Reimbursed By Medicare7934970AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare8163569CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-228599MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Stonewall Jackson Memorial HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1230 Hospital PlazaAddressLine1
CityWestonCity
StateWVState
ZIP Code26452ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Stonewall Jackson Memorial HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA Conducted1CHNAConducted
Community DefinitionXCommunityDefinition
Needs Assessment Conducted12NeedsAssessmentConducted
Take Into Account1TakeIntoAccount
Other Facilities0OtherFacilities
CHNA Widely Available1CHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Adopt Implement StrategyXAdoptImplementStrategy
Develop Community PlanXDevelopCommunityPlan
Prioritize Health NeedsXPrioritizeHealthNeeds
All Needs Addressed0AllNeedsAddressed
Organization Incur Excise Tax0OrganizationIncurExciseTax
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free0UsesFPGFree
Uses FPG Discounted0UsesFPGDiscounted
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges1GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)

ExplanationExplanationIdentifierIdentifier
Part I, Line 3c: WV food stamp eligibility guidelines are used. We also evaluate the patient's assets and the amount of medical debt. We have signs posted at Registration, around and in the Emergency Department and in all physician clinics. We send letters to patients who are not paying their bills and give the application to private pay inpatients. We also tell the patients during telephone conversations if the patient indicates he/she is not able to pay the bill or pay all of the bill.
Part I, Line 7: The cost of charity care was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions.The unreimbursed cost of Medicaid was estimated using a cost to charge ratio derived from Worksheet 2 of the Schedule H instructions.
Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 5238684.
Part II: We recruit physicians to this area based entirely on what services the patients need. Our goal is to be able to provide physicians who can address these needs in the community.
Part III, Line 4: Patient accounts receivable are carried at the original charge less an estimate made for doubtful or uncollectible accounts. The allowance is based upon a review of the outstanding balances aged by financial class. Management uses collection percentages based upon historical collection experience to determine collectability. Management also reviews troubled, aged accounts to determine collection potential. Patient accounts receivable are written off when deemed uncollectible. Recoveries of accounts previously written off are recorded as a reduction to bad debt expense when received. Interest is not charged on patient accounts receivable.
Part III, Line 9b: Our collections policy applies to all patients regardless of financial class or any other classification. During our collections process, if the patient indicates they do not have the ability to pay their bill, the credit staff offers exoneration.
Part V, Section B, Line 3: The Hospital took into account input from representatives from health department, schools, and local businesses.Stonewall Jackson Memorial Hospital
Part V, Section B, Line 7: Action has been taken on the top 5 Community Needs identified in the Community Health Needs Assessment. The remaining items were not addressed due to low community need.Stonewall Jackson Memorial Hospital
Part V, Section B, Line 21: Charges are the same for all payers and private pay but private pay patients are given a 20% discount off of charges if the bill is paid within 30 days of the statement date.Stonewall Jackson Memorial Hospital
Part V, Section B, Line 22: Charges are the same for all payers and private pay but private pay patients are given a 20% discount off of charges if the bill is paid within 30 days of the statement date.Stonewall Jackson Memorial Hospital
Part VI, Line 3: We have signs posted at Registration, around and in the Emergency Department and in all physician clinics. We send letters to patients who are not paying their bills. We give the application to Private Pay inpatients. We tell the patients when during telephone conversations if the patient indicates he/she is not able to pay the bill or pay all of the bill.
Part VI, Line 4: Stonewall Jackson Memorial Hospital serves a relatively large rural population of about 65,000 people with an average household income of $32,000. 30% of the population is disabled. Approximately 30% are Medicaid Eligible or are uninsured. We are located in a federally-designated medically underserved area.
Part VI, Line 5: Stonewall Jackson Memorial Hospital (SJMH) is a 70 bed rural acute hospital located in Lewis County West Virginia. SJMH is the only hospital located in the county as such it is solely responsible for the healthcare of this rural community. SJMH provides 24 hours Emergency Room and Obstetrics services and provides care regardless of the patient's ability to pay. The majority of the governing body is comprised of community members. Medical privileges are offered to all qualified physicians in the community and SJMH has worked diligently to provide other physician services by expanding the services they provide.SJMH continues to make capital improvement to the facility and expand patient care services to meet the needs of the community.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantNursing School Scholarships for recent high school graduates.TypeOfGrant
Number Of Recipients22NumberOfRecipients
Amount Of Cash Grant22000AmountOfCashGrant
Method Of ValuationFMV - CashMethodOfValuation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Substantiation Required1SubstantiationRequired
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Joseph Snead
Vice-President23127600000117510184410261468000
John W Wyllie
Director3990850000012500085680420153000
Avah Stalnaker
CEO2555900009316012500085680285974000
Peter Edgerton
Physician4234550000012500085680444523000
Doyle Sickles
Physician44702700000125000185190478046000
Ronald Pearson
Physician4314000000012500000443900000
Virgil W McMillion
Physician40167000000125000183370432507000
Shafic Sraj
Physician39683500000125000185190427854000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 3Management duties customarily are performed under the direct supervision of officers, directors, trustees or key employees, but the Hospital has contracted out the management duties of the Maintenance department. The manager of the Maintenance department (also considered a department head) is employed by the Maintenance company. All other Maintenance staff are employees of the Hospital. The Hospital contracts out the management duties of the Pharmacy department. The manager of the Pharmacy department (also considered a department head) is employed by the Pharmacy company. All other Pharmacy staff are employees of the Hospital.
Form 990, Part VI, Section B, line 11The process the Hospital uses to review their 990 before filing with the IRS is the CFO is responsible for reviewing the form 990 for completeness and accuracy. A completed copy is provided for the board. It is then signed and submitted to the IRS.
Form 990, Part VI, Section B, line 12cAll board members disclose possible conflicts of interest prior to appointment and periodically throughout their terms as trustees.
Form 990, Part VI, Section B, line 15The Hospital obtains salary survey data. Performance evaluations are done on each of these personnel & financial conditions are considered.
Form 990, Part VI, Section C, line 19The annual audited financial statements are published in the local newspaper.
Form 990Miscellaneous changes were made to Schedule O additional information and Schedule H additional information that were found to be inadvertently misstated. On Schedule J, 'compensation committee' was removed from question 3 as it was inadvertently checked.Amended Return Information

Schedule R IRS990ScheduleR

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Stonewall Home Oxygen Therapy IncBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1100 Market Place Mall Suite 8AddressLine1
CityWestonCity
StateWVState
ZIP Code26452ZIPCode
FieldValueIRS element (for citing)
EIN550754278EIN
Primary ActivityOxygen Therapy ServicesPrimaryActivity
Legal Domicile StateWVLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
Share Of Total Income-128266ShareOfTotalIncome
Share Of EOY Assets381702ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
Controlled Org1ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1Stonewall Home Oxygen Therapy IncBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeATransactionType
Amount Involved7200AmountInvolved
Method Of Amt DeterminationFMV - CashMethodOfAmtDetermination