BELMONT COMMUNITY HOSPITAL INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- BELMONT COMMUNITY HOSPITAL INC (EIN 34-0714643)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-08-13
- IRS object ID
- 201422259349302097
- Schema version
- 2012v2.1
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-08-13T14:03:17-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550526247 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILSON KOZICKI & GWYNN PLLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 204 THREE SPRINGS DR STE C | AddressLine1 |
| City | WEIRTON | City |
| State | WV | State |
| ZIP Code | 26062 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 340714643 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELMONT COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | BELM | NameControl |
| Phone | 7406711200 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4697 HARRISON STREET | AddressLine1 |
| City | BELLAIRE | City |
| State | OH | State |
| ZIP Code | 43906 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JAMES B MURDY | Name |
| Title | CFO | Title |
| Phone | 3042433681 | Phone |
| Date Signed | 2014-08-07 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DENNIS A KOZICKI | Name |
| PTIN | P00366642 | PTIN |
| Phone | 3047485550 | Phone |
| Date Prepared | 2014-08-07 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | RONALD VIOLI | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 MEDICAL PARK | AddressLine1 |
| City | WHEELING | City |
| State | WV | State |
| ZIP Code | 26003 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 24786524 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.WHEELINGHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1903 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE NEEDED CARE TO THE COMMUNITY REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 4 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 4 | NbrIndependentVotingMembers |
| Total Nbr Employees | 271 | TotalNbrEmployees |
| Total Nbr Volunteers | 17 | TotalNbrVolunteers |
| Total Gross UBI | 2690808 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1446455 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 24209332 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 19741196 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 73165 | InvestmentIncomePriorYear |
| Investment Income Current Year | 58760 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 3428668 | OtherRevenuePriorYear |
| Other Revenue Current Year | 3195868 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 27711165 | TotalRevenuePriorYear |
| Total Revenue Current Year | 24442279 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 10840988 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 11243722 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 16799437 | OtherExpensePriorYear |
| Other Expenses Current Year | 14181272 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 27640425 | TotalExpensesPriorYear |
| Total Expenses Current Year | 25424994 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 70740 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -982715 | RevenuesLessExpensesCY |
| Total Assets BOY | 12433524 | TotalAssetsBOY |
| Total Assets EOY | 12126728 | TotalAssetsEOY |
| Total Liabilities BOY | 5081283 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 5827464 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 7352241 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 6299264 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | BELMONT COMMUNITY HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE TO PATIENTS FROM BELMONT COUNTY AND SURROUNDING COMMUNITIES REGARDLESS OF RACE, CREED, SEX, SEXUAL ORIENTATION, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATIONS AND STABILITY OF THE HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PAY FOR ESSENTIAL MEDICAL SERVICES, AND OUR MISSION IS TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTHCARE EDUCATION. THEREFORE, IN KEEPING WITH BELMONT COMMUNITY HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF ITS COMMUNITY, FREE CARE OR SUBSIDIZED CARE, CARE PROVIDED TO PERSONS COVERED BY GOVERNMENT PROGRAMS AT OR BELOW COST, AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR INDIVIDUAL'S INABILITY TO PAY COEXIST. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 23818803 | Expense |
| Revenue | 19741196 | Revenue |
| Description | BELMONT COMMUNITY HOSPITAL SERVED 841 INPATIENTS AND 82,619 OUTPATIENTS DURING THE PERIOD OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013. | Description |
| Total Program Service Expense | 23818803 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 1 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 41 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 271 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 4 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 4 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 0 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | OH | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAMES B MURDY CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3042433681 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE MEDICAL PARK | AddressLine1 |
| City | WHEELING | City |
| State | WV | State |
| ZIP Code | 26003 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (11 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| ROBERT A BITTENGLE | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| C GARY HILL | ||||||||
| PRESIDENT | 1.00 | 0 | 0 | 0 | X | |||
| RICHARD M POLINSKY | ||||||||
| VICE PRESIDENT | 1.00 | 0 | 0 | 0 | X | |||
| NELLIE T MAGYAR | ||||||||
| SECRETARY/TREASURER | 1.00 | 0 | 0 | 0 | X | |||
| JAMES B MURDY | ||||||||
| CHIEF FINANCIAL OFFICER | 4.00 | 0 | 265206 | 54799 | X | 51.00 | ||
| JOHN DEBLASIS | ||||||||
| ADMINISTRATOR | 25.00 | 0 | 146557 | 19209 | X | 25.00 | ||
| CHARLES L GEIGER | ||||||||
| CHIEF OF STAFF | 40.00 | 235189 | 0 | 35188 | X | |||
| MARWAN YANES | ||||||||
| PHYSICIAN | 40.00 | 255059 | 0 | 9301 | X | |||
| SHASHI GUPTA | ||||||||
| PHYSICIAN | 40.00 | 232258 | 0 | 17665 | X | |||
| MAHAVEER MUKKAMALLA | ||||||||
| PHYSICIAN | 40.00 | 256065 | 0 | 17483 | X | |||
| SIVARAM R KOLLENGODE | ||||||||
| PHYSICIAN | 40.00 | 205659 | 0 | 3713 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1184230 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 411763 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 157358 | TotalOtherCompensation |
| Number Individuals GT100 K | 15 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEREK H ANDREINI MD | BusinessNameLine1 |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4697 HARRISON STREET | AddressLine1 |
| City | BELLAIRE | City |
| State | OH | State |
| ZIP Code | 43906 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | PHYSICIAN SERVICES | DescriptionOfServices |
| Compensation | 215000 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
| Related Organizations | 10000 | RelatedOrganizations |
| Government Grants | 1436455 | GovernmentGrants |
| Total Contributions | 1446455 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| GROSS PATIENT REVENUE | 623990 | 49618751 | 49618751 |
| CHARITY CARE | 623990 | -786289 | -786289 |
| BAD DEBT | 623990 | -2208939 | -2208939 |
| CONTRACTUAL ALLOWANCE | 623990 | -26882327 | -26882327 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 19741196 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 56083 | TotalRevenueColumn |
| Exclusion | $56,083 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 429325 | Real |
| Personal | 10800 | Personal |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 343922 | Real |
| Personal | 0 | Personal |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 85403 | Real |
| Personal | 10800 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 96203 | TotalRevenueColumn |
| Exclusion | $96,203 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 3000 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 323 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 2677 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2677 | TotalRevenueColumn |
| Exclusion | $2,677 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|
| OUTPATIENT PHARMACY | 446110 | 2690808 | 2690808 | |
| OTHER | 624210 | 355999 | $355,999 | |
| CONVENIENCE | 900099 | 52858 | $52,858 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 3099665 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 24442279 | TotalRevenueColumn |
| Related Or Exempt Function Income | 19741196 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 2690808 | UnrelatedBusinessRevenue |
| Exclusion | $563,820 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 170519 | Total |
| Program Services | 170519 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9466080 | Total |
| Program Services | 9409623 | ProgramServices |
| Management And General | 56457 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30278 | Total |
| Program Services | 30092 | ProgramServices |
| Management And General | 186 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 938537 | Total |
| Program Services | 933093 | ProgramServices |
| Management And General | 5444 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 638308 | Total |
| Program Services | 633743 | ProgramServices |
| Management And General | 4565 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 129819 | Total |
| Management And General | 129819 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 260 | Total |
| Management And General | 260 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 46530 | Total |
| Management And General | 46530 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 945 | Total |
| Management And General | 945 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4523644 | Total |
| Program Services | 4495827 | ProgramServices |
| Management And General | 27817 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 173677 | Total |
| Management And General | 173677 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 876145 | Total |
| Program Services | 876145 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19068 | Total |
| Program Services | 1454 | ProgramServices |
| Management And General | 17614 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 46573 | Total |
| Program Services | 46573 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 943212 | Total |
| Program Services | 943212 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 599016 | Total |
| Program Services | 599016 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| PURCHASED SERVICES | 5904226 | 4988005 | 916221 |
| OTHER EXPENSES | 673491 | 481092 | 192399 |
| MEDICAL SERVICES | 163500 | 163500 | |
| DUES, BOOKS, SUBSCRIPTI | 81166 | 46909 | 34257 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25424994 | Total |
| Program Services | 23818803 | ProgramServices |
| Management And General | 1606191 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1038369 | BOY |
| EOY | 1702219 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 102811 | BOY |
| EOY | 103429 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2525433 | BOY |
| EOY | 2271231 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 817010 | BOY |
| EOY | 623872 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 234077 | BOY |
| EOY | 233630 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 21212893 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 16346374 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5256241 | BOY |
| EOY | 4866519 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1836276 | BOY |
| EOY | 1766276 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 623307 | BOY |
| EOY | 559552 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12433524 | BOY |
| EOY | 12126728 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4811988 | BOY |
| EOY | 5584746 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 269295 | BOY |
| EOY | 242718 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5081283 | BOY |
| EOY | 5827464 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5683063 | BOY |
| EOY | 4700348 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 65774 | BOY |
| EOY | 66713 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1603404 | BOY |
| EOY | 1532203 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7352241 | BOY |
| EOY | 6299264 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12433524 | BOY |
| EOY | 12126728 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -982715 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -70262 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $945 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 945 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | BELMONT COMMUNITY HOSPITAL IS A MEMBER OF THE OHIO HOSPITAL ASSOCIATION AND PAYS ANNUAL DUES. FOR 2013, THE PERCENTAGE OF OHA DUES RELATED TO LOBBYING ACTIVITIES IS 5.3%. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1603404 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -16205 | InvestmentEarningsOrLosses |
| Other Expenditures | 54996 | OtherExpenditures |
| End Of Year Balance | 1532203 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1080422 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 578017 | InvestmentEarningsOrLosses |
| Other Expenditures | 55035 | OtherExpenditures |
| End Of Year Balance | 1603404 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 238912 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 877121 | InvestmentEarningsOrLosses |
| Other Expenditures | 35611 | OtherExpenditures |
| End Of Year Balance | 1080422 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1188491 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -946938 | InvestmentEarningsOrLosses |
| Other Expenditures | 2641 | OtherExpenditures |
| End Of Year Balance | 238912 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1188491 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 29467 | InvestmentEarningsOrLosses |
| Other Expenditures | 29467 | OtherExpenditures |
| End Of Year Balance | 1188491 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 1 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 274164 | OtherCostOrOtherBasis |
| Book Value | 274164 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 8595046 | OtherCostOrOtherBasis |
| Depreciation | 6507577 | Depreciation |
| Book Value | 2087469 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11817693 | OtherCostOrOtherBasis |
| Depreciation | 9486952 | Depreciation |
| Book Value | 2330741 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 525990 | OtherCostOrOtherBasis |
| Depreciation | 351845 | Depreciation |
| Book Value | 174145 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 4866519 | TotalOfBookValueLandBuildings |
Investments Program Related InvestmentsProgramRelated (3 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| DORIS C NARDELLA TRUST | 61413 | F |
| MELLOTT TRUST | 1532203 | F |
| CONTRIBUTED CDS | 172660 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Program Related | 1766276 | TotalOfBookValueProgramRelated |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | Identifier |
| Return Reference | PART V, LINE 4: | ReturnReference |
| Explanation | THE INCOME FROM THE ENDOWMENT FUND MUST BE USED FOR THE UPKEEP AND MAINTENANCE OF THE HOSPITAL. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 0 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 343670 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 166922 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 176748 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00700 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3186688 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1894847 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1291841 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05080 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3530358 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2061769 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1468589 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05780 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3044 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 3044 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3044 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 3044 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3533402 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2061769 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1471633 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05790 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense | $965,307 | BadDebtExpenseAmount |
| Amount Attributable To | 15689 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 3981961 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 5367255 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -1385294 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELMONT COMMUNITY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4697 HARRISON STREET | AddressLine1 |
| City | BELLAIRE | City |
| State | OH | State |
| ZIP Code | 43906 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELMONT COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 0 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 400.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Notified All Patients | X | NotifiedAllPatients |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 7: THE RATIO FROM WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS WAS USED. | |
| PART I, L7 COL(F): NO BAD DEBT EXPENSE WAS INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), AS BAD DEBT WAS REPORTED AS A REDUCTION TO NET PATIENT SERVICE REVENUE. | |
| PART III, LINE 4: THE PERCENTAGE FROM WORKSHEET 2 WAS USED TO CALCULATE THE AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE AT COST REFLECTED ON LINE 2. THIS RATIO WAS APPLIED TO THE TOTAL BAD DEBT EXPENSE INCLUDED IN NET PATIENT SERVICES REVENUE. THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE THAT COULD REASONABLY BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICY WAS CALCULATED BY APPLYING THE PERCENTAGE OF CHARITY TO GROSS PATIENT REVENUE TO THE TOTAL BAD DEBT EXPENSE AT COST.BELMONT COMMUNITY HOSPITAL DOES NOT HAVE SEPARATE AUDITED FINANCIAL STATEMENTS SO THERE IS NO TEXT OF THE BAD DEBT EXPENSE FOOTNOTE TO PROVIDE. THE BAD DEBT REFLECTED ON THE FINANCIAL STATEMENTS IS THE GROSS AMOUNT OF THE ACCOUNTS DEEMED UNCOLLECTIBLE. THIS WOULD BE FOR ACCOUNTS THAT HAVE HAD NO PAYMENT FOR 60 DAYS AND HAVE HAD A MINIMUM OF STATEMENTS PRODUCED. THEREFORE, THE BAD DEBT AMOUNTS WOULD BE AFTER ANY DISCOUNTS OR PATIENT PAYMENTS HAVE BEEN APPLIED. | |
| PART III, LINE 8: THE COSTS REFLECTED IN LINE 6 ARE THE ALLOWABLE COSTS FROM WORKSHEET D-1 OF THE 12/31/12 CMS COST REPORT. THIS REPORT WAS USED AS BELMONT COMMUNITY HOSPITAL'S COST REPORT IS FILED ON A CALENDAR YEAR BASIS, AND 12/31/12 CMS COST REPORT IS THE CALENDAR YEAR FILING THAT WOULD FALL IN THE FISCAL YEAR REPORTED ON FORM 990. NONE OF THE SHORTFALL ON LINE 7 IS TREATED AS COMMUNITY BENEFIT. DESPITE THE FACT THAT THE PROGRAM SERVES ALL ELDERLY AND DISABLED BENEFICIARIES AND COULD REPRESENT COMMUNITY BENEFIT, IT IS NOT TREATED AS COMMUNITY BENEFIT TO BE CONSISTENT WITH THE PRESENTATION OF THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS. | |
| PART III, LINE 9B: BELMONT COMMUNITY HOSPITAL'S COLLECTION POLICY HAS BEEN ESTABLISHED TO DEFRAY THE COSTS OF MEDICALLY NECESSARY SERVICES FOR THOSE PATIENTS WHO MEET CERTAIN GUIDELINES AND HAVE NO OTHER MEDICAL FUNDING SOURCES. INPATIENT, OUTPATIENT, EMERGENCY ROOM SERVICES, PROFESSIONAL SERVICES OF EMPLOYED PHYSICIANS AND PRESCRIPTION DRUGS ON AN ACUTE/EMERGENT BASIS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE/CHARITY CARE. THE FINANCIAL ASSISTANCE/CHARITY CARE APPLICATION MUST BE SIGNED BYTHE APPLICANT ATTESTING TO THE TRUTHFULNESS AND ACCURACY OF THE INFORMATION PROVIDED. CERTAIN DENIAL LETTERS ARE REQUIRED IN ORDER TO BE ELIGIBLE FOR CHARITY CARE. ELIGIBILITY IS DETERMINED BY REFERENCING THE FINANCIAL ASSISTANCE/CHARITY CARE MATRIX, WHICH IS BASED ON THE FEDERAL POVERTY GUIDELINES FOR THE MOST CURRENT YEAR AVAILABLE. THOSE APPROVED APPLICANTS WHO ARE AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES AND HAVE PROVIDED THE REQUIRED DOCUMENTATION ARE ELIGIBLE TO RECEIVE CHARITY CARE, AND THOSE WHO ARE FROM 201% TO 400% OF THOSE LIMITS ARE ELIGIBILE FOR DISCOUNTS. | |
| PART V, SECTION B, LINE 3: INTERVIEWS WERE CONDUCTED WITH SELECTED STAKEHOLDERS FROM THE WHEELING SERVICE AREA TO DISCUSS THE COMMUNITY HEALTH NEEDS IN THE WHEELING SERVICE AREA. THE FOLLOWING IDEAS WERE DISCUSSED:-POPULATION AND ECONOMIC TRENDS IN BOTH THE PRIMARY AND SECONDARY SERVICE AREAS AND FUTURE EXPECTATIONS-CURRENT PERCEPTIONS ABOUT OVERALL HEALTH CARE IN THE SERVICE AREA INCLUDING WHEELING HOSPITAL'S HEALTH CARE-WHEELING HOSPITAL'S CURRENT OPERATIONS AND THE EXTENT TO WHICH THESE SERVICES ARE MEETING COMMUNITY NEEDS-THE QUALITY AND ACCESS OF PRIMARY CARE SERVICES, EMERGENCY SERVICES, INPATIENT SERVICES, LONG TERM CARE SERVICES AND PUBLIC HEALTH SERVICES IN THE SERVICE AREA-WHEELING HOSPITAL'S POSSIBLE ROLES FOR MEETING FUTURE HEALTH CARE NEEDS FOR COMMUNITY HEALTH SERVICES-POTENTIAL FOR SUCCESS IN EXPANDING SERVICES AT WHEELING HOSPITAL AND THE CHALLENGES FACED IN EXPANDING SERVICES IN THE AREAA VARIETY OF VARIOUS COMMUNITY REPRESENTATIVES WERE INTERVIEWED, INCLUDING A REPRESENTATIVE FROM BELMONT COMMUNITY HOSPITAL, THE WHEELING HOSPITAL DIRECTOR OF NURSING, WHEELING HOSPITAL'S SUPPLIES AND INVENTORY MANAGER, FORMER MAYOR OF WHEELING AND MEMBERS OF THE WHEELING HOSPITAL BOARD. THESE INDIVIDUALS WERE CHOSEN BECAUSE THEY PROVIDED A RANGE OF PERSPECTIVES ON THE STATE OF THE COMMUNITY AND HEALTH CARE, AS WELL AS PROVIDING DIVERSIFIED BACKGROUNDS. | BELMONT COMMUNITY HOSPITAL |
| PART V, SECTION B, LINE 7: BELMONT COMMUNITY HOSPITAL IS A SMALL FACILITY WITH LIMITED FINANCIAL RESOURCES AND, AS SUCH, IS NOT FINANCIALLY CAPABLE OF HIRING IN EVERY AREA OF MEDICAL PRACTICE LISTED IN THE CHNA OR ESTABLISHING PROJECTS THAT ADDRESS THE NEED FOR THE AREA'S AGING POPULATION. IT SHOULD BE NOTED THAT BELMONT COMMUNITY HOSPITAL COLLABORATES WITH ITS PARENT HOSPITAL, WHEELING HOSPITAL, ON RECRUITING INITIATIVES. THE PARENT HOSPITAL HAS ALSO TAKEN ON FEASIBILITY STUDIES IN RELATION TO THE PROJECTS THAT ADDRESS THE NEED FOR THE AREA'S AGING POPULATION. THE PARENT HOSPITAL IS LOCATED LESS THAN 9 MILES FROM BELMONT COMMUNITY HOSPITAL. | BELMONT COMMUNITY HOSPITAL |
| PART V, SECTION B, LINE 20D: THE HOSPITAL CHARGES THE SAME TO EVERY PATIENT. | BELMONT COMMUNITY HOSPITAL |
| PART VI, LINE 2: BELMONT COMMUNITY HOSPITAL ENGAGED ARNETT & FOSTER TO PERFORM A FORMAL NEEDS ASSESSMENT TO ASSESS THE HEALTH CARE NEEDS FOR THE COMMUNITY THAT IT SERVES. THIS ASSESSMENT WAS COMPLETED AND DATED DECEMBER 2012. SEE THE ATTACHED BELMONT COMMUNITY HOSPITAL IMPLEMENTATION PLAN FOR THE HOSPITAL'S RESPONSE TO THE CHNA. | |
| PART VI, LINE 3: INFORMATION IS INCLUDED ON THE BACK OF PATIENT INVOICES REGARDING THE HCAP PROGRAM. SELF PAY ACCOUNTS OVER $500 ARE SCREENED BY THE MEDICAL ADVOCACY SERVICES FOR HEALTHCARE (MASH) SERVICE OFF SITE FOR GOVERNMENT PROGRAM ELIGIBILITY. IN ADDITION, SELF PAY PATIENTS ARE CONTACTED BY THE PATIENT ACCOUNTING DEPARTMENT TO DISCUSS MEANS OF PAYMENT. IF THE PATIENT STATES THAT THEY DO NOT HAVE THE MEANS TO PAY, BCH STAFF REVIEWS OTHER OPTIONS, SUCH AS PAYMENT PLAN, CHARITY OR DISCOUNT. | |
| PART VI, LINE 4: BELMONT COMMUNITY HOSPITAL PREDOMINANTLY SERVICES THE WHEELING METROPOLITAN STATISTICAL AREA. THE PRIMARY SERVICES AREA INCLUDES ONE COUNTY IN THE NORTHERN PANHANDLE OF WEST VIRGINIA (OHIO COUNTY) AND ONE COUNTY IN OHIO (BELMONT COUNTY), WITH A TOTAL POPULATION OF APPROXIMATELY 114,000.THE RACIAL MAKEUP OF THE MSA AS OF THE 2012 CENSUS WAS 93.75% WHITE, 3.85% AFRICAN AMERICAN, 0.6% ASIAN, 0.1% NATIVE AMERICAN, WITH THE REMAINDER FROM OTHER RACES OR A COMBINATION OF TWO OR MORE RACES.THE MEDIAN HOUSEHOLD INCOME FOR 2012 WAS APPROXIMATELY $41,000, WHILE THE MEDIAN HOUSEHOLD INCOME FOR THE UNITED STATES WAS APPROXIMATELY $53,000. THE BELOW POVERTY LEVEL PERCENTAGE FOR 2012 WAS APPROXIMATELY 15%, WHILE THE BELOW POVERTY LEVEL PECENTAGE WAS APPROXIMATELY 14.9% FOR THE UNITED STATES. | |
| PART VI, LINE 5: A MAJORITY OF THE HOSPITAL'S BOARD MEMBERS ARE RESIDENTS OF THE PRIMARY SERVICE AREA AND ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE HOSPITAL.IN ADDITION, THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ANY QUALIFIED PHYSICIAN IN THE COMMUNITY. | |
| PART VI, LINE 6: BELMONT COMMUNITY HOSPITAL IS AN AFFILIATE OF WHEELING HOSPITAL, OFFERING PRIMARY CARE AND SELECTED SPECIALITY SERVICES FOR THE RESIDENTS OF THE UPPER OHIO VALLEY. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 1 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAMES B MURDY | ||||||||||||||
| CHIEF FINANCIAL OFFICER | 0 | 235105 | 0 | 30101 | 0 | 0 | 0 | 17145 | 0 | 37654 | 0 | 320005 | 0 | 0 |
| JOHN DEBLASIS | ||||||||||||||
| ADMINISTRATOR | 0 | 138303 | 0 | 8254 | 0 | 0 | 0 | 8820 | 0 | 10389 | 0 | 165766 | 0 | 0 |
| CHARLES L GEIGER | ||||||||||||||
| CHIEF OF STAFF | 128962 | 0 | 106227 | 0 | 0 | 0 | 2380 | 0 | 32808 | 0 | 270377 | 0 | 0 | 0 |
| MARWAN YANES | ||||||||||||||
| PHYSICIAN | 254956 | 0 | 103 | 0 | 0 | 0 | 0 | 0 | 9301 | 0 | 264360 | 0 | 0 | 0 |
| SHASHI GUPTA | ||||||||||||||
| PHYSICIAN | 232155 | 0 | 103 | 0 | 0 | 0 | 2349 | 0 | 15316 | 0 | 249923 | 0 | 0 | 0 |
| MAHAVEER MUKKAMALLA | ||||||||||||||
| PHYSICIAN | 194257 | 0 | 61808 | 0 | 0 | 0 | 1898 | 0 | 15585 | 0 | 273548 | 0 | 0 | 0 |
| SIVARAM R KOLLENGODE | ||||||||||||||
| PHYSICIAN | 205556 | 0 | 103 | 0 | 0 | 0 | 2055 | 0 | 1658 | 0 | 209372 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SUPPLEMENTAL INFORMATION | Identifier |
| Return Reference | PART III | ReturnReference |
| Explanation | 5A: GEIGER AND MUKKAMALLA RECEIVE INCENTIVE COMPENSATION BASED ON CASH RECEIPTS. PART II: THE REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS FOR JAMES B MURDY IS FOR SERVICES RENDERED AS CFO FOR THE FILING ORGANIZATION AND THE RELATED ORGANIZATION. THE MAJORITY OF HIS TIME IS SPENT AT THE RELATED ORGANIZATION. PART II: THE REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS FOR JOHN DEBLASIS IS FOR SERVICES RENDERED AS ADMINISTRATOR FOR THE FILING ORGANIZATION. THE MAJORITY OF HIS TIME IS SPENT WITH THE FILING ORGANIZATION. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | AN OUTSIDE CPA FIRM IS HIRED TO REVIEW THE 990. | |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL MEMBERS OF THE BOARD OF DIRECTORS AND OFFICERS RECEIVE A COPY OF THE CONFLICT OF INTEREST POLICY ANNUALLY. RECIPIENTS ARE ANNUALLY ASKED TO ACKNOWLEDGE THEY HAVE READ THE POLICY, IDENTIFY ANY AREAS OF CONFLICT AND RETURN THE SIGNED DISCLOSURE FORM TO BELMONT COMMUNITY HOSPITAL. RESPONSES ARE REVIEWED AND IDENTIFIED. CONFLICTS ARE REFERRED TO THE BOARD OF DIRECTORS FOR DISCUSSION AND APPROVAL. EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE AT HIRING AND WHEN A CHANGE OCCURS THAT MAY BE A CONFLICT OF INTEREST. | |
| FORM 990, PART VI, SECTION B, LINE 15 | OFFICERS AND KEY EMPLOYEES COMPENSATION IS REVIEWED BY A BELMONT COMMUNITY HOSPITAL COMMITTEE. THE COMMITTEE REVIEWS NATIONAL, REGIONAL AND LOCAL COMPENSATION SURVEYS. ADDITIONALLY, YEARS OF SERVICE ARE ALSO TAKEN INTO ACCOUNT. | |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. | |
| PART VII, SECTION A, 1A (E) | THE REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS FOR JAMES B MURDY IS FOR SERVICES RENDERED AS CFO FOR THE FILING ORGANIZATION AND THE RELATED ORGANIZATION. THE MAJORITY OF HIS TIME IS SPENT AT THE RELATED ORGANIZATION. THE REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS FOR JOHN DEBLASIS IS FOR SERVICES RENDERED AS ADMINISTRATOR FOR THE FILING ORGANIZATION AND FOR OTHER SERVICES TO THE RELATED ORGANIZATION. | |
| FORM 990, PART XI, LINE 9: | REVALUATION OF PERMANENTLY RESTRICTED FOR OTHER-THAN-TEMPORARY IMPAIRMENT -71,201. TEMPORARILY RESTRICTED CONTRIBUTIONS 939. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|
| WHEELING HOSPITAL INC | |||||||||
| ONE MEDICAL PARK | WHEELING | WV | 26003 | 550357057 | HOSPITAL | WV | 501C(3) | 3 | 0 |
| BELMONT COMMUNITY HOSPITAL AUXILIARY | |||||||||
| 4697 HARRISON STREET | BELLAIRE | OH | 43906 | 346567473 | FUNDRAISING FOR HOSPITAL | OH | 501C(3) | 9 | 0 |
| THE MEDICAL PARK FOUNDATION | |||||||||
| ONE MEDICAL PARK | WHEELING | WV | 26003 | 550744690 | RAISING CONTRIBUTIONS FOR RELATED ORGANIZATION | WV | 501C(3) | 1 | 0 |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOUNTAINEER FREEDOM RISK RETENTION GROUP INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE MEDICAL PARK | AddressLine1 |
| City | WHEELING | City |
| State | WV | State |
| ZIP Code | 26003 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 320184323 | EIN |
| Primary Activity | CAPTIVE INSURANCE COMPANY | PrimaryActivity |
| Legal Domicile State | WV | LegalDomicileState |
| Type Of Entity | C | TypeOfEntity |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 1 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 1 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| WHEELING HOSPITAL | ||
| L | 107601 | ACTUAL AMOUNT |
| WHEELING HOSPITAL | ||
| M | 439830 | ACTUAL AMOUNT |
| WHEELING HOSPITAL | ||
| O | 1978005 | ACTUAL AMOUNT |
| WHEELING HOSPITAL | ||
| P | 1823612 | ACTUAL AMOUNT |
| WHEELING HOSPITAL | ||
| K | 115466 | ACTUAL AMOUNT |