GUTHRIE TOWANDA MEMORIAL HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- GUTHRIE TOWANDA MEMORIAL HOSPITAL (EIN 24-0786657)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-05-13
- IRS object ID
- 201321339349303207
- Schema version
- 2011v1.5
- 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 | 2013-05-13T13:26:51-05:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 232932984 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PARENTEBEARD LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 MARKET STREET | AddressLine1 |
| City | WILLIAMSPORT | City |
| State | PA | State |
| ZIP Code | 17701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 240786657 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE MEMORIAL HOSPITAL INC OF TOWANDA PA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MEMO | NameControl |
| Phone | 5702652191 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 91 HOSPITAL DRIVE | AddressLine1 |
| City | TOWANDA | City |
| State | PA | State |
| ZIP Code | 188489703 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | GARY A BAKER | Name |
| Title | PRESIDENT/CEO | Title |
| Phone | 5702652191 | Phone |
| Date Signed | 2013-05-09 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JULIUS C GREEN CPA JD | Name |
| PTIN | P00350393 | PTIN |
| Phone | 5703236023 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | GARY A BAKER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 91 HOSPITAL DRIVE | AddressLine1 |
| City | TOWANDA | City |
| State | PA | State |
| ZIP Code | 188489703 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 41208473 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.MEMORIALHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1946 | YearFormation |
| State Legal Domicile | PA | StateLegalDomicile |
| Activity Or Mission Description | TO OPERATE AN ACUTE CARE HOSPITAL AND LONG TERM CARE FACILITY IN TOWANDA, PENNSYLVANIA. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 28 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 25 | NbrIndependentVotingMembers |
| Total Nbr Employees | 587 | TotalNbrEmployees |
| Total Nbr Volunteers | 22 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 277713 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 122234 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 40025437 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 40120588 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 292127 | InvestmentIncomePriorYear |
| Investment Income Current Year | 283227 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 702016 | OtherRevenuePriorYear |
| Other Revenue Current Year | 326935 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 41297293 | TotalRevenuePriorYear |
| Total Revenue Current Year | 40852984 | 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 | 21459214 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 21861118 | 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 | 18843904 | OtherExpensePriorYear |
| Other Expenses Current Year | 19682470 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 40303118 | TotalExpensesPriorYear |
| Total Expenses Current Year | 41543588 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 994175 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -690604 | RevenuesLessExpensesCY |
| Total Assets BOY | 46198397 | TotalAssetsBOY |
| Total Assets EOY | 43935309 | TotalAssetsEOY |
| Total Liabilities BOY | 20936803 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 19735323 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 25261594 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 24199986 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | THE MISSION OF MEMORIAL HOSPITAL, INC., A NONPROFIT ORGANIZATION, IS TO PROVIDE SUPERIOR QUALITY HEALTH CARE SERVICES IN A CARING, EFFICIENT, AND FINANCIALLY RESPONSIBLE MANNER THAT WILL IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 39114237 | Expense |
| Revenue | 40120588 | Revenue |
| Description | MEMORIAL HOSPITAL, INC. OF TOWANDA, PA IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL AND LONG TERM CARE FACILITY LOCATED IN TOWANDA, PA. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, EMERGENCY CARE, LONG-TERM CARE AND HOME HEALTH SERVICES TO RESIDENTS OF TOWANDA, PA AND SURROUNDING COMMUNITIES. OUR DOCTORS CONTINUOUSLY WORK WITH OUR OWN QUALIFIED SPECIALISTS AND MANY OTHERS WITHIN THE BRADFORD AND SULLIVAN COUNTY MEDICAL COMMUNITY AS WELL AS OUTSIDE OF THIS AREA TO PROVIDE ACCESS TO QUALITY SPECIALTY CARE.WE ROUTINELY WORK WITH SPECIALISTS IN SAYRE, PA; ELMIRA, NY; BINGHAMTON, NY; WILLIAMSPORT, PA; SCRANTON, PA; DANVILLE, PA; AND PHILADELPHIA, PA, TO MEET OUR PATIENTS' HEALTHCARE NEEDS.IN FEBRUARY 2008, COMMUNITY HEALTH ASSOCIATES, LLC, A SINGLE MEMBER LLC OWNED SOLELY BY MEMORIAL HOSPITAL, INC. WAS ESTABLISHED. THE PURPOSE OF COMMUNITY HEALTH ASSOCIATES, LLC IS TO EMPLOY PHYSICIANS TO ASSIST THE HOSPITAL WITH MEETING ITS MISSION AND TO IMPROVE THE RECRUITING AND RETENTION OF PHYSICIANS IN THE AREA.IN THE YEAR ENDING JUNE 30, 2012, THE HOSPITAL ADMITTED 1,781 PATIENTS AND HAD A TOTAL OF 53,151 PATIENT DAYS. TOTAL PATIENT DAYS WERE COMPRISED OF 5,631 ACUTE CARE; 388 NURSERY; 25,672 PERSONAL CARE HOME, AND 22,770 SKILLED NURSING. WE CONDUCTED 4,972 HOME HEALTH VISITS AND RECEIVED 53,196 OTHER OUTPATIENT VISITS. THE MATERNITY CENTER DELIVERED 171 NEWBORNS. THE ER SAW 11,313 VISITS DURING THE YEAR. DURING THE FISCAL YEAR JUNE 30, 2012, THE HOSPITAL PROVIDED APPROXIMATELY $182,500 IN CHARITY CARE (COST BASIS) TO THE COMMUNITIES IT SERVES. MEMORIAL HOSPITAL IS DIRECTED BY A BOARD OF COMMUNITY LEADERS KNOWN AS TRUSTEES AND IS SUPPORTED BY THE SERVICE OF DOZENS OF VOLUNTEERS INCLUDING A VERY ACTIVE AUXILIARY.MANY OF MEMORIAL HOSPITAL'S ACTIVE MEDICAL STAFF PHYSICIANS ARE BOARD CERTIFIED IN THEIR RESPECTIVE SPECIALTIES, REFLECTING A DEDICATION AND COMMITMENT TO PROVIDE THE HIGHEST QUALITY OF CARE TO MEMORIAL HOSPITAL'S PATIENTS. ALL THREE LEADERSHIP GROUPS OF THE HOSPITAL - THE BOARD OF TRUSTEES, MEDICAL STAFF AND ADMINISTRATION - CONTINUOUSLY WORK TOGETHER TO IDENTIFY AND DIRECT THE PRIORITIES OF THE HOSPITAL THROUGH THE DEVELOPMENT AND IMPLEMENTATION OF STRATEGIC PLANS WITHIN THE SCOPE OF OUR MISSION. FROM EMERGENCY SERVICES TO OUR MATERNITY CENTER, FROM TOP-NOTCH RADIOLOGY DIAGNOSTICS TO LONG-TERM CARE, FROM HOME HEALTH TO OUTPATIENT THERAPIES, WE ARE HERE FOR FAMILIES AND INDIVIDUALS IN OUR COMMUNITIES. WE ARE COMMITTED TO MEETING THE HEALTH CARE NEEDS OF OUR RESIDENTS AND WILL DO OUR BEST TO MEET AND EXCEED THEIR EXPECTATIONS.MEMORIAL HOSPITAL, INC. PROVIDES HEALTH CARE TO RESIDENTS IN THE BRADFORD AND SULLIVAN COUNTY AREAS. THE HOSPITAL PROVIDES A WIDE RANGE OF SERVICES TO PATIENTS WITHOUT REGARD TO THE INDIVIDUAL'S ABILITY TO PAY. THE HOSPITAL'S EMERGENCY DEPARTMENT IS AVAILABLE ON A 7 DAY A WEEK, 24 HOUR A DAY BASIS FOR THE EMERGENT, AS WELL AS NON-EMERGENT, NEEDS OF THOSE THAT SEEK CARE. THE HOSPITAL HAS A HOSPITAL-BASED SKILLED NURSING FACILITY THAT CARES FORA VERY HIGH PERCENTAGE OF MEDICAL ASSISTANCE RESIDENTS, AS WELL AS SOME MEDICARE RESIDENTS. | Description |
| Total Program Service Expense | 39114237 | 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 | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | 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 | 1 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 30 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 587 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| 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 |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 28 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 25 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | 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 | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | 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 | PA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILLIAM ROHRBACH | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5702682207 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 91 HOSPITAL DRIVE | AddressLine1 |
| City | TOWANDA | City |
| State | PA | State |
| ZIP Code | 18848 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (34 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| RONALD BLACK MD | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| DONALD BRENNAN | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| PETER BRODERICK | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| BRIAN GROVE | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| RAY DEPAOLA | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| HANK DUNN | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| BRIAN EMICK | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| MARK GANNON | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| LEWIS HOPE | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| MARJORY KREISCHER | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| LEO LAMBERT | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| WILLIAM MCNETT | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| JODY PLACE | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| GERALD E SHAFFER | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| MARGUERITE SHANER | |||||||
| AUXILIARY PRESIDENT | 5.00 | X | 0 | 0 | 0 | ||
| BARBARA YANAK OD | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| JAMES PARKS | |||||||
| CHAIRMAN | 5.00 | X | 0 | 0 | 0 | X | |
| JOHN L SCHOONOVER III | |||||||
| VICE-CHAIRMAN | 5.00 | X | 0 | 0 | 0 | X | |
| ROBERT FERRARIO | |||||||
| SECRETARY | 5.00 | X | 0 | 0 | 0 | X | |
| DAVID PACKARD | |||||||
| TREASURER | 5.00 | X | 0 | 0 | 0 | X | |
| WILLIAM ROHRBACH | |||||||
| CFO/ASST SECRETARY | 40.00 | X | 168951 | 0 | 12093 | X | |
| ALFREDO LLINAS | |||||||
| VP MEDICAL STAFF | 40.00 | X | 137446 | 0 | 9191 | ||
| LISA CERAOLO | |||||||
| VP MEDICAL STAFF | 40.00 | X | 186054 | 0 | 11144 | ||
| JOSEPH CAMA MD | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| TOM THOMPSON | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| STACY L GARRITY | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| JAMES RODENHIZER | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| ERIC R ROWE | |||||||
| TRUSTEE | 5.00 | X | 0 | 0 | 0 | ||
| GARY A BAKER | |||||||
| PRESIDENT/CEO | 40.00 | 237246 | 0 | 52018 | X | ||
| LARRY LINNELL | |||||||
| FAMILY PRACTITIONER | 40.00 | 188023 | 0 | 11660 | X | ||
| GEETA KRISHNAN | |||||||
| ENT PHYSICIAN | 22.00 | 149500 | 0 | 0 | X | ||
| TIMOTHY DENNEN | |||||||
| FAMILY PRACTITIONER | 40.00 | 170136 | 0 | 12947 | X | ||
| JAI NAIDU | |||||||
| PEDIATRICIAN | 40.00 | 145362 | 0 | 15940 | X | ||
| CYNTHIA LAMBERT | |||||||
| PHARMACIST | 40.00 | 122923 | 0 | 17105 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1505641 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 142098 | TotalOtherCompensation |
| Number Individuals GT100 K | 11 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| TEAM CARE PC | |||||
| 2031 ORANGE HILL ROAD | ATHENS | PA | 18810 | EMERGENCY PHYSICIAN SERVICES | 1051200 |
| GULFSTREAM ANESTHESIA CONSULTANTS | |||||
| PO BOX 212110 ROYAL | PALM BEACH | FL | 33421 | ANESTHESIA SERVICES | 853811 |
| KINGS MEDICAL GROUP | |||||
| PO BOX 72483 | CLEVELAND | OH | 44192 | MRI SERVICES | 305060 |
| MORRISON MANAGEMENT SPECIALIST | |||||
| PO BOX 102289 | ATLANTA | GA | 30368 | DIETARY MANAGEMENT SERVICES | 215962 |
| ASSOCIATED RADIOLOGISTS | |||||
| 100 EAST FOURTEENTH STREET | ELMIRA HEIGHTS | NY | 14903 | RADIOLOGY SERVICES | 182908 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 9 | NumberOfContractorsGT100K |
| Related Organizations | 18366 | RelatedOrganizations |
| All Other Contributions | 103868 | AllOtherContributions |
| Noncash Contributions | 9700 | NoncashContributions |
| Total Contributions | 122234 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT SVC REV | 621990 | 40058377 | 40058377 |
| THERAPIES & PROGRAMS | 621990 | 62211 | 62211 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 40120588 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 351082 | TotalRevenueColumn |
| Exclusion | $351,082 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 119367 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 68299 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 51068 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 51068 | TotalRevenueColumn |
| Exclusion | $51,068 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 211905 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 279760 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -67855 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -67855 | TotalRevenueColumn |
| Exclusion | -$67,855 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Gaming | 11961 | GrossIncomeGaming |
| Gaming Direct Expenses | 7430 | GamingDirectExpenses |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4531 | TotalRevenueColumn |
| Exclusion | $4,531 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| CAFETERIA/VENDING | 722210 | 118559 | $118,559 |
| PURCHASE DISCOUNTS | 900099 | 91139 | $91,139 |
| PHARMACY REVENUE | 900099 | 20485 | $20,485 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 41153 | TotalRevenueColumn |
| Exclusion | $41,153 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 271336 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 40852984 | TotalRevenueColumn |
| Related Or Exempt Function Income | 40120588 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $610,162 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 502352 | Total |
| Program Services | 502352 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16152288 | Total |
| Program Services | 15131802 | ProgramServices |
| Management And General | 1020486 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1014149 | Total |
| Program Services | 952978 | ProgramServices |
| Management And General | 61171 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3006794 | Total |
| Program Services | 2821736 | ProgramServices |
| Management And General | 185058 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1185535 | Total |
| Program Services | 1114403 | ProgramServices |
| Management And General | 71132 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 441229 | Total |
| Program Services | 245754 | ProgramServices |
| Management And General | 195475 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33482 | Total |
| Management And General | 33482 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 81400 | Total |
| Management And General | 81400 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3294 | Total |
| Management And General | 3294 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4833372 | Total |
| Program Services | 4498121 | ProgramServices |
| Management And General | 335251 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 66131 | Total |
| Program Services | 52107 | ProgramServices |
| Management And General | 14024 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3501953 | Total |
| Program Services | 3300827 | ProgramServices |
| Management And General | 201126 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 933729 | Total |
| Program Services | 916584 | ProgramServices |
| Management And General | 17145 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 156384 | Total |
| Program Services | 154570 | ProgramServices |
| Management And General | 1814 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 46203 | Total |
| Program Services | 41913 | ProgramServices |
| Management And General | 4290 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 483702 | Total |
| Program Services | 483702 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2313547 | Total |
| Program Services | 2313547 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 877658 | Total |
| Program Services | 877658 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 4696903 | 4696903 | |
| DIETARY EXPENSE | 499660 | 483470 | 16190 |
| REPAIRS & MAINTENANCE | 357012 | 357012 | |
| ADMIN ALLOCATION | 97189 | 97189 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 259622 | Total |
| Program Services | 71609 | ProgramServices |
| Management And General | 188013 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 41543588 | Total |
| Program Services | 39114237 | ProgramServices |
| Management And General | 2429351 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1351 | BOY |
| EOY | 1339 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2871330 | BOY |
| EOY | 697478 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5073889 | BOY |
| EOY | 5676009 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 545393 | BOY |
| EOY | 529251 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 228509 | BOY |
| EOY | 583445 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 45093531 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 24782369 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21778753 | BOY |
| EOY | 20311162 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 80167 | BOY |
| EOY | 70627 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 289586 | BOY |
| EOY | 579075 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15329419 | BOY |
| EOY | 15486923 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 46198397 | BOY |
| EOY | 43935309 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2536021 | BOY |
| EOY | 2180617 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11575250 | BOY |
| EOY | 10294177 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6825532 | BOY |
| EOY | 7260529 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20936803 | BOY |
| EOY | 19735323 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24440400 | BOY |
| EOY | 23631966 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 756194 | BOY |
| EOY | 503020 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 65000 | BOY |
| EOY | 65000 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25261594 | BOY |
| EOY | 24199986 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 46198397 | BOY |
| EOY | 43935309 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -690604 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -371004 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| 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 | 1 | GrantsOtherOrganizations |
| Grants Other Organizations | $3,294 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 0 | OtherActivities |
| Total Lobbying Expenditures IIB | 3294 | 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 | THE MEMORIAL HOSPITAL, INC. OF TOWANDA, PA INCURS LOBBYING EXPENSES ONLY AS A PORTION OF THEIR HAP DUES APPLICABLE TO THE YEAR ENDED 6/30/12. THESE EXPENSES ARE APPROX. 25.04% OF DUES FOR THE YEAR. | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 1 | AgentTrusteeEtc |
| Beginning Balance | 7144 | BeginningBalance |
| Additions During Year | 113932 | AdditionsDuringYear |
| Distributions During Year | 111786 | DistributionsDuringYear |
| Ending Balance | 9290 | EndingBalance |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 247164 | OtherCostOrOtherBasis |
| Book Value | 247164 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 25766744 | OtherCostOrOtherBasis |
| Depreciation | 10161691 | Depreciation |
| Book Value | 15605053 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 18743250 | OtherCostOrOtherBasis |
| Depreciation | 14620678 | Depreciation |
| Book Value | 4122572 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 336373 | OtherCostOrOtherBasis |
| Book Value | 336373 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 20311162 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| DEFERRED FINANCING COSTS, NET | 33922 |
| BENEFICIAL INTEREST IN ASSETS HELD BY MEMORIAL HOSPITAL FDN | 15351323 |
| OTHER CURRENT ASSETS | 101678 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 15486923 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (6 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | $649,456 |
| AMTS W/H FROM EMPLOYEES FOR TAXES, ETC. | $76,295 |
| BLUE CROSS ADVANCE | $184,441 |
| PENSION LIABILITY | $2,508,154 |
| AMOUNTS DUE TO AFFILIATES | $3,085,353 |
| ESTIMATED MED MALPRACTICE CLAIMS LIAB | $756,830 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 7260529 | TotalOfAmounts |
| Total Revenue | 40852984 | TotalRevenue |
| Total Expenses | 41543588 | TotalExpenses |
| Excess Or Deficit For Year | -690604 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -5960 | NetUnrealizedGLOnInvestments |
| Other | -$365,044 | OtherAmount |
| Total Adjustments | -371004 | TotalAdjustments |
| Excess Or Deficit Per FS | -1061608 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 40625564 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -5960 | NetUnrealizedGainsInvestments |
| Other Revenues | -365044 | OtherRevenues |
| Revenue Not Rptd F990 | -371004 | RevenueNotRptdF990 |
| Revenue Subtotal | 40996568 | RevenueSubtotal |
| Other Revenues Not Included | -143584 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -143584 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 40852984 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 41687172 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 143584 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 143584 | ExpensesNotRptdF990 |
| Expenses Subtotal | 41543588 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 41543588 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART IV, LINE 1B: | THE HOSPITAL MAINTAINS A SEPARATE ACCOUNT WITH SKILLED NURSING FACILITY RESIDENT FUNDS OF WHICH WE ARE THE REPRESENTATIVE PAYEE. FUNDS ARE USED TO PAY PATIENTS' BILLS AND PERSONAL EXPENSES. | |
| PART X: | THE ORGANIZATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN NOT TO BE SUSTAINTED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD IS MET. MANAGEMENT DETERMINED THAT THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2012 & 2011. THE ORGANIZATION'S FEDERAL INCOME TAX RETURNS FOR JUNE 30, 2011, 2010, AND 2009 REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: |
| PENSION LIABILITY ADJUSTMENT -892,068. CHANGE IN INTEREST IN MEMORIAL HOSPITAL FOUNDATION 508,561. CHANGE IN TEMPORARILY RESTRICTED INTEREST IN MEMORIAL HOSPITAL FOUNDATION 18,463. TOTAL TO SCHEDULE D, PART XI, LINE 8: -365,044. | PART XI, LINE 8 - OTHER ADJUSTMENTS: | |
| CHANGE IN INTEREST IN MEMORIAL HOSPITAL FOUNDATION 508,561. PENSION LIABILITY ADJUSTMENT -892,068. CHANGE IN TEMPORARILY RESTRICTED INTEREST IN MEMORIAL HOSPITAL FOUNDATION 18,463. | PART XII, LINE 2D - OTHER ADJUSTMENTS: | |
| RENTAL EXPENSES -68,299. LOSS ON DISPOSAL OF EQUIPMENT -67,855. GAMING EXPENSES -7,430. | PART XII, LINE 4B - OTHER ADJUSTMENTS: | |
| LOSS ON DISPOSAL OF EQUIPMENT 67,855. RENTAL EXPENSES 68,299. GAMING EXPENSES 7,430. | PART XIII, LINE 2D - OTHER ADJUSTMENTS: |
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 |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 182498 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 182498 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00500 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3945955 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1999706 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1946249 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05280 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4128453 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1999706 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2128747 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05780 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 46203 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 46203 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00130 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6226536 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4649219 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1577317 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04280 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6272739 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4649219 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1623520 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04410 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10401192 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6648925 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3752267 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10190 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $1,670,219 | BadDebtExpenseAmount |
| Amount Attributable To | 71120 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 347369 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 330865 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 16504 | 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 | THE MEMORIAL HOSP INC OF TOWANDA PA | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 91 HOSPITAL DRIVE | AddressLine1 |
| City | TOWANDA | City |
| State | PA | State |
| ZIP Code | 18848 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | 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 | THE MEMORIAL HOSPITAL INC OF TOWANDA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 7: THE RATIO OF COST TO CHARGES WAS COMPUTED USING PATIENT CHARGES AND PATIENT COST EXCLUDING RELATED BAD DEBT COSTS COUNTED ELSEWHERE IN THE COMMUNITY BENEFIT NUMBERS. THE NUMBERS USED IN THE CALCULATION OF THE RATIO WERE OBTAINED FROM THE MEDICARE COST REPORT FOR THE RELATED PERIOD. THIS RATIO IS USED IN THE CALCULATION OF CHARITY CARE, MEDICAID, OTHER MEANS-TESTED GOVERNMENT PROGRAMS AND SUBSIDIZED HEALTH SERVICES. FOR THE REMAINING LINES, DIRECT EXPENSES WERE IDENTIFIED BY PROGRAM BASED ON PROGRAM RECORDS. | |
| PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25 COLUMN (A) BUT SUBTRACTED OUT FOR PURPOSES OF CALCULATING THE PERCENTAGE ON SCH H, PART I, LINE 7, COLUMN (F) IS $4,696,903. | |
| PART III, LINE 4: ACCOUNTS RECEIVABLE, PATIENTS ARE REPORTED AT NET REALIZABLE VALUE. ACCOUNTS ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE BASED UPON THE ORGANIZATION'S APPROVED WRITE-OFF POLICY. THE ALLOWANCE FOR DOUBTFUL COLLECTIONS IS ESTIMATED BASED UPON A PERIODIC REVIEW OF THE ACCOUNTS RECEIVABLE AGING, PAYOR CLASSIFICATIONS, AND APPLICATION OF HISTORICAL WRITE-OFF PERCENTAGES.TOTAL RATIO OF COST TO CHARGES (BAD DEBT EXPENSE WAS BACKED OUT TO CALCULATE THE RATIO) WAS USED TO CALCULATE BAD DEBT EXPENSE.MEMORIAL HOSPITAL OF TOWANDA PROVIDES CARE TO ALL PATIENTS WHO NEED IT, REGARDLESS OF THEIR ABILITY TO PAY. THIS IS PART OF THE HOSPITAL'S MISSION. | |
| PART III, LINE 8: MEDICARE ALLOWABLE COST AMOUNT DETERMINED FROM MEDICARE COST REPORT. | |
| PART III, LINE 9B: IF UPON REGISTRATION, PATIENT IS DETERMINED TO HAVE NO INSURANCE AND QUALIFIES FOR FINANCIAL ASSISTANCE THEY ARE ASKED TO PROVIDE COPIES OF A W-2, PAY STUB, OR INCOME TAX RETURN TO COMPLETE OUR CHARITY CARE APPLICATION. DETERMINATION IS MADE BASED ON INFORMATION RECEIVED AND FINANCIAL GUIDELINES. | |
| PART V, SECTION B, LINE 19D: ALL PATIENTS ARE CHARGED GROSS CHARGES FOR SERVICES PROVIDED | THE MEMORIAL HOSPITAL, INC. OF TOWANDA |
| PART V, SECTION B, LINE 21: ALL PATIENTS ARE CHARGED GROSS CHARGES FOR SERVICES PROVIDED. | THE MEMORIAL HOSPITAL, INC. OF TOWANDA |
| PART VI, LINE 2: MEMORIAL HOSPITAL CONDUCTS ITS OWN HEALTH CARE ASSESSMENT ON AN ONGOING BASIS FOR THE HOSPITAL'S PRIMARY (ZIP CODES: 18837, 18854, 18815, 18853, 18814, 18848, 18832, 18833, 18614, 16947, 16926, 17743, 17724 AND 17735) AND SECONDARY (16914, 18817, 18840, 18831, 18850, 18851, 18829, 18845, 18818, 18828, 18839, 18801, 18843, 18846, 18616 AND 18632) SERVICE AREA. THE HOSPITAL USES ITS BOARD OF TRUSTEES, PHYSICIANS ON STAFF, EMPLOYEES AND COMMUNITY MEMBERS TO IDENTIFY NEEDS BASED ON INFORMATION OBTAINED BY THESE INDIVIDUALS OR GROUPS. BASED ON WHAT IS OBTAINED, THE HOSPITAL CAN THEN DETERMINE WHAT HEALTHCARE SERVICES SHOULD BE CONSIDERED TO BE OFFERED IN THE COMMUNITY.IN ACCORDANCE WITH THE AFFORDABLE CARE ACT, THE HOSPITAL IS UNDERGOING A COMMUNITY NEEDS ASSESSMENT WITH THE GUIDANCE OF PARENTEBEARD FOR FISCAL YEAR 2013. THE FINAL COMMUNITY MEETING IS SCHEDULED TO BE HELD ON MAY 16, 2013 AND A FINAL REPORT WILL BE ISSUED SOON AFTER. | |
| PART VI, LINE 3: INFORMATION IS PROVIDED THROUGHOUT THE HOSPITAL REGARDING THE CHARITY CARE PROGRAM. TELEPHONE CALLS ARE MADE TO ALL SELF PAY PATIENTS AS WELL AS SEEING THEM PERSONALLY IF THEY HAPPEN TO BE AN INPATIENT OF THE HOSPITAL. EVERY INTAKE AREA OF THE HOSPITAL HAS INFORMATION REGARDING THE FINANCIAL ASSISTANCE THE HOSPITAL CAN PROVIDE AND THE CONTACT INFORMATION FOR THE HOSPITAL'S FINANCIAL COUNSELOR IS MADE AVAILABLE. ALL NEW HIRED EMPLOYEES IN INTAKE AREAS ARE TRAINED IN THE FINANCIAL ASSISTANCE POLICIES AS PART OF THEIR ORIENTATION PROCESS. A NOTICE FOR FINANCIAL AID IS POSTED ON THE HOSPITAL'S WEB SITE FOR THOSE SEEKING THE INFORMATION VIA THE WEB. IN THE EVENT AN INTERPRETER IS NEEDED TO ASSIST A PATIENT WHO DOES NOT SPEAK ENGLISH, ONE CAN BE PROVIDED. | |
| PART VI, LINE 4: MEMORIAL HOSPITAL SERVES A RURAL PORTION OF BRADFORD AND SULLIVAN COUNTIES IN NORTHEAST PA. THE TOTAL POPULATION FOR BOTH COUNTIES IS APPROXIMATELY 67,000. THE HOSPITAL SERVES A HIGH PERCENTAGE OF MEDICAL ASSISTANCE PATIENTS AND IS ELIGIBLE FOR DSH REIMBURSEMENT AS A RESULT. ACCORDING TO THE PENNSYLVANIA HEALTH CARE COST CONTAINMENT COUNCIL (PHC4), MEMORIAL HOSPITAL HAD A 13.86% SHARE OF NET PATIENT REVENUE COMING FROM MEDICAL ASSISTANCE PATIENTS. THE AVERAGE FOR THE REGION MEMORIAL HOSPITAL IS LOCATED IN IS 8.03%. MEMORIAL HOSPITAL ALSO HAD, ACCORDING TO PHC4, AN UNCOMPENSATED CARE PERCENTAGE OF 4.86% WITH THE REGION AVERAGE BEING 2.97%. THE HOSPITAL'S 24 HOUR EMERGENCY ROOM CARES FOR MANY PATIENTS SEEKING PRIMARY CARE WHO DO NOT HAVE AN EXISTING PRIMARY CARE PHYSICIAN. WITHIN BRADFORD AND SULLIVAN COUNTIES THERE ARE AREAS DESIGNATED AS MEDICALLY UNDERSERVED, WITH THE HOSPITAL CARING FOR MANY PATIENTS WITHIN THOSE AREAS. | |
| PART VI, LINE 5: MEMORIAL HOSPITAL IS GOVERNED BY A 30 MEMBER VOLUNTEER BOARD OF TRUSTEES WITH THE MAJORITY OF THOSE TRUSTEES RESIDING IN THE HOSPITAL'S PRIMARY SERVICE AREA. THE CFO AND 2 EMPLOYED PHYSICIANS ARE MEMBERS OF THE BOARD OF TRUSTEES. THE REMAINING 27 MEMBERS ARE COMMUNITY MEMBERS OF THE AREAS THE HOSPITAL SERVES THAT ARE NEITHER EMPLOYEES, CONTRACTORS OF THE ORGANIZATION, OR FAMILY MEMBERS THEREOF. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY WHO SEEK THOSE PRIVILEGES. ANY SURPLUS FUNDS GENERATED BY THE HOSPITAL ARE USED FOR FUNDING IMPROVEMENTS IN PATIENT CARE. THE HOSPITAL'S 24 HOUR EMERGENCY ROOM TREATS ALL PATIENTS WHO PRESENT REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL PARTICIPATES WITH ALL GOVERNMENT SPONSORED HEALTH CARE PROGRAMS AND OFFERS FINANCIAL ASSISTANCE TO PATIENTS WHO SEEK ASSISTANCE AND MEET THE GUIDELINES. | |
| PART VI, LINE 6: MEMORIAL HOSPITAL IS SUPPORTED BY THE MEMORIAL HOSPITAL FOUNDATION, WHICH WAS ESTABLISHED IN 2003 TO FOSTER AND SUPPORT SPECIFIC PROJECTS AND PROGRAMS TO IMPROVE THE HOSPITAL'S SERVICES TO ITS PATIENTS. THE MISSION OF THE MEMORIAL HOSPITAL FOUNDATION IS TO GENERATE RESOURCES FOR THE SUSTAINABILITY AND ADVANCEMENT OF HEALTHCARE IN THE COMMUNITIES IT HAS THE PRIVILEGE OF SERVING.PART VI, LINE 7: AT PRESENT THE HOSPITAL DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH ANY STATE. THE HOSPITAL PLANS TO FILE A COMMUNITY BENEFIT REPORT WITH THE COMMONWEALTH OF PA BEGINNING WITH THE JUNE 30, 2013 RETURN. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| 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 | 0 | 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 (6 entries)
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| WILLIAM ROHRBACH | |||||||||||||
| 143931 | 0 | 25020 | 0 | 0 | 0 | 6063 | 0 | 6030 | 0 | 181044 | 0 | 0 | 0 |
| LISA CERAOLO | |||||||||||||
| 186054 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 11144 | 0 | 197198 | 0 | 0 | 0 |
| GARY A BAKER | |||||||||||||
| 187590 | 0 | 49656 | 0 | 0 | 0 | 11948 | 0 | 40070 | 0 | 289264 | 0 | 0 | 0 |
| LARRY LINNELL | |||||||||||||
| 188023 | 0 | 0 | 0 | 0 | 0 | 5677 | 0 | 5983 | 0 | 199683 | 0 | 0 | 0 |
| TIMOTHY DENNEN | |||||||||||||
| 170136 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 12947 | 0 | 183083 | 0 | 0 | 0 |
| JAI NAIDU | |||||||||||||
| 145362 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 15940 | 0 | 161302 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | JIM PARKS (CHAIRMAN) IS THE BROTHER-IN-LAW OF ROBERT FERRARIO (SECRETARY). | |
| FORM 990, PART VI, SECTION A, LINE 3 | MEMORIAL HOSPITAL HAS A MANAGEMENT CONTRACT WITH QUORUM HEALTH RESOURCES. GARY BAKER, PRESIDENT/CEO, IS EMPLOYED BY QUORUM HEALTH RESOURCES. | |
| FORM 990, PART VI, SECTION B, LINE 11 | REVIEWED IN DETAIL BY MANAGEMENT WITH THE HELP OF PARENTEBEARD. A COPY OF THE RETURN WAS EMAILED TO THE MEMBERS OF THE FINANCE COMMITTEE OF THE BOARD OF TRUSTEES FOR THEIR REVIEW BEFORE FILING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | OUR TRUSTEES, MEDICAL STAFF AND MANAGEMENT STAFF ALL ARE REQUIRED TO DISCLOSE CONFLICTS OF INTEREST THROUGH A FORMAL PROCESS OF REVIEWING THE POLICY & DISCLOSING & SIGNING A STATEMENT. THEY ARE ENCOURAGED TO PARTICIPATE IN DISCUSSION, BUT WILL ABSTAIN DURING VOTES. FAILURE TO FULLY DISCLOSE ANY CONFLICTS OF INTEREST ARE REVIEWED BY MANAGEMENT. DISCIPLINARY ACTIONS RESULTING FROM INADEQUATE DISCLOSURE ARE DETERMINED ON A CASE BY CASE MANNER AND COULD RESULT IN TERMINATION OF EMPLOYMENT. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION COMMITTEE REVIEWS AND APPROVES THE SALARIES OF THE CEO, CFO AND VP'S. MEMBERS OF THE BOARD, AS WELL AS THE VP OF THE MANAGEMENT COMPANY, ARE INVOLVED IN SETTING COMPENSATION. SURVEYS ARE USED TO COMPARE THE SALARIES TO MAINTAIN APPROPRIATENESS OF WAGES. REVIEW AND APPROVAL IS DOCUMENTED IN COMMITTEE MINUTES. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND/OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. | |
| FORM 990, PART VII, SECTION A: | AVERAGE HOURS PER WEEK FOR THE FOUNDATION AND RELATED ORGANIZATIONS ARE AS FOLLOWS: WILLIAM ROHRBACH - 42 HOURS GARY A. BAKER - 42 HOURS | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -5,960. PENSION LIABILITY ADJUSTMENT -892,068. CHANGE IN INTEREST IN MEMORIAL HOSPITAL FOUNDATION 508,561. CHANGE IN TEMPORARILY RESTRICTED INTEREST IN MEMORIAL HOSPITAL FOUNDATION 18,463. TOTAL TO FORM 990, PART XI, LINE 5: -371,004. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HEALTH ASSOCIATES LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 91 HOSPITAL DRIVE | AddressLine1 |
| City | TOWANDA | City |
| State | PA | State |
| ZIP Code | 18848 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 262096228 | EIN |
| Primary Activities | EMPLOYS PHYSICIANS FOR THE HOSPITAL | PrimaryActivities |
| Legal Domicile State | PA | LegalDomicileState |
| Total Income | 1999045 | TotalIncome |
| EOY Assets | 851049 | EOYAssets |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE MEMORIAL HOSPITAL INC OF TOWANDA | BusinessNameLine1 |
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE MEMORIAL HOSPITAL FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 91 HOSPITAL DRIVE | AddressLine1 |
| City | TOWANDA | City |
| State | PA | State |
| ZIP Code | 188489703 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 651160811 | EIN |
| Primary Activities | SUPPORTS THE ACTIVITIES AND PURPOSES OF THE HOSPITAL | PrimaryActivities |
| Legal Domicile State | PA | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 11A | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE MEMORIAL HOSPITAL INC OF TOWANDA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | 1 | 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 | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| THE MEMORIAL HOSPITAL FOUNDATION | ||
| C | 18366 | CASH |
| THE MEMORIAL HOSPITAL FOUNDATION | ||
| D | 6348156 | CASH |