Fayette Memorial Hospital Association: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- Fayette Memorial Hospital Association (EIN 35-0900741)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-07-26
- IRS object ID
- 201332079349300823
- 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 I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-07-26T12:50:43-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351178661 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUE & CO LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE AMERICAN SQUARE 2200 | AddressLine1 |
| City | INDIANAPOLIS | City |
| State | IN | State |
| ZIP Code | 46282 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 350900741 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAYETTE MEMORIAL HOSPITAL ASSOCIATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | FAYE | NameControl |
| Phone | 7658255131 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1941 VIRGINIA AVE | AddressLine1 |
| City | CONNERSVILLE | City |
| State | IN | State |
| ZIP Code | 47331 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | RANDALL WHITE | Name |
| Title | CEO | Title |
| Phone | 7658255131 | Phone |
| Date Signed | 2013-07-25 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AMBER KOCHER CPA | Name |
| PTIN | P01286298 | PTIN |
| Phone | 3176334705 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAYETTE REGIONAL HOSPITAL SYSTEM SERVES WHITEWATER VALLEY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | RANDALL WHITE | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1941 VIRGINIA AVE | AddressLine1 |
| City | CONNERSVILLE | City |
| State | IN | State |
| ZIP Code | 47331 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 59920736 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.FAYETTEREGIONAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1913 | YearFormation |
| State Legal Domicile | IN | StateLegalDomicile |
| Activity Or Mission Description | FAYETTE REGIONAL HEALTH SYSTEM'S (FRHS) VISION IS FOR OUR TEAM TO SERVE THE HEALTH NEEDS OF THE WHITEWATER VALLEY RESIDENTS BY PROVIDING COMPASSIONATE, HIGH QUALITY, COST EFFECTIVE CARE. FRHS IS COMMITTED TO THE HEALTHCARE THAT THE COMMUNITY WANTS AND DESERVES; ACHIEVING THIS GOAL BY CONTINUING TO PROVIDE A FULL CONTINUUM OF INPATIENT AND OUTPATIENT HEALTHCARE SERVICES TO CONNERSVILLE AND THE SURROUNDING AREA' RESIDENTS. AT FRHS, WE ARE COMMITTED TO PROVIDING THE CARE FOR THE NEEDS OF THE COMMUNITY THROUGHOUT ITS LIFETIME. FOUNDED IN 1913, FRHS HAS BEEN PROVIDING QUALITY AND COMPASSIONATE HEALTH CARE FOR 100 YEARS. THE MAIN HOSPITAL IS LOCATED IN THE HEART OF CONNERSVILLE, INDIANA, WITH FACILITIES IN TWO ADDITIONAL COUNTIES IN ORDER TO PROVIDE QUALITY SERVICES CLOSE TO HOME. THE EQUIPMENT AND FACILITIES ENABLES US TO LIVE OUR MISSION, "TO CARE, TO SERVE, TO HEAL." | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 697 | TotalNbrEmployees |
| Total Nbr Volunteers | 100 | TotalNbrVolunteers |
| Total Gross UBI | 2671 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 269676 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 29930 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 54741645 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 55778339 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 785369 | InvestmentIncomePriorYear |
| Investment Income Current Year | 831204 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1381701 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2653870 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 57178391 | TotalRevenuePriorYear |
| Total Revenue Current Year | 59293343 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 127675 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 129881 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 31131094 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 29617348 | 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 | 26947186 | OtherExpensePriorYear |
| Other Expenses Current Year | 28475698 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 58205955 | TotalExpensesPriorYear |
| Total Expenses Current Year | 58222927 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -1027564 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1070416 | RevenuesLessExpensesCY |
| Total Assets BOY | 56614183 | TotalAssetsBOY |
| Total Assets EOY | 56560397 | TotalAssetsEOY |
| Total Liabilities BOY | 32179472 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 28894609 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 24434711 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 27665788 | NetAssetsOrFundBalancesEOY |
| Mission Description | FAYETTE REGIONAL HEALTH SYSTEM IS A MULTI-FACETED HEALTH CARE CENTER WHICH PROVIDES SAFE, ACCURATE AND COMPASSIONATE HEALTH CARE THROUGH SERVICE EXCELLENCE TO THE CITIZENS OF EAST CENTRAL INDIANA TO PROMOTE HEALING AND HEALTHY LIVING. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 51304199 | Expense |
| Grants | 129881 | Grants |
| Revenue | 55800451 | Revenue |
| Description | THE HOSPITAL PROVIDES INPATIENT AND OUTPATIENT SERVICES AND ACUTE REHAB SERVICES. MEDICARE AND MEDICAID AMOUNTED TO APPROXIMATELY 74% OF TOTAL SERVICES PROVIDED BY THE HOSPITAL. UNINSURED CARE WAS APPROXIMATELY $1.6 MILLION, AS CALCULATED BY GROSS CHARGES, FOR THE YEAR ENDED SEPTEMBER 30, 2012. TOTAL COMMUNITY BENEFIT CONTRIBUTIONS ARE $129,881. | Description |
| Total Program Service Expense | 51304199 | 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 | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | 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 | 1 | GrantsToOrganizations |
| Grants To Individuals | 1 | 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 | 1 | 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 | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 96 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 697 | 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 |
| 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 | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | 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 | 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 | IN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VICKY HOPKINS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7658277709 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1941 VIRGINIA AVENUE | AddressLine1 |
| City | CONNERSVILLE | City |
| State | IN | State |
| ZIP Code | 47331 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (19 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 |
|---|---|---|---|---|---|---|---|
| CHARLES BROCHIN | |||||||
| CHAIRPERSON | 1.00 | X | 12000 | 0 | 0 | ||
| LOUISE WHITAKER | |||||||
| VICE CHAIRPERSON | 1.00 | X | 7500 | 0 | 0 | ||
| ARLENE BLIVEN | |||||||
| TREASURER | 1.00 | X | 7500 | 0 | 0 | ||
| MALCOLM MILES | |||||||
| SECRETARY | 1.00 | X | 7500 | 0 | 0 | ||
| JOEL LONG | |||||||
| MEMBER | 1.00 | X | 6000 | 0 | 0 | ||
| JIM THOMAS | |||||||
| MEMBER | 1.00 | X | 6000 | 0 | 0 | ||
| SANDRA CATES | |||||||
| MEMBER | 1.00 | X | 6000 | 0 | 0 | ||
| DR STEVEN JOHNSON | |||||||
| MEMBER (OCT-DEC '11) & CHIEF OF STAFF | 40.00 | X | 299520 | 0 | 18078 | ||
| DR PETRONIO ILAGAN | |||||||
| MEMBER (JAN-SEP '12) & CHIEF OF STAFF | 40.00 | X | 271330 | 0 | 15815 | ||
| JAG PATEL MD | |||||||
| MEMBER & MEDICAL STAFF | 40.00 | X | 276773 | 0 | 14886 | ||
| RANDALL WHITE | |||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | X | 245113 | 0 | 22546 | X | |
| GARY SMITH | |||||||
| CHIEF FINANCIAL OFFICER | 40.00 | 45285 | 0 | 2339 | X | ||
| BETH WAMPLER | |||||||
| VP OF PAT CARE SVCS | 40.00 | 149670 | 0 | 18716 | X | ||
| RHONDA MCPHERSON | |||||||
| VP HUMAN RESOURCES | 40.00 | 127732 | 0 | 10209 | X | ||
| STEPHEN CASTLEMAN | |||||||
| PHYSICIAN | 40.00 | 375209 | 0 | 22893 | X | ||
| MICHAEL ROWE | |||||||
| PHYSICIAN | 40.00 | 368388 | 0 | 16282 | X | ||
| JOHN LANDRY | |||||||
| PHYSICIAN | 40.00 | 297647 | 0 | 17583 | X | ||
| HATEM M DAJANI | |||||||
| PHYSICIAN | 40.00 | 288177 | 0 | 8950 | X | ||
| KENNETH PAHREN | |||||||
| PHYSICIAN | 40.00 | 224383 | 0 | 11814 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3021727 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 180111 | TotalOtherCompensation |
| Number Individuals GT100 K | 28 | 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 |
|---|---|---|---|---|---|
| KEY BENEFIT ADMINISTRATORS | |||||
| 8330 ALLISON POINTE TRAIL | INDIANAPOLIS | IN | 46205 | CONSULTING | 884519 |
| WEATHERBY LOCUMS INC | |||||
| PO BOX 972633 | DALLAS | TX | 75392 | LOCUM TENENS SERVICE PROVIDER | 825444 |
| WELLS FARGO | |||||
| 300 N MERIDIAN STREET | INDIANAPOLIS | IN | 46204 | WHOLESALE LOCKBOX PROVIDER | 793493 |
| PREFERRED EMERGENCY SPECIALISTS INC | |||||
| 7324 YANKEE RD STE B | LIBERTY TOWNSHIP | OH | 45044 | ER PHYSICIANS | 597056 |
| BARTON & ASSOCIATES | |||||
| 10 DEARBORN RD | PEABODY | MA | 01960 | LOCUM TENENS SERVICE PROVIDER | 482404 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 19 | NumberOfContractorsGT100K |
| Related Organizations | 29930 | RelatedOrganizations |
| Total Contributions | 29930 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT REVENUE | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 55778339 | TotalRevenueColumn |
| Related Or Exempt Function Income | 55778339 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 55778339 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 423585 | TotalRevenueColumn |
| Exclusion | $423,585 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 80147 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 55364 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 24783 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 24783 | TotalRevenueColumn |
| Related Or Exempt Function Income | 22112 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 2671 | UnrelatedBusinessRevenue |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 976517 | Securities |
| Other | 3131 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 557260 | Securities |
| Other | 14769 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 419257 | Securities |
| Other | -11638 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 407619 | TotalRevenueColumn |
| Exclusion | $407,619 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| BILLING SERVICES | 900099 | 306433 | $306,433 |
| CAFETERIA REVENUE | 900099 | 215001 | $215,001 |
| AMBULANCE REVENUE | 900099 | 167903 | $167,903 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1939750 | TotalRevenueColumn |
| Exclusion | $1,939,750 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 2629087 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 59293343 | TotalRevenueColumn |
| Related Or Exempt Function Income | 55800451 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 2671 | UnrelatedBusinessRevenue |
| Exclusion | $3,460,291 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 129881 | Total |
| Program Services | 129881 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1463187 | Total |
| Program Services | 1293783 | ProgramServices |
| Management And General | 169404 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22789467 | Total |
| Program Services | 20144065 | ProgramServices |
| Management And General | 2645402 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 440405 | Total |
| Program Services | 389283 | ProgramServices |
| Management And General | 51122 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3295242 | Total |
| Program Services | 2913728 | ProgramServices |
| Management And General | 381514 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1629047 | Total |
| Program Services | 1439973 | ProgramServices |
| Management And General | 189074 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 270821 | Total |
| Program Services | 239466 | ProgramServices |
| Management And General | 31355 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 268124 | Total |
| Program Services | 237081 | ProgramServices |
| Management And General | 31043 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5543452 | Total |
| Program Services | 4901543 | ProgramServices |
| Management And General | 641909 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 254653 | Total |
| Program Services | 225005 | ProgramServices |
| Management And General | 29648 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5279376 | Total |
| Program Services | 4668144 | ProgramServices |
| Management And General | 611232 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4184240 | Total |
| Program Services | 3694158 | ProgramServices |
| Management And General | 490082 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 84168 | Total |
| Program Services | 74423 | ProgramServices |
| Management And General | 9745 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1341405 | Total |
| Program Services | 1186101 | ProgramServices |
| Management And General | 155304 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2898367 | Total |
| Program Services | 2534149 | ProgramServices |
| Management And General | 364218 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 544893 | Total |
| Program Services | 481807 | ProgramServices |
| Management And General | 63086 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT | 5649125 | 4995085 | 654040 |
| HOSPITAL ASSESSMENT FEE | 1813440 | 1595827 | 217613 |
| DUES & SUB. | 172561 | 152355 | 20206 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 171073 | Total |
| Program Services | 8342 | ProgramServices |
| Management And General | 162731 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 58222927 | Total |
| Program Services | 51304199 | ProgramServices |
| Management And General | 6918728 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 814772 | BOY |
| EOY | 1480670 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9579883 | BOY |
| EOY | 9363132 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 605401 | BOY |
| EOY | 393013 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 846247 | BOY |
| EOY | 866863 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 715804 | BOY |
| EOY | 602056 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 76353143 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 50258708 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27695833 | BOY |
| EOY | 26094435 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13934860 | BOY |
| EOY | 15890722 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 782585 | BOY |
| EOY | 1340126 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1638798 | BOY |
| EOY | 529380 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 56614183 | BOY |
| EOY | 56560397 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2500431 | BOY |
| EOY | 2698794 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20970383 | BOY |
| EOY | 20025091 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 622880 | BOY |
| EOY | 1111579 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8085778 | BOY |
| EOY | 5059145 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32179472 | BOY |
| EOY | 28894609 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23710383 | BOY |
| EOY | 26386889 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 724328 | BOY |
| EOY | 1278899 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24434711 | BOY |
| EOY | 27665788 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 56614183 | BOY |
| EOY | 56560397 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1070416 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 2160661 | 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 |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| 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 | $1,454 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 1454 | 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 | PAY MEMBERSHIP DUES TO TRADE ORGANIZATIONS OF WHICH A PORTION OF THE DUES ARE USED FOR LOBBY EXPENSES BY THE TRADE ORGANIZATIONS. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1244594 | OtherCostOrOtherBasis |
| Book Value | 1244594 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 52283557 | OtherCostOrOtherBasis |
| Depreciation | 31519445 | Depreciation |
| Book Value | 20764112 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 22631041 | OtherCostOrOtherBasis |
| Depreciation | 18739263 | Depreciation |
| Book Value | 3891778 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 193951 | OtherCostOrOtherBasis |
| Book Value | 193951 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 26094435 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| LINE OF CREDIT | $760,273 |
| DERIVIATIVE LIABILITY | $4,062,214 |
| THIRD PARTY PAYABLE | $236,658 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 5059145 | TotalOfAmounts |
| Total Revenue | 59293343 | TotalRevenue |
| Total Expenses | 58222927 | TotalExpenses |
| Excess Or Deficit For Year | 1070416 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 1606090 | NetUnrealizedGLOnInvestments |
| Other | $554,571 | OtherAmount |
| Total Adjustments | 2160661 | TotalAdjustments |
| Excess Or Deficit Per FS | 3231077 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 60698311 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 1606090 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 1606090 | RevenueNotRptdF990 |
| Revenue Subtotal | 59092221 | RevenueSubtotal |
| Investment Expenses Not Included | 268124 | InvestmentExpensesNotIncluded |
| Other Revenues Not Included | -67002 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 201122 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 59293343 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 58021805 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 67002 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 67002 | ExpensesNotRptdF990 |
| Expenses Subtotal | 57954803 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 268124 | InvestmentExpensesNotIncluded2 |
| Expenses Not Rptd On Fin Stmt | 268124 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 58222927 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE SYSTEM AND RECOGNIZE A TAX LIABILITY IF THE SYSTEM HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE SYSTEM, AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2012 AND 2011, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. AS SUCH, THE SYSTEM IS GENERALLY EXEMPT FROM INCOME TAXES. HOWEVER, THE SYSTEM IS REQUIRED TO FILE FEDERAL FORM 990 - RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX WHICH IS AN INFORMATIONAL RETURN ONLY. THE SYSTEM IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, AS OF THE DATE THE FINANCIAL STATEMENTS WERE ISSUED, THERE WERE NOT AUDITS FOR ANY TAX PERIODS IN PROGRESS. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | CHANGE IN TEMPORARILY RESTRICTED NET ASSETS 554,571. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | LOSS ON FIXED ASSETS -11,638. RENTAL EXPENSES -55,364. | |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 55,364. LOSS ON FIXED ASSETS 11,638. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 0 | AmountsBudgetedForCharityCare |
| 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 | 746208 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 746208 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01420 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9764770 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5572431 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4192339 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07970 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10510978 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5572431 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4938547 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09390 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 3 | NumberOfActivitiesOrPrograms |
| Total Community Benefit Expense | 3000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 3000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 112 | NumberOfActivitiesOrPrograms |
| Total Community Benefit Expense | 35058 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 35058 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 115 | NumberOfActivitiesOrPrograms |
| Total Community Benefit Expense | 38058 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 38058 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00080 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 115 | NumberOfActivitiesOrPrograms |
| Total Community Benefit Expense | 10549036 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5572431 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4976605 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09470 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 3 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 94823 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 94823 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00180 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 3 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 94823 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 94823 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00180 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $5,649,125 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 11043319 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 11917975 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -874656 | 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 | 0 | 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 | FAYETTE REGIONAL HOSPITAL SYSTEM | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1941 VIRGINIA AVE | AddressLine1 |
| City | CONNERSVILLE | City |
| State | IN | State |
| ZIP Code | 47331 | 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 | FAYETTE MEMORIAL HOSPITAL ASSOCIATION | 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 | 150.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 0 | ExplainsBasis |
| Explains Application Method | 0 | ExplainsApplicationMethod |
| Includes Publicity Measures | 0 | IncludesPublicityMeasures |
| Actions On Nonpayment | 0 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 0 | NondiscrimEmergencyCarePolicy |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 3C: THE HOSPITAL HAS A SLIDING SCALE BASED ON THE FEDERAL POVERTY GUIDELINES WITH FREE CARE TO INDIVIDUALS WHO HAVE INCOME BETWEEN 100% AND 133% OF POVERTY AND PROVIDE DISCOUNTED CARE UP TO INCOME OF 300% OF POVERTY. THE LARGEST NUMBER OF THE ORGANIZATION'S PATIENTS MEET THE FEDERAL POVERTY GUIDELINES FOR DISCOUNTED CARE AROUND 200% DEPENDING ON THE HOUSEHOLD SIZE. | ||
| PART I, LINE 6A: ORGANIZATION'S COMMUNITY BENEFIT REPORT IS AVAILABLE UPON REQUEST. | ||
| PART I, L7 COL(F): THE BAD DEBT EXPENSES INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN PART I, LINE 7, COLUMN (F) IS $5,649,125. | ||
| PART II: FRHS EMPLOYEES PARTICIPATE IN COMMUNITY BUILDING ACTIVITIES TO PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES INCLUDING:**HEALTH FAIR, CONNERSVILLE, IN, 131.5 HRS; BROOKVILLE, IN, 35.5 HRS: FRHS TEAM MEMBERS SPONSOR A HEALTH FAIR FOR OUR COMMUNITY ANNUALLY. BOOTHS ARE SET UP FOR THE SCREENS AND TESTING OF BLOOD PRESSURE, CHOLESTEROL, COMPUTERIZED HEALTH RISK APPRAISAL, CATARACT, GLAUCOMA, COLORECTAL, BLOOD SUGAR, PERIPHERAL VASCULAR DISEASE, TB, IMMUNIZATIONS FOR CHILDREN, BODY FAT ANALYSIS, CHEMICAL DEPENDENCY, AND NUMEROUS EDUCATIONAL AND DEMONSTRATION BOOTHS.**LOCAL FACTORY HEALTH FAIR, CONNERSVILLE, IN, 56.75 HRS; PROVIDED ROOT BLOWER AND SAPA HEALTH FAIR. **BLOOD DRIVE, CONNERSVILLE, IN, 16.5 HRS: DONATED BLOOD.**PINK PAJAMA PARTY, CONNERSVILLE, IN, 14 HRS: TEAM MEMBERS DONATED TIME DURING PINK PAJAMA PARTY AND STYLE SHOW EVENT FOR BREAST CANCER SURVIVORS.**WALK FOR AUTISM, BROOKVILLE, IN, 5 HRS: TEAM MEMBER PARTICIPATED IN WALK FOR AUTISM EVENT.**PHYSICAL NIGHT, CONNERSVILLE, IN, 28.7 HRS: TEAM MEMBERS ASSISTED WITH HIGH SCHOOL AND MIDDLE SCHOOL PHYSICAL NIGHTS.**5K, CONNERSVILLE, IN, 2 HRS: TEAM MEMBERS PARTICIPATED IN EVENT TO BENEFIT FITNESS/ WELLNESS PROGRAMS FOR YOUTH.**CAREER DAY, CONNERSVILLE, IN, 13 HRS: TEAM MEMBERS SPOKE AT THE HIGH SCHOOL ON CAREER DAY ABOUT HEALTH CARE PROFESSIONS.**RACE FOR THE CURE, INDIANAPOLIS, IN, 7 HRS: TEAM MEMBERS PARTICIPATED IN THE ANNUAL SUSAN G. KOMEN RACE FOR THE CURE THAT RAISES MONEY FOR THE INDIANA CHAPTER WHICH HELPS FIND A CURE FOR BREAST CANCER. **EVERTON ELEMENTRY, EVERTON, IN, 7 HRS: TEAM MEMBER VOLUNTEERED TIME TO HELP READ WITH KIDS AT EVERTON ELEMENTARY AND OTHER COMMUNITY EVENTS.**CELEBRATE WOMEN, BROOKVILLE, IN, 20.75 HRS: TEAM MEMBER SPOKE AT HEALTH FAIR FOR WOMEN AT THE BROOKVILLE LIBRARY.**FRAZEE BIKE RODEO, CONNERSVILLE, IN, 10 HRS: ANNUAL BIKE RODEO-INSTRUCTED STUDENTS ON BIKE SAFETY.**COMMUNITY BLOOD PRESSURE SCREENING, CONNERSVILLE, IN, 18 HRS: TEAM MEMBERS PROVIDED BLOOD PRESSURE CHECKS AT COMMUNITY BASKETBALL GAMES.**HEART HEALTH EVENT, CONNERSVILLE, IN, 10 HRS: TEAM MEMBERS VOLUNTEERED TIME AT EVENT.**MEDICAL MISSIONS, HONDURAS, 40 HRS: TEAM MEMBER VOLUNTEERED TIME TO ASSIST DURING A MEDICAL MISSION TO HONDURAS TO PROVIDE HEALTHCARE TO THE LOCAL COMMUNITY.**LIONS CLUB, CONNERSVILLE, IN, 4.5 HRS: TEAM MEMBERS PRESENTED AS GUEST SPEAKERS ON STROKE SIGNS AND CANCER CARE SYMPTOMS AND TREATMENT.**CPR CLASS, CONNERSVILLE, IN 11 HRS: TEAM MEMBER TEACHES CPR AND FIRST AID CLASSES AT NURSING HOMES AND SAPP. | ||
| PART III, LINE 4: FOOTNOTE TO ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSES: THE SYSTEM EVALUATES THE COLLECTABILITY OF ITS ACCOUNTS RECEIVABLE BASED ON CERTAIN FACTORS, SUCH AS PAYER TYPE, HISTORICAL COLLECTION TRENDS AND AGING CATEGORIES. THE ALLOWANCE THAT IS APPLIED TO THE RECEIVABLE BALANCES IS BASED ON THE HISTORICAL EXPERIENCE AND TIME LIMITS, IF ANY, FOR EACH PARTICULAR PAYER SOURCE, SUCH AS PRIVATE, INSURANCE, MEDICARE AND MEDICAID. ACTUAL RESULTS COULD DIFFER FROM THE ESTIMATED ALLOWANCES.PART III, LINE 3: RATIONAL FOR INCLUDING OTHER BAD DEBT AMOUNT IN COMMUNITY BENEFIT: NONE HAS BEEN INCLUDED. THE HOSPITAL HAS A DETAILED CHARITY CARE POLICY WHICH STATES THAT TO PARTICIPATE IN CHARITY CARE CANDIDATES MUST COOPERATE FULLY. IN ADDITION THE HOSPITAL EDUCATES PATIENTS WITH LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THIS REASON THE ORGANIZATION BELIEVES THAT IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE. | ||
| PART III, LINE 8: THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED SEPTEMBER 30, 2012 REPORT: HOSPITAL STATEMENT OF REIMBURSABLE COST. | ||
| PART V, SECTION B, LINE 11H: CHARITY DISCOUNTS CAN BE GRANTED FOR DECEASED PATIENTS WITH NO ESTATE. | FAYETTE MEMORIAL HOSPITAL ASSOCIATION | |
| PART VI, LINE 2: THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES THROUGH ONGOING COMMUNICATION WITH LOCAL COMMUNITY LEADERS AND ORIGINATIONS. THE HOSPITAL TEAM MEMBERS REGULARLY PARTICIPATE IN COMMUNITY EVENTS AND LOCAL CIVIC ORGANIZATIONS INCLUDING ROTARY, KIWANIS, AND CHAMBER OF COMMERCE. COMMUNITY NEEDS ARE DISSEMINATED THROUGH THESE LOCAL COMMUNITY ORGANIZATIONS AND EVENTS PROVIDING THE HOSPITAL WITH FEEDBACK REGARDING THE NEEDS OF THE COMMUNITY. IN ADDITION THE HOSPITAL COMPLETES AND SUBMITS ANNUALLY A COMMUNITY BENEFIT PLAN TO THE INDIANA STATE DEPARTMENT OF HEALTH WHICH ADDRESSES THE GOALS SET TO FOCUS ON THE NEEDS OF THE COMMUNITY.FRHS RECOGNIZES FIVE PRIMARY AREAS OF CONCERN FACING ITS COMMUNITY AS THE FRHS EMPHASIS IN THE IMPLEMENTATION OF THE COMMUNITY BENEFIT PLAN: 1. CITIZENS WHO ARE MEDICALLY UNDERSERVED. 2. ISSUES THAT IMPACT ADOLESCENTS INCLUDING EDUCATION, PREGNANCY AND GENERAL BEHAVIORAL CONCEPTS SPECIFIC TO THIS AGE GROUP. 3. CHILDHOOD GROWTH AND DEVELOPMENT, AS WELL AS ABUSE AND NEGLECT PREVENTION. 4. HEALTH ISSUES THAT REQUIRE INCREASED AWARENESS IN THE GENERAL COMMUNITY POPULATION. 5. CHALLENGES IMPACTING THE AREA WHICH DIRECTLY RELATE TO THE COMMUNITY'S ABILITY TO OBTAIN COMPREHENSIVE MEDICAL CARE. | ||
| PART VI, LINE 3: ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS DISCUSSED WITH PATIENTS OR GUARANTORS TO INFORM AND EDUCATE PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE. CHARITY CARE APPLICATIONS AND PAMPHLETS DETAILING BILLING PROCEDURES AND CONTACT INFORMATION FOR THE BILLING OFFICE ARE MADE AVAILABLE TO PATIENTS. ANY QUESTIONS REGARDING THE ORGANIZATION'S WRITTEN CHARITY CARE POLICY CAN BE DIRECTED AND ANSWERED BY A MEMBER OF THE PATIENT ACCOUNTS' PERSONNEL. PATIENT ACCOUNTS' PERSONNEL WILL NOTIFY INDIVIDUALS WITH APPROVED APPLICATIONS QUALIFYING FOR REDUCED LIABILITY UNDER THE CHARITY CARE POLICY. FRHS STAFFS A FULL TIME REPRESENTATIVE FROM CLAIMAID CONSULTING 5 DAYS A WEEK TO ASSIST COMMUNITY MEMBERS WITH ELIGIBILITY FOR ASSISTANCE FOR PROGRAMS SUCH AS MEDICAID, HIP, AND OTHER PRIVATE ASSISTANCE PROGRAMS. | ||
| PART VI, LINE 4: FRHS'S MAIN AREAS OF SERVICE ARE FAYETTE, FRANKLIN AND UNION COUNTIES SERVING AN APPROXIMATE POPULATION OF 54,000. FAYETTE COUNTY HAS RANKED IN THE TOP TWO COUNTIES FOR UNEMPLOYMENT IN THE PAST SEVERAL YEARS AND HAS A HIGH NUMBER OF PRIVATE PAY INDIVIDUALS. UNION COUNTY AND FRANKLIN COUNTY HAVE LITTLE TO NO INDUSTRY.PART VI, LINE 5: DURING THE FISCAL YEAR FRHS HAS DEMONSTRATED CONTINUED COMMUNITY STEWARDSHIP THROUGH THE ATTAINMENT OF MANY GOALS THAT ADDRESS THE NEEDS OF OUR COMMUNITY. WE CONTINUE TO STRIVE FOR EXCELLENCE IN THE CONTRIBUTIONS AND SERVICES THAT WE PROVIDE TO AREA CITIZENS. DETAILS FOR FURTHERING FRHS'S EXEMPT PURPOSE FOR **MEDICALLY UNDERSERVED CITIZEN: THE FRANKLIN COUNTY COMMUNITY HAS CONTINUED TO BENEFIT FROM THE SERVICES AT THE BROOKVILLE HEALTHPLEX FACILITY WITH LABORATORY AND RADIOLOGY SERVICES. SUSTAINED CARDIOLOGY AND ONCOLOGY SERVICES WITH THE FRHS CARE CENTERS ENABLE PATIENTS TO BE SEEN LOCALLY FOR MORE ACCESSIBLE CARE WITH LESS TRAVEL, TIME AND EXPENSE. THE ST VINCENT CARDIOLOGY GROUP CONTINUES TO ADDRESS THE NEED FOR LOCAL SERVICES FOR OUR CARDIAC PATIENTS, DECREASING THE COST OF COMMUTING. RADIATION ONCOLOGY WAS ADDED TO OUR CANCER CENTER TO DECREASE COMMUTE DEMANDS ON PATIENTS THAT REQUIRE THIS TREATMENT. AN IMMEDIATE CARE FACILITY HAS REMAINED OPEN IN CONNERSVILLE TO ASSIST PATIENTS TO BETTER ACCESS CARE WITHOUT EXPENSIVE TRAVEL AND TRANSPORTATION ARRANGEMENTS FOR THOSE WITHOUT VEHICLES. THIS SERVICE DECREASES PATIENT COSTS AS IT IS NOT AS EXPENSIVE AS A VISIT TO THE EMERGENCY DEPARTMENT. LABORATORY AND RADIOLOGY SERVICES FURTHER HELP PATIENTS TO REMAIN LOCAL FOR TESTING.SPONSORSHIP OF THE ANNUAL COMMUNITY HEALTH FAIRS IN FAYETTE, UNION AND FRANKLIN COUNTIES WITH EXTENSIVE REPRESENTATION OF FRHS SERVICES BY STAFF HAS CONTINUED. A WIDE ARRAY OF SCREENINGS OFFERED INCLUDED BLOOD PRESSURE, BLOOD SUGAR, CHOLESTEROL AND BONE DENSITY. TEAM MEMBERS WERE AVAILABLE TO HELP PARTICIPANTS UTILIZE HEALTH RISK SURVEYS AS WELL AS TO EDUCATE THEM ON A VARIETY OF HEALTH ISSUES. ALL ATTEMPTS ARE MADE TO OFFER FREE HEALTH AIDES SUCH AS PILL DISPENSERS, NUTRITIONAL GUIDES FOR FAST FOOD RESTAURANTS, ETCETERA. TWO CARDIAC SCORING PROCEDURES, FEMALE WELLNESS EXAM, AND CHOLESTEROL SCREENING CERTIFICATES WERE AMONG THE BOOTH PRIZES GIVEN AWAY AT THE EVENT. THERE WAS AN FRHS PRESENCE IN COMMUNITY HEALTH FAIRS IN 2012 OFFERED BY STAFF INCLUDING TWO IN AN INDUSTRIAL SETTING AT ROOTS BLOWER & SAPA FOR EASY ACCESS FOR THEIR EMPLOYEES. AS IN THE PAST YEAR, STAFF WAS INVOLVED WITH A HEALTH FAIR AT THE FRANKLIN COUNTY LIBRARY THAT ADDRESSED HEALTH NEEDS IN THAT COMMUNITY.MULTIPLE VOLUNTEERS WERE INVOLVED IN FOOD PANTRIES AND MINISTRIES TO ASSIST LOW INCOME INDIVIDUALS WITH NUTRITIONAL AID WHICH IMPACT THEIR GENERAL HEALTH. AN FRHS FOOD DRIVE IS HELD IN FEBRUARY TO ASSIST WITH THE POST-HOLIDAY NEED FOR FOOD. THIS SERVICE CANNOT BE UNDERVALUED AT AN ECONOMIC TIME WHEN MANY FAMILIES HAVE BASIC NUTRITIONAL NEEDS THAT ARE NOT BEING MET IN A MORE TRADITIONAL FASHION. FRHS STAFF HAS HAD A LONG TERM COMMITMENT TO PARTICIPATE IN THE ANGEL FOOD MINISTRIES PROGRAM IN THE SERVICE AREA. FUND RAISING FOR CHARITABLE ORGANIZATIONS INVOLVED IN EDUCATIONAL ASSISTANCE THROUGH SCHOLARSHIP PROGRAMS WAS CONTINUED BY FRHS STAFF. PARTICIPATION IN THE FAYETTE AND FRANKLIN COUNTY RELAY FOR LIFE CANCER SOCIETY EVENTS RAISED FUNDS TO ENABLE CARE/SERVICES FOR ONCOLOGY PATIENTS AND SURVIVORS OF CANCER. ADDITIONALLY, FRHS ASSISTED FURTHER THROUGH ANNOUNCEMENTS FOR THE RELAY AND A MONETARY GIFT. MANY FRHS TEAM MEMBERS AND LEADERSHIP STAFF CONTRIBUTED TIME TO WALK DURING THE 24 HOUR EVENT. THERE WAS ALSO PARTICIPATION IN THE STATE SUSAN B KOMEN WALK IN INDIANAPOLIS. AN FRHS TEAM MEMBER IS ON THE CANCER SOCIETY BOARD AND ATTENDS MONTHLY MEETINGS. FINANCIAL DONATIONS WERE PROVIDED FOR ACTIVITIES INCLUDING THE DONUT DAYS AND JEANS DAYS TO RAISE FUNDS. A BREAST CANCER AWARENESS TABLE WAS AVAILABLE IN THE FRHS ATRIUM TO EDUCATE PATIENTS AND STAFF. FRANKLIN AND FAYETTE COUNTY CANCER SOCIETIES BOTH RECEIVED A DONATION FROM FRHS. BREAST CANCER AWARENESS IN PARTICULAR WAS SUPPORTED IN 2012 WITH THE PINK PJ PARTY FOR BREAST CANCER AWARENESS THAT INCLUDED A FASHION SHOW. SEVERAL COMMUNITY SERVICE GROUPS INCLUDING PSI IOTA XI, TRI KAPPA, AND ETA PI KAPPA WERE ASSISTED WITH PROGRAMS AND PROJECTS THAT DIRECTLY IMPROVED THE MEDICAL OUTCOME FOR COMMUNITY MEMBERS WHILE ALSO INCREASING HEALTH EDUCATION. MANY HOURS WERE DONATED BY FRHS STAFF TO THE LOCAL HOPE PREGNANCY CRISES CENTER AS WELL AS THE HOUSE OF RUTH SHELTER FOR PROGRAMS AND PROJECTS TO HELP MEET THE NEEDS OF THIS POPULATION. THERE WAS A SILENT AUCTION THIS YEAR THAT STAFF SUPPORTED. A LOCAL GOLF TOURNEY AND THE ANNUAL GALA EVENT HAVE RAISED FUNDS TO PROVIDE ADDITIONAL HEALTH SERVICES TO THE COMMUNITY AS WELL AS TO UPDATE FACILITIES. AREA 9 AGENCY ON AGING WAS SUPPORTED MONETARILY FOR THE ANNUAL PICNIC AS WELL AS THE VOLUNTEER LUNCH FOR THE PLANNING PROCESS. **ADOLESCENT POPULATION ISSUES: THE WHITEWATER CARE PAVILION OFFERS COMPREHENSIVE BEHAVIORAL HEALTH SERVICES FOR ADOLESCENTS INCLUDING RESIDENTIAL, ACUTE INPATIENT CARE AND OUTPATIENT THERAPY OPTIONS. FRHS ENCOURAGED YOUTH TO BE ACTIVE AND HEALTH CONSCIOUS THROUGH COACHING AND SEVERAL SPONSORSHIPS FOR YOUTH SPORTS GROUPS INCLUDING BASKETBALL, GYMNASTICS, WRESTLING, FRANKLIN COUNTY BOYS BASEBALL, CONNERSVILLE PARKS AND RECREATION PROGRAM, CAST SWIMMING, CHEERLEADING AND A 5K RUN. A STAFF MEMBER DONATED OVER 300 HOURS AS A FOOTBALL COACH AT LINCOLN HIGH SCHOOL. CONNERSVILLE AND THE BROOKVILLE COMMUNITIES WERE ASSISTED BY TWO ATHLETIC TRAINERS THROUGH FRHS FINANCIAL PARTICIPATION THAT EQUALED OVER 4,000 HOURS. 180 HOURS WERE DONATED FOR A FRIDAY NIGHT YOUTH PROGRAM AT THE CROSSPOINT BIKER CHURCH. A TEAM MEMBER WAS A GUEST SPEAKER AT THE CAREER CENTER, CONNERSVILLE HIGH SCHOOL, FOR CAREER/ VOCATIONAL DAY AND AT BALL STATE. MANY LOCAL YOUTH GROUPS AND INDIVIDUAL CHILDREN WERE ASSISTED BY FRHS STAFF THROUGH ACTIVITIES SUCH AS 4H FAIR, BOYS AND GIRLS CLUB, AND BIG BROTHERS/BIG SISTERS. BOY SCOUTS AND GIRL SCOUTS WERE ALSO SUPPORTED. SEVERAL SPORTS PHYSICALS FOR LOCAL HIGH SCHOOL AND ELEMENTARY YOUTH WERE SPONSORED AND STAFFED BY FRHS TEAM MEMBERS, ENABLING THEM TO PARTICIPATE IN SCHOOL SPORTS PROGRAMS AND WERE COMPLETED BY FRHS PHYSICIANS. AS WELL, TEAM MEMBER PROVIDED BLOOD PRESSURE CHECKS AT COMMUNITY BASKETBALL GAMES. PROM AND AFTER PROM WERE SPONSORED BY FRHS DONATIONS. ST GABRIEL'S AMERICAN HERITAGE GIRLS (WHICH IS SIMILAR TO GIRL SCOUTS) WAS SUPPORTED BY A STAFF MEMBER BY VOLUNTEERING AS A GROUP LEADER. ADDITIONALLY, OVER 50 HOURS WERE DONATED TO SUPPORT OTHER SCHOOL AND CHURCH EVENTS AT ST GABRIEL'S SCHOOL. JUNIOR ACHIEVEMENT BANQUET WAS SUPPORTED BY FRHS. FRHS PURCHASED THE SCORE BOARD FOR THE BABE RUTH LEAGUE BALLPARK FOR LOCAL BASEBALL LEAGUES FOR AREA YOUTH. STAFF MEMBER DONATED TIME ON THE ADVISORY BOARD FOR THE WHITE WATER TECH CAREER CENTER AND VOLUNTEERED AT THE LINK FUNDRAISER. OVER 100 HOURS WERE ALSO DONATED BY FRHS STAFF FOR AN AFTER SCHOOL PROGRAM THROUGH THE LINK PROGRAM. HEALTH CARE PROFESSIONALS SPOKE AT LOCAL CLASSES, AND PARTICIPATED IN FUNDRAISING FOR SCHOLARSHIPS. FOOD, CLOTHING, AND SHELTER PROVISIONS ARE PROVIDED IN COOPERATION WITH COMMUNITY CHURCHES, MISSIONS, SORORITY ACTIVITIES, AND SCHOOL CORPORATION PROJECTS. FRHS STAFF DONATED TIME TO THE LOCAL HOPE PREGNANCY CARE CENTER FOR PROGRAMS AND PROJECTS TO HELP MEET THE NEEDS OF THIS POPULATION. A BABY FORMULA PROGRAM THROUGH THE HOPE PREGNANCY CENTER IS AVAILABLE FOR TEEN MOTHERS FOR THEIR BABY'S NUTRITIONAL NEEDS. DONATIONS WERE OFFERED TO THE CONNERSVILLE HIGH SCHOOL ATHLETICS AND BAND PROGRAMS INCLUDING THE CROSS COUNTRY TEAM. | ||
| PART VI, LINE 5: **CONTINUE OF ADOLESCENT POPULATION** 48 HOURS WERE DONATED BY A STAFF MEMBER FOR THE JUNIOR SHOOTING SPORTS WITH THE AMERICAN LEGION. THIS STAFF MEMBER IS ALSO FINANCE OFFICER FOR THE 10TH DISTRICT IN INDIANA. ANOTHER STAFF MEMBER TEACHES GUN SAFETY AT A LOCAL FIRING RANGE. FRHS STAFF ASSISTED WITH TICKET SALES FOR THE FRANKLIN COUNTY SPRING PLAY. THERE CONTINUED TO BE STRONG PARTICIPATION IN THE FAYETTE CO. 4H FAIR BY PURCHASING LIVESTOCK FROM TEAM MEMBERS CHILDREN THAT PARTICIPATE IN THESE PROGRAMS AS WELL AS SPONSORSHIP IN FRANKLIN COUNTY 4H FAIR ACTIVITIES.**CHILDHOOD ISSUES: CHRISTMAS GIVING TO THE DIVISION OF FAMILY AND CHILDREN INITIATIVE WHERE DEPARTMENTS SPONSOR NEEDY CHILDREN AT THE HOLIDAY WITH SHOES, CLOTHING, BOOKS AND TOYS WAS AGAIN SUPPORTED BY FRHS DEPARTMENT STAFF. THE DEPARTMENTS SUPPORT CHILDREN ACTIVITIES SUCH AS CHURCH HOLIDAY PROGRAMS, THE 4H FAIR, GIRL SCOUTS, BOY SCOUTS AND CUB SCOUTS. FRHS STAFF MEMBER HANDED OUT BACKPACKS WITH SCHOOL SUPPLIES AT THE PARK ROAD CHRISTIAN CENTER. 88 HOURS WERE DONATED TO THE SAMARITAN'S PURSE OPERATION CHRISTMAS CHILD THROUGH WORK AS A CHURCH AND COMMUNITY RELATIONS VOLUNTEER AS WELL AS PACKING BOXES. EVERTON ELEMENTARY SCHOOL OFFERED SEVERAL VOLUNTEER OPPORTUNITIES FOR STAFF TO HELP READ WITH STUDENTS AND OTHER SCHOOL EVENTS. TEAM MEMBERS VOLUNTEERED HOURS FOR A VARIETY OF DIVISION FOR FAMILY AND CHILDREN ACTIVITIES INCLUDING A GIFT DRIVE AT CHRISTMAS, A COAT DRIVE, A BOOK DRIVE AND A FOOD DRIVE TO BENEFIT FAMILIES IN OUR AREA. ENJOYMENT COMBINED WITH CHARITY IN THE COMMUNITY PROGRAMS THAT INCLUDE THE BIKE RODEO SAFETY EVENT AND THE THOMAS THE TRAIN ACTIVITY WHICH BENEFITED THE HOUSE OF RUTH SHELTER LOCALLY. A DONATION TO THE UNITED YOUTH PROJECT WAS OFFERED. **INCREASING HEALTHCARE-RELATED ISSUES AWARENESS AND EDUCATION: SPEAKING ENGAGEMENTS WERE DONATED BY STAFF ON A VARIETY OF HEALTH ISSUES AT LOCAL SCHOOL, EVENTS AND COMMUNITY GROUPS. FRHS HAS COORDINATED LIVING THROUGH GRIEF AND LIVING THROUGH CANCER GROUPS FOR TEN YEARS TO COUNSEL AND SUPPORT FAMILIES THROUGH DIFFICULT FAMILY SITUATIONS. SMOKING CESSATION PROGRAM IS AVAILABLE THROUGH THE FRHS HEALTH WORKS DEPARTMENT. FRHS HOME HEALTH OFFERS BLOOD PRESSURE AND BLOOD GLUCOSE CLINICS AT VARIOUS SITES IN FRANKLIN, FAYETTE AND UNION COUNTY. A TEAM MEMBER IS ON THE LOCAL PROLIFE COMMITTEE AND STAFF HAVE PARTICIPATED IN THE LIFE CHAIN EVENT IN THE COMMUNITY. NUTRITIONAL PROGRAMS AT THE FAYETTE COUNTY COURTHOUSE, IVY TECH, AND SEVERAL OTHER COMMUNITY CENTERS WERE PRESENTED IN THE PAST YEAR. ALSO, STAFF PREPARED A PROGRAM FOR THE DIABETES SUPPORT GROUP. 60 CASES OF WATER WERE DONATED TO THE COMMUNITY FOOD BANK FROM THE FRHS DIETARY DEPT. A STAFF MEMBER DONATED OVER 100 HOURS WORKING AT THE LORD'S KITCHEN BY SHOPPING, COOKING, SERVING AND CLEANING UP AT THIS LOCAL SOUP KITCHEN FOR THE NEEDY. ANOTHER STAFF MEMBER DONATED OVER 200 HOURS WITH THE COMMUNITY SHARING PROGRAM HANDING OUT FOOD AT THE FAYETTE COUNTY ANNEX BUILDING. CPR AND FIRST AID ARE TAUGHT BY AN FRHS VOLUNTEER AT NURSING HOMES AND A LOCAL BUSINESS. TEAM MEMBER WAS THE OUTPATIENT CLINICAL INSTRUCTOR FOR THE DPT STUDENTS. FRHS STAFF HAVE PARTICIPATED AND CONTRIBUTED TO THE WALK FOR ALZHEIMER'S, WALK FOR AUTISM, WALK A MILE IN HER SHOES (DOMESTIC VIOLENCE AWARENESS) AND THE HOME RUN 5K RUN FOR THE HIGH SCHOOL.**OTHER AREAS OF PARTICIPATION BEYOND THE PREVIOUSLY STATED GOALS INCLUDE: THE FRHS FOUNDATION IS A CAUSE THAT FRHS STAFF SUPPORTS ANNUALLY THROUGH A VARIETY OF FUNCTIONS SUCH AS THE GOLF OUTING. OVER 80 HOURS WERE DONATED BY STAFF. ALSO, TEAM MEMBERS VOLUNTEERED 143 HOURS FOR PREPARATION FOR THE FOUNDATION BOOTS AND BLING FUNDRAISER. OVER 1000 HOURS WERE DONATED BY FRHS THROUGH PARTICIPATION IN LOCAL MINISTRIES INCLUDING VBS, CHURCH ACTIVITIES, FOOD DRIVES AND PANTRIES, AND CHRISTMAS PROGRAMS FOR THE NEEDY INDIVIDUALS IN OUR COMMUNITIES. TWIN CITY MISSION IS A PROGRAM THAT ASSISTS WITH REPAIRING HOMES. A TEAM MEMBER DONATED 65 HOURS FOR THIS MISSION. MANY STAFF MEMBERS VOLUNTEERED TIME AND SERVICES FOR A LOCAL FUNDRAISER FOR THE SON OF A TEAM MEMBER, TO ASSIST HIS FAMILY WITH EXPENSES DURING HIS ILLNESS TEAM MEMBER IS THE CHAPLAIN AND TREASURER FOR THE LADIES AUXILIARY AT THE EAGLES CLUB, VOLUNTEERING FOR MEETINGS, ORGANIZING EVENTS AND PARTICIPATING IN COMMUNITY EVENTS WITH THE EAGLES. OVER $14,000 WAS DONATED FOR MINISTERIAL SERVICES FOR FRHS PATIENTS AND FAMILIES. FRHS DONATED SERVICES AND TESTING FOR FUNDRAISERS AT VARIOUS COMMUNITY CHARITY EVENTS. CONTRIBUTED FINANCIALLY TO THE CONNERSVILLE AND FRANKLIN COUNTY CHAMBER OF COMMERCE, KIWANIS, JAYCEES, OPTIMIST CLUB, CONNERSVILLE FOP, BICENTENNIAL COMMITTEE, AND VONDA BISHOP MINISTRIES CHARITY. DONATION TO THE CAMBRIDGE CITY FIRE DEPT FOR THE WESTERN WAYNE FIREMAN 5K RUN. ADDITIONALLY, A STAFF MEMBER CONTRIBUTED 174 HOURS AS A VOLUNTEER FIREMAN IN EVERTON. BLOOD WAS DONATED BY STAFF MEMBERS FOR THE BLOOD DRIVE SPONSORED BY FRHS. CONNERSVILLE IS CELEBRATING ITS BICENTENNIAL IN 2013. A STAFF MEMBER IS ON THAT COMMITTEE TO PLAN THIS EVENT. A FINANCIAL DONATION IS ALSO INCLUDED IN THE FRHS SUPPORT OF THIS UPCOMING COMMUNITY CELEBRATION. WE CONTINUE TO SEARCH FOR NEW AVENUES TO INCREASE THE AWARENESS AND HEALTH STATUS OF THE CITIZENS OF OUR MULTI COUNTY AREA. | ||
| PART VI, LINE 6: NOT APPLICABLE. ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. | ||
| IN | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 0 | RecordsMaintained |
Recipient Table RecipientTable (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | Amount Of Cash GrantAmountOfCashGrant | Amount Of Non Cash AssistanceAmountOfNonCashAssistance | Method Of ValuationMethodOfValuation | Description Of Non Cash AssistanceDescriptionOfNonCashAssistance | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|---|---|
| FRANKLIN COUNTY HIGH SCHOOL | |||||||||
| 1941 VIRGINIA AVE | CONNERSVILLE | IN | 47331 | 350900741 | 35526 | 6980 | COST | FOOD AND SUPPLIES | CONTRIBUTIONS FOR DONATED FOOD AND SUPPLIES AT COST FOR FOOTBALL FUNDRAISING EVENTS, SPONSORSHIP DONATIONS, AND PAY SALARY & BENEFITS FOR ATHLETIC DIRECTOR. |
| CONNERSVILLE HIGH SCHOOL | |||||||||
| 1941 VIRGINIA AVE | CONNERSVILLE | IN | 47331 | 350900741 | 40997 | 2645 | COST | FOOD AND SUPPLIES | CONTRIBUTIONS FOR DONATED FOOD AND SUPPLIES AT COST FOR FOOTBALL, MARCHING BAND AND AFTER-PROM EVENTS, SPONSORSHIP DONATIONS, AND PAY SALARY & BENEFITS FOR ATHLETIC DIRECTOR. |
| FAYETTE COUNTY MINISTERIAL ASSOCIATION | |||||||||
| 1941 VIRGINIA AVE | CONNERSVILLE | IN | 47331 | 350900741 | 14300 | CONTRIBUTIONS TO PAY SALARY & BENEFITS FOR REVEREND. | |||
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | NURSING SCHOLARSHIPS | TypeOfGrant |
| Number Of Recipients | 3 | NumberOfRecipients |
| Amount Of Cash Grant | 3000 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: ASSISTANCE IS PROVIDED TO PUBLIC CHARITIES FOR GENERAL SUPPORT. THE ORGANIZATION DOES NOT MONITOR THE USE OF THESE FUNDS BY THESE PUBLIC CHARITIES. IN ADDITION THE ORGANIZATION MAKES SCHOLARSHIPS AND STUDENT LOANS AVAILABLE TO ELIGIBLE PERSONS TO FURTHER HEALTHCARE IN THE COMMUNITY. THE ORGANIZATION DOES MONITOR THE USE OF THE SCHOLARSHIPS AND STUDENTS LOANS. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Written Policy Re T And E Expenses | 0 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| 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 | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (10 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR STEVEN JOHNSON | |||||||||||||
| 296520 | 0 | 0 | 0 | 3000 | 0 | 10350 | 0 | 7728 | 0 | 317598 | 0 | 0 | 0 |
| DR PETRONIO ILAGAN | |||||||||||||
| 262330 | 0 | 0 | 0 | 9000 | 0 | 10113 | 0 | 5702 | 0 | 287145 | 0 | 0 | 0 |
| JAG PATEL MD | |||||||||||||
| 270773 | 0 | 0 | 0 | 6000 | 0 | 10150 | 0 | 4736 | 0 | 291659 | 0 | 0 | 0 |
| RANDALL WHITE | |||||||||||||
| 245113 | 0 | 0 | 0 | 0 | 0 | 9994 | 0 | 12552 | 0 | 267659 | 0 | 0 | 0 |
| BETH WAMPLER | |||||||||||||
| 149670 | 0 | 0 | 0 | 0 | 0 | 6482 | 0 | 12234 | 0 | 168386 | 0 | 0 | 0 |
| STEPHEN CASTLEMAN | |||||||||||||
| 375209 | 0 | 0 | 0 | 0 | 0 | 11202 | 0 | 11691 | 0 | 398102 | 0 | 0 | 0 |
| MICHAEL ROWE | |||||||||||||
| 368388 | 0 | 0 | 0 | 0 | 0 | 10331 | 0 | 5951 | 0 | 384670 | 0 | 0 | 0 |
| JOHN LANDRY | |||||||||||||
| 297647 | 0 | 0 | 0 | 0 | 0 | 10440 | 0 | 7143 | 0 | 315230 | 0 | 0 | 0 |
| HATEM M DAJANI | |||||||||||||
| 288177 | 0 | 0 | 0 | 0 | 0 | 6562 | 0 | 2388 | 0 | 297127 | 0 | 0 | 0 |
| KENNETH PAHREN | |||||||||||||
| 224383 | 0 | 0 | 0 | 0 | 0 | 8252 | 0 | 3562 | 0 | 236197 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 1A | TAX INDEMNIFICATION AND GROSS-UP PAYMENTS WERE MADE DURING THE YEAR AND WERE APPROVED BY THE BOARD. |
| PART I, LINE 7 | PERFORMANCE INCENTIVE PAY IS A GOAL-BASED NON-FIXED PAYMENT THAT IS DIRECTLY TIED TO THE PERFORMANCE OF THE INDIVIDUAL IN ACHIEVING PERSONAL AND ORGANIZATIONAL GOALS. THE PROGRAM IS GOVERNED BY THE BOARD OF TRUSTEES AND DELEGATED TO THE EXECUTIVE COMMITTEE OF THE BOARD TO BE REVIEWED AND APPROVED. PAYOUTS ARE BASED ON EACH INDIVIDUAL'S PERFORMANCE AGAINST PRE-DEFINED GOALS AND OBJECTIVES ALIGNED WITH THE OVERALL MISSION, VISION, AND STRATEGIC GOALS OF THE ORGANIZATION AND THE PROFITABILITY OF FRHS FOR THE FISCAL YEAR. IF THE HOSPITAL MEETS OR EXCEEDS BUDGET WITH RESPECT TO EXCESS REVENUE OVER EXPENSES EXCLUDING ANY INTEREST INCOME, EACH EMPLOYEE WILL RECEIVE ON WEEK'S PAY BASED UPON AN AVERAGE NUMBER OF REGULAR SCHEDULED HOURS WORKED PER WEEK. THE BOARD HAS THE AUTHORITY TO APPROVE PAYMENTS AT ITS DISCRETION WITH REGARDS TO COURAGEOUS ACTIONS BY EMPLOYEES AT ANYTIME IN ACCORDANCE WITH THE ORGANIZATION'S WHISTLE BLOWER POLICY. |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | DR JAG PATEL | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | BOARD MEMBER AND EMPLOYEE | Relationship |
| Amount Of Transaction | 30000 | AmountOfTransaction |
| Description Of Transaction | DR. PATEL OWNS A BUILDING WHICH HE RENTS TO THE HOSPITAL FOR PHYSICIAN OFFICES. | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE PROCESS OF REVIEWING THE FORM 990 ENTAILS A DETAILED REVIEW OF THE FORM 990 BY THE ORGANIZATION'S CFO AND CONTROLLER. THE GOVERNING BODY REVIEWS AND APPROVES THE FORM 990 INCLUDING REQUESTED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, AND ARE PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY PRIOR TO FILING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | ANNUAL INFORMATION ABOUT THE CONFLICT OF INTEREST AND DISCLOSURE ARE PROVIDED TO MEMBERS OF THE BOARD OF TRUSTEES, CHIEF EXECUTIVE OFFICER, ADMINISTRATIVE STAFF, ALL DEPARTMENT MANAGERS, INDIVIDUALS WITH INFLUENCE OVER PURCHASING, AND INDIVIDUALS WITH CONTRACTS TO FAYETTE REGIONAL HOSPITAL SYSTEM. ANNUAL QUESTIONNAIRES ARE TO BE COMPLETED BY EACH MEMBER OF THE BOARD OF TRUSTEES AND THE EXECUTIVE TEAM, THEN REVIEWED AND NOTED IN THE BOARD MINUTES. IN ADDITION, ANY INDIVIDUAL ASSOCIATED WITH FAYETTE REGIONAL HEALTH SYSTEM IS TO DECLARE SITUATIONS OF ACTUAL OR POTENTIAL CONFLICTS OF INTEREST AS THEY ARISE, IN WRITING, AND IN SUFFICIENT DETAIL. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE PROCESS FOR DETERMINING COMPENSATION FOR THE CEO IS GOVERNED BY THE BOARD OF TRUSTEES AND DELEGATED TO THE EXECUTIVE COMMITTEE OF THE BOARD TO REVIEW AND APPROVE ANNUALLY. IN ADDITION, ALL EMPLOYMENT CONTRACTS AND AMENDMENTS FOR THE CEO WILL BE REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD AND CO-SIGNED BY THE CHAIR OF THE BOARD OF TRUSTEES AND THE SECRETARY OF THE BOARD. THE PROCESS FOR DETERMINING COMPENSATION FOR OTHER OFFICERS/KEY EMPLOYEES IS REVIEWED ANNUALLY BY THE EXECUTIVE COMMITTEE AND CEO. THE SECRETARY OF THE BOARD OF TRUSTEES IS RESPONSIBLE FOR RECORDING IN THE MINUTES THE DELIBERATION AND DECISIONS. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED GAINS ON INVESTMENTS: 1,606,090. CHANGE IN TEMPORARILY RESTRICTED NET ASSETS 554,571. TOTAL TO FORM 990, PART XI, LINE 5: 2,160,661. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| PART XI, LINE 2C | THE AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT; AND NO PROCESSES HAVE CHANGED FROM PRIOR YEAR. | OVERSIGHT OF THE AUDIT |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAYETTE MEMORIAL HOSPITAL FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1941 VIRGINIA AVENUE | AddressLine1 |
| City | CONNERSVILLE | City |
| State | IN | State |
| ZIP Code | 47331 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311010071 | EIN |
| Primary Activities | TO BENEFIT FAYETTE REGIONAL HOSPITAL SYSTEM | PrimaryActivities |
| Legal Domicile State | IN | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | LINE 11A, I | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAYETTE REGIONAL HOSPITAL | 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 | 0 | 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 | 1 | 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 | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAYETTE MEMORIAL HOSPITAL FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | P | TransactionType |
| Amount Involved | 141480 | AmountInvolved |
| Method Of Amt Determination | FAIR MARKET VALUE | MethodOfAmtDetermination |