ST JOSEPHS HOSPITAL OF BUCKHANNON INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- ST JOSEPHS HOSPITAL OF BUCKHANNON INC (EIN 55-0356996)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-08-08
- IRS object ID
- 201332209349300453
- 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 D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-08-08T06:28:12-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 550486667 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Arnett Foster Toothman PLLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O Box 2629 | AddressLine1 |
| City | Charleston | City |
| State | WV | State |
| ZIP Code | 25329 | 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 | 550356996 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Joseph's Hospital of Buckhannon Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | STJO | NameControl |
| Phone | 3044732000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 Amalia Drive | AddressLine1 |
| City | Buckhannon | City |
| State | WV | State |
| ZIP Code | 26201 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Sue Johnson-Phillippe | Name |
| Title | President & CEO | Title |
| Phone | 3044732000 | Phone |
| Date Signed | 2013-08-01 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Dale Carpenter | Name |
| PTIN | P00189642 | PTIN |
| Phone | 3043460441 | 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 | Sue Johnson-Phillippe | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 Amalia Drive | AddressLine1 |
| City | Buckhannon | City |
| State | WV | State |
| ZIP Code | 26201 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 46550314 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Group Exemption Number | 0928 | GroupExemptionNumber |
| Organization501c3 | X | Organization501c3 |
| Web Site | http://www.stj.net/ | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1989 | YearFormation |
| State Legal Domicile | WV | StateLegalDomicile |
| Activity Or Mission Description | We are inspired by the love of Christ to provide our community with quality health care in ways that respect the God-given dignity of each person and the sacredness of human life. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 517 | TotalNbrEmployees |
| Total Nbr Volunteers | 46 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 207160 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 78938 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 44950431 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 45780822 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 445640 | InvestmentIncomePriorYear |
| Investment Income Current Year | 400576 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 256611 | OtherRevenuePriorYear |
| Other Revenue Current Year | 282402 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 45859842 | TotalRevenuePriorYear |
| Total Revenue Current Year | 46542738 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 4949 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 3044 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 24438958 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 24786332 | 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 | 21113920 | OtherExpensePriorYear |
| Other Expenses Current Year | 22413244 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 45557827 | TotalExpensesPriorYear |
| Total Expenses Current Year | 47202620 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 302015 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -659882 | RevenuesLessExpensesCY |
| Total Assets BOY | 29883959 | TotalAssetsBOY |
| Total Assets EOY | 31151609 | TotalAssetsEOY |
| Total Liabilities BOY | 32510999 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 35330359 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -2627040 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -4178750 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | We are inspired by the love of Christ to provide our community with quality health care in ways that respect the God-given dignity of each person and the sacredness of human life. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 38672830 | Expense |
| Grants | 3044 | Grants |
| Revenue | 45780822 | Revenue |
| Description | The Hospital provides impartial access to treatment or accomodation for care that is available or medically indicated regardless of race, creed, sex, national origin or source of payment. In order to enable our patients to lead healthy, productive lives, the hospital strives to supply a comprehensive range of acute inpatient, long-term and outpatient care, outreach clinics, home care and emergency room services including prevention, guidance, diagnosis, treatment, restoration, rehabilitation, and other efforts as may be required, to meet the health care needs of the community as the hospital resources will permit. Although payment for services rendered is essential to the operation and stabillity of the hospital, it is recognized that not all individuals possess the financial means to purchase essential medical services. Our mission is to serve the community with respect to providing health care services and health care education. In keeping with this commitment, the hospital will serve all members of its community regardless of means or source of payment. Ths hospital also operates physician clinics and durable medical equipment services centers. | Description |
| Total Program Service Expense | 38672830 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | 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 | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 1 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 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 | 28 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 517 | NumberOfEmployees |
| Employment Tax Returns Filed | 0 | 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 | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | 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 | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Renee Hofer | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3044732185 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 Amalia Drive | AddressLine1 |
| City | Buckhannon | City |
| State | WV | State |
| ZIP Code | 26201 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| Sue Johnson-Phillippe | ||||||||
| President & CEO | 40.00 | X | X | 0 | 251006 | 0 | ||
| Sr Diane Bushee | ||||||||
| Member | 1.00 | X | 0 | 0 | 0 | |||
| Sr Marian Creamer | ||||||||
| Member | 1.00 | X | 0 | 0 | 0 | |||
| Steve Foster | ||||||||
| Treasurer | 1.00 | X | 0 | 0 | 0 | |||
| Sr Mary Grace Barile | ||||||||
| Member | 1.00 | X | 0 | 0 | 0 | |||
| Sr Francesca Lowis | ||||||||
| Vice-Chair/Secretary | 1.00 | X | 0 | 0 | 0 | |||
| Michael G Sellards | ||||||||
| President & CEO - SMMC/PHS | 40.00 | X | X | 0 | 840980 | 39713 | ||
| Terry Cronin | ||||||||
| Chair | 1.00 | X | 0 | 0 | 0 | |||
| Bob Skinner | ||||||||
| Member | 1.00 | X | 0 | 0 | 0 | |||
| Robert Blake MD | ||||||||
| Member | 1.00 | X | 3000 | 0 | 0 | |||
| Joseph Reed MD | ||||||||
| Member | 1.00 | X | 27943 | 0 | 0 | |||
| Dennis Xander | ||||||||
| Member | 1.00 | X | 0 | 0 | 0 | |||
| Sr Gail Borgmeyer | ||||||||
| Member | 1.00 | X | 0 | 0 | 0 | |||
| Renee Hofer | ||||||||
| Senior VP, Fiscal Services | 40.00 | X | 106800 | 0 | 8327 | |||
| John Rollins | ||||||||
| Chief of Staff | 40.00 | 278873 | 0 | 26778 | X | |||
| Susan Long | ||||||||
| General Surgeon | 40.00 | 603323 | 0 | 26778 | X | |||
| James Kim | ||||||||
| Orthopedic Surgeon | 40.00 | 494998 | 0 | 16713 | X | |||
| Yaser Kalash | ||||||||
| Cardiologist | 40.00 | 483960 | 0 | 26778 | X | |||
| Salvatore Lanasa | ||||||||
| General Surgeon | 40.00 | 481409 | 0 | 26778 | X | |||
| Kimberly Farry | ||||||||
| Physician | 40.00 | 299998 | 0 | 541 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2780304 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1091986 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 172406 | TotalOtherCompensation |
| Number Individuals GT100 K | 23 | 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 |
|---|---|---|---|---|---|
| WVU Medical Corporation | |||||
| PO Box 740 | Morgantown | WV | 26507 | ER Physician Coverage | 932250 |
| Employee Benefit Service | |||||
| PO Box 890144 | Charlotte | NC | 28289 | Third Party Administrator | 762958 |
| Nelson Mullins Riley & Scarborough LLP | |||||
| 949 3rd Ave Ste 200 | Huntington | WV | 25701 | Legal Services | 326377 |
| The Tomayko Group | |||||
| 2403 Sidney St | Pittsburgh | PA | 15203 | Nuclear Medicine Services | 296613 |
| Alliance Imaging | |||||
| PO Box 96485 | Chicago | IL | 60693 | MRI Services | 263400 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 19 | NumberOfContractorsGT100K |
| Related Organizations | 62804 | RelatedOrganizations |
| All Other Contributions | 16134 | AllOtherContributions |
| Total Contributions | 78938 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Patient service revenu | 622110 | 44516910 | 44516910 |
| Medicare incentive pay | 622110 | 1263912 | 1263912 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 45780822 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 399807 | TotalRevenueColumn |
| Exclusion | $399,807 | ExclusionAmount |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 262 | TotalRevenueColumn |
| Exclusion | $262 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 63097 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 7576 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 55521 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 55521 | TotalRevenueColumn |
| Exclusion | $55,521 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 769 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 769 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 769 | TotalRevenueColumn |
| Exclusion | $769 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Cafeteria and vending | Description |
| Business Code | 722212 | BusinessCode |
| Total Revenue Column | 223601 | TotalRevenueColumn |
| Exclusion | $223,601 | ExclusionAmount |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3018 | TotalRevenueColumn |
| Exclusion | $3,018 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 226619 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 46542738 | TotalRevenueColumn |
| Related Or Exempt Function Income | 45780822 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $682,978 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3044 | Total |
| Program Services | 3044 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 434488 | Total |
| Program Services | 352761 | ProgramServices |
| Management And General | 81727 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18778608 | Total |
| Program Services | 15246352 | ProgramServices |
| Management And General | 3532256 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 742063 | Total |
| Program Services | 602481 | ProgramServices |
| Management And General | 139582 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3590005 | Total |
| Program Services | 2914725 | ProgramServices |
| Management And General | 675280 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1241168 | Total |
| Program Services | 1007704 | ProgramServices |
| Management And General | 233464 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 442242 | Total |
| Management And General | 442242 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 372320 | Total |
| Management And General | 372320 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42494 | Total |
| Management And General | 42494 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22179 | Total |
| Management And General | 22179 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2793721 | Total |
| Program Services | 2268222 | ProgramServices |
| Management And General | 525499 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 244901 | Total |
| Management And General | 244901 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3627806 | Total |
| Program Services | 2945416 | ProgramServices |
| Management And General | 682390 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 453893 | Total |
| Program Services | 368516 | ProgramServices |
| Management And General | 85377 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 807898 | Total |
| Program Services | 655932 | ProgramServices |
| Management And General | 151966 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47644 | Total |
| Program Services | 38682 | ProgramServices |
| Management And General | 8962 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 266602 | Total |
| Program Services | 216454 | ProgramServices |
| Management And General | 50148 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1533314 | Total |
| Program Services | 1244897 | ProgramServices |
| Management And General | 288417 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 759911 | Total |
| Program Services | 616972 | ProgramServices |
| Management And General | 142939 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Bad debt | 6703385 | 6703385 | 0 |
| Medical supplies | 1692182 | 1373883 | 318299 |
| Provider tax | 895613 | 727148 | 168465 |
| Dues and subscriptions | 161419 | 131056 | 30363 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1545720 | Total |
| Program Services | 1255200 | ProgramServices |
| Management And General | 290520 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47202620 | Total |
| Program Services | 38672830 | ProgramServices |
| Management And General | 8529790 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 779116 | BOY |
| EOY | 967360 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1704565 | BOY |
| EOY | 1597396 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5798257 | BOY |
| EOY | 6381569 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 42158 | BOY |
| EOY | 24247 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 843190 | BOY |
| EOY | 915298 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 563561 | BOY |
| EOY | 1009940 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 39375526 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 23559677 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16165434 | BOY |
| EOY | 15815849 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3475731 | BOY |
| EOY | 3899535 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 472350 | BOY |
| EOY | 472350 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 39597 | BOY |
| EOY | 68065 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29883959 | BOY |
| EOY | 31151609 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9086105 | BOY |
| EOY | 10353589 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16858 | BOY |
| EOY | 22644 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 213850 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2419704 | BOY |
| EOY | 2059275 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20988332 | BOY |
| EOY | 22681001 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32510999 | BOY |
| EOY | 35330359 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -2696606 | BOY |
| EOY | -4254435 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 44566 | BOY |
| EOY | 50685 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25000 | BOY |
| EOY | 25000 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -2627040 | BOY |
| EOY | -4178750 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29883959 | BOY |
| EOY | 31151609 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -659882 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -891828 | 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 D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 468833 | OtherCostOrOtherBasis |
| Book Value | 468833 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 385317 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 24687793 | OtherCostOrOtherBasis |
| Depreciation | 14177462 | Depreciation |
| Book Value | 10895648 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 12584357 | OtherCostOrOtherBasis |
| Depreciation | 8513408 | Depreciation |
| Book Value | 4070949 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1249226 | OtherCostOrOtherBasis |
| Depreciation | 868807 | Depreciation |
| Book Value | 380419 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 15815849 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (7 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Accrued pension costs | $8,603,676 |
| Notes payable - related parties | $2,508,226 |
| Bonds reported on parent's return | $8,617,571 |
| Lease payable | $854,369 |
| Accrued malpractice liability | $728,713 |
| LT Debt 2003 series | $913,622 |
| Medicare claims liability | $454,824 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 22681001 | TotalOfAmounts |
| Total Revenue | 46542738 | TotalRevenue |
| Total Expenses | 47202620 | TotalExpenses |
| Excess Or Deficit For Year | -659882 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 238618 | NetUnrealizedGLOnInvestments |
| Other | -$1,130,446 | OtherAmount |
| Total Adjustments | -891828 | TotalAdjustments |
| Excess Or Deficit Per FS | -1551710 | ExcessOrDeficitPerFS |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part XI, Line 8 - Other Adjustments: | Identifier |
| Explanation | Change in pension plan funded status -1,130,446. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 125.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 0 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 942009 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 942009 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02320 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7882183 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6568741 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1313442 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03230 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 212667 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 205423 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 7244 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9036859 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6774164 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2262695 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05570 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4165 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3160 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1005 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4165 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3160 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1005 | NetCommunityBenefitExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9041024 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6777324 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2263700 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05570 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 29749 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 29749 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 29749 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 29749 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $2,872,050 | BadDebtExpenseAmount |
| Amount Attributable To | 554306 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 6530389 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 6595855 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -65466 | 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 | St Joseph's Hosptial of Buckhannon | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 Amalia Drive | AddressLine1 |
| City | Buckhannon | City |
| State | WV | State |
| ZIP Code | 26201 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | Skilled Nursing Facility, Outpatient Physician Clinic | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Joseph's Hospital of Buckhannon Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 125.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lawsuit | X | PermitLawsuit |
| Permit Lien On Residence | X | PermitLienOnResidence |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 5 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (5 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| St Joseph's Hospital | ||||
| 1 Amalia Drive | Buckhannon | WV | 26201 | Skilled nursing facility |
| St Joseph's Hospital | ||||
| 1 Amalia Drive | Buckhannon | WV | 26201 | Physician Clinics |
| St Joseph's Hospital | ||||
| 1 Amalia Drive | Buckhannon | WV | 26201 | DME Services |
| St Joseph's Hospital | ||||
| 1 Amalia Drive | Buckhannon | WV | 26201 | Home Health |
| St Joseph's Hospital | ||||
| 1 Amalia Drive | Buckhannon | WV | 26201 | Hospice |
Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| Part I, Line 3c: Uncompensated Care Procedure: 1) Anyone applying for uncompensated care will be required to fill out an Uncompensated Care Application. This can be done in the following manner: a) The admissions clerk can take the application at the time of the admission. b) The Credit/Collection department can take the application when doing financial assessment. c) The application can be taken any time during the billing cycle. d) The application can be mailed to the patient. 2) Anyone applying for uncompensated care will be required to provide the hospital with proof of income. The proof of income can be as listed: a) Tax return from most recent year of filing, check stubs from the last three months or a check stub showing year-to-date earnings. b) A statement of earnings from the employer or source of income. c) Medicaid denial letter or verification through WVDHHR screening website. The associate will insure that Medicaid eligibility is solicited. If appropriate documentation is not attached, application will be denied. d) Listing of all assets, ATV's, Boats, Campers, Property, Stocks, Bonds, CD's etc. The most current months bank statement is required. 3) The Business Office Manager or his/her designee will make all determinations: a) The Monthly income is listed and multiplied by 12. b) The chart is referenced to determine uncompensated eligibility. c) If eligible, this is noted and signed by the associate. d) If not eligible, expense information is analyzed. Non-discretionary expenses are considered necessities of life or job (shelter, food, utilities, car loan, etc.). e) Comparison of expenses to income determines disposable income for payment of a hospital debt. f) Total expenses are then totaled, with the same expense to income comparison. g) Accounts will be required to have asset information verified with the county assessors office. If cash convertible asset information is exactly twice the amount of the patient portion of the St. Joseph's Hospital bill or more, applicant is not eligible for assistance. If substantial hard assets exist, they will be considered.4) A patient will be notified if Uncompensated Care is denied or a percentage is granted. 5) Accounts approved for uncompensated care will be written off using the appropriate forms and codes.6) Medicare accounts that are written off to Uncompensated Care must be listed on the Medicare bad Debt Compliance Checklist. Medicare accounts will be required to have asset information verified with the county assessors office.7) Determination for Uncompensated Care will be based on annual income guidelines (see attachment). Determination will be made at the end of each month.8) St. Joseph's Hospital will make medically necessary services available on an inpatient or outpatient basis to individuals who cannot afford to pay for such services.9) Accounts that have been referred to a collection agency will not be eligible for consideration. | |
| Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 6515539. | |
| Part II: The recruitment of physicians to this community is vital for the health of the community. | |
| Part III, Line 4: Patient accounts receivable: Patient accounts receivable are carried at the net realizable value less an estimate for doubtful or uncollectible accounts. The allowance is based upon a review of the outstanding balances, aged by financial class. Management uses collection percentages, based upon historical collection experience, to determine collectibility. Management also reviews troubled, aged accounts to determine collection potential. Patient accounts receivable are written off when deemed uncollectible. Recoveries of accounts previously written off are recorded as a reduction to bad debt expense when received. Interest is not charged on patient accounts receivable.Upshur County WV is the primary service area for St. Joseph's Hospital. The 2010 census showed that 19.3% of the population in Upshur county to be below poverty level. Thus, 19.3% of the bad debt cost was used to calculate the estimated amount of the Organization's bad debt expense attributable to patients under the Organization's financial assistance policy.The cost of bad debt expense was determined using the cost to charge ratio. | |
| Part III, Line 9b: Prior to an account going to collections, especially if it is a self-pay patient, the Organization checks Medicaid and charity eligibility. St. Joseph's hospital requires all self-pay patients to talk to a financial counselor to determine qualification for charity care and Medicaid programs. Self-pay patients are required to show proof that they have been denied by Medicaid. After it is determined that self-pay patients do not qualify for assistance, and if they are still unable to pay their bills, they are set up on a payment plan suited to their income level. Only when a self-pay patient falls behind on his/her payments and it is certain he or she does not qualify for assistance are they sent to a collection agency. | |
| Part V, Section B, Line 11h: Debt to income ratio | St. Joseph's Hospital of Buckhannon, Inc |
| Part V, Section B, Line 19d: Patients with no insurance coverage are considered self pay patients. Those patients are automatically given a 15% uninsured discount from gross charges, based on commercial insurance average. | St. Joseph's Hospital of Buckhannon, Inc |
| Part VI, Line 2: St. Joseph's Hospital will contract with an outside company to perform the community wide needs assessment and is in the process of scheduling this assessment. In addition, an outside company performs post admission surveys for all inpatients. This survey includes questions regarding whether the patients needs were met during the stay, and the hospital reviews this HCAHPS data to determine what services may need to be added based on that data. | |
| Part VI, Line 4: St. Joseph's Hospital is located in a small town in a rural, mountainous region of West Virginia. The hospital serves its home county (with a population of approximately 24,254 residents), as well as parts of five surrounding counties. The population served is an aging population with growing health concerns. In St. Joseph's Hospital's home county, 20.0% of the population is below the poverty level and only 14.7% have college degrees. The teen pregnancy rate is 8.9%. | |
| Part VI, Line 5: St. Joseph's hospital promotes the health of the community by maintaining an open medical staff, using community members on its board of directors, providing support of community health activities (blood screenings, health fair, flu shot clinics, etc.). The Hospital has also been actively recruiting both primary care providers and specialists to meet the health care needs of our service area. | |
| Part VI, Line 6: St. Joseph's Hospital of Buckhannon, Inc. is a not-for-profit health care facility wholly sponsored by Pallottine Health Services, Inc. (PHS). Pallottine Health Services is a ministry of the Pallottine Missionary Sisters and includes both St. Joseph Hospital of Buckhannon, West Virginia and St. Mary's Medical Center of Huntington, West Virginia. Both of these hospitals are committed to the core values of compassion, hospitality, reverence, interdependence, stewardship, and trust. PHS files a community benefit report every three years in West Virginia. St. Joseph's Hospital is included in this community benefit report. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| 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 (8 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Sue Johnson-Phillippe | |||||||||||||
| 0 | 232606 | 0 | 10000 | 0 | 8400 | 0 | 0 | 0 | 0 | 0 | 251006 | 0 | 0 |
| Michael G Sellards | |||||||||||||
| 0 | 565000 | 0 | 141250 | 0 | 134730 | 0 | 23850 | 0 | 26560 | 0 | 891390 | 0 | 0 |
| John Rollins | |||||||||||||
| 278873 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 28362 | 0 | 307235 | 0 | 0 | 0 |
| Susan Long | |||||||||||||
| 447103 | 0 | 156220 | 0 | 0 | 0 | 0 | 0 | 27138 | 0 | 630461 | 0 | 0 | 0 |
| James Kim | |||||||||||||
| 494998 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 18428 | 0 | 513426 | 0 | 0 | 0 |
| Yaser Kalash | |||||||||||||
| 452988 | 0 | 0 | 0 | 30972 | 0 | 0 | 0 | 27810 | 0 | 511770 | 0 | 0 | 0 |
| Salvatore Lanasa | |||||||||||||
| 481409 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 27810 | 0 | 509219 | 0 | 0 | 0 |
| Kimberly Farry | |||||||||||||
| 299998 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 579 | 0 | 300577 | 0 | 0 | 0 |
Schedule L IRS990ScheduleL
Loan Table LoanTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Joseph Reed MD | NamePerson |
| Purpose Of Loan | Purchase of a building | PurposeOfLoan |
| Loan To Organization | X | LoanToOrganization |
| Original Principal | $220,500 | OriginalPrincipalAmount |
| Balance Due | 213850 | BalanceDue |
| Default | 0 | Default |
| Approved By Board | 1 | ApprovedByBoard |
| Written Agreement | 1 | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 213850 | TotalBalanceDue |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section A, line 6 | The Organization is a membership (not a stock) corporation under West Virginia State law. The Organization's sole corporate member is Pallottine Health Services, a related not-for-profit organization. | |
| Form 990, Part VI, Section A, line 7a | In accordance with the terms and requirements of its governing documents (i.e. bylaws), on an annual basis, the Organization's current board members recommend the list of candidates for membership to the governing body for the subsequent term to the St. Joseph's Hospital board of directors. The Pallottine Health Services board of directors will approve and elect these candidates to serve as the organization's board of directors. | |
| Form 990, Part VI, Section A, line 7b | Pallottine Health Services, as the sole corporate member, also has the right to approve or ratify significant decisions of the Organization's governing body including the amendment of bylaws and charters, removal of members of the governing body, and the decision to dissolve the organization. | |
| Form 990, Part VI, Section B, line 11 | The Form 990 is reviewed by the organization's management (A team comprised of representatives of the finance and administration departments) in consultation with an accounting firm (Arnett Foster Toothman). The financial review is based on the organization's audited financial statements for the relevant time period. Before the Form 990 is filed with the IRS, the finance committee of the organization's board of directors reviews the Form 990. Relevant portion of the form 990 are transmitted to the board before the return is filed. | |
| Form 990, Part VI, Section B, line 12c | Upon employment and annually thereafter, each key employee and officer of the organization is required to complete a conflict of interest and disclosure form, providing sufficient information about his/her personal interests and relationships so the organization can (1) determine whether any potential or actual conflicts of interest may exist, and (2) monitor work or service assignments to avoid placing the key employee, officer or director in a position where there may be an appearance (potential or actual) of a conflict of interest or a question of objectivity. The completed conflict of interest and disclosure forms for directors are returned to the organization. These members are monitored and not assigned any projects that would create any potential conflict of interest. The determination of conflict of interest would be made at the PHS board level. Any board member with a potential conflict recuses himself or herself from all discussions regarding the conflict. | |
| Form 990, Part VI, Section B, line 15 | Pallottine Health Services (PHS), the organization's single member, regularly provides documentation to PHS's compensation committee with respect to the compensation of the Organization's officers and key employees for review and approval. Such information includes comparable data from similar size tax-exempt organizations in Buckhannon, West Virginia and surrounding communities as well as compensation for these positions (as disclosed on Form 990) with other organizations in the health care industry that are of similar size, demographics, and geography. Review and approval of the compensation arrangement by the officers/executive committee is documented. | |
| Form 990, Part VI, Section C, line 19 | The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request at its office at 1 Amalia Drive, Buckhannon, WV 26201. A nominal fee is charged if copies are requested. | |
| Form 990, Part XI, line 5: | Net unrealized gains on investments: 238,618. Change in pension plan funded status -1,130,446. Total to Form 990, Part XI, Line 5: -891,828. | Changes in Net Assets or Fund Balances: |
| Form 990, Part IV, Question 24A | St. Joseph's Hospital is part of the obligated group for tax-exempt bonds held by Pallottine Health Services. All bonds are reported on the Pallottine Health Services Form 990 for the year ended 9/30/12. | Clarification of 'no' response |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| Pallottine Health Services | ||||||||||
| 2900 First Avenue | Huntington | WV | 25702 | 550688201 | Parent - management | WV | 501(C)(3) | 11a | N/A | 0 |
| Pallottine Missionary Sisters | ||||||||||
| 1 Amalia Drive | Buckhannon | WV | 26201 | 431783315 | Church | MO | 501(C)(3) | 1 | N/A | 0 |
| St Mary's Medical Center | ||||||||||
| 2900 First Avenue | Huntington | WV | 25702 | 550357050 | Hospital | WV | 501(C)(3) | 3 | N/A | 0 |
| St Mary's Medical Center Foundation | ||||||||||
| 2900 First Avenue | Huntington | WV | 25702 | 141887211 | Foundation | WV | 501(C)(3) | 11b | N/A | 0 |
| St Joseph's Foundation of Buckhannon | ||||||||||
| 1 Amalia Drive | Buckhannon | WV | 26201 | 550727650 | Foundation | WV | 501(C)(3) | 11c | N/A | 0 |
Form990 Schedule R Part III Form990ScheduleRPartIII (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Predominant Income TypePredominantIncomeType | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner |
|---|---|---|---|---|---|---|---|---|---|
| St Mary's Occupational Health and Medical Services | |||||||||
| 2900 First Avenue | Huntington | WV | 25702 | 542136110 | Medical Services | WV | N/A | 0 | 0 |
| Tri-State MRI | |||||||||
| 2900 First Avenue | Huntington | WV | 25702 | 550669726 | Medical Services | WV | N/A | 0 | 0 |
| Claire-Frances Health Services | |||||||||
| 200 Mall Road Suite 3 | Ashland | KY | 41101 | 311517507 | Medical Services | WV | N/A | 0 | 0 |
| Huntington Area MRI | |||||||||
| 2900 First Avenue | Huntington | WV | 25702 | 261877332 | Medical Services | WV | N/A | 0 | 0 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Percentage OwnershipPercentageOwnership | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|
| Upshur Medical Management Services | ||||||||||
| 1 Amalia Drive | Buckhannon | WV | 26201 | 550727649 | Inactive | WV | Saint Joseph's Hospital | C | 1.00000 | |
| Vanguard Financial Services | ||||||||||
| 2900 First Avenue | Huntington | WV | 25702 | 450496141 | Collection Agency | WV | C | N/A | ||
| 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 | 1 | 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 | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| St Joseph's Foundation of Buckhannon Inc | ||
| C | 62804 | Internal accounting records |
| St Joseph's Foundation of Buckhannon Inc | ||
| N | 52823 | Internal accounting records |