GEISINGER JERSEY SHORE HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- GEISINGER JERSEY SHORE HOSPITAL (EIN 24-0792115)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-05-15
- IRS object ID
- 201341359349301689
- 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 G
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-05-15T09:15:19-05:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 232932984 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PARENTEBEARD LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1650 MARKET STREET SUITE 4500 | AddressLine1 |
| City | PHILADELPHIA | City |
| State | PA | State |
| ZIP Code | 19103 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 240792115 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JERSEY SHORE HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | JERS | NameControl |
| Phone | 5703980100 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1020 THOMPSON STREET | AddressLine1 |
| City | JERSEY SHORE | City |
| State | PA | State |
| ZIP Code | 17740 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CAREY W PLUMMER | Name |
| Title | PRESIDENT & CEO | Title |
| Phone | 5703980100 | Phone |
| Date Signed | 2013-05-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JULIUS C GREEN CPA JD | Name |
| PTIN | P00350393 | PTIN |
| Phone | 2159720701 | 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 | CAREY W PLUMMER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1020 THOMPSON STREET | AddressLine1 |
| City | JERSEY SHORE | City |
| State | PA | State |
| ZIP Code | 17740 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 30497822 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.JSH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1922 | YearFormation |
| State Legal Domicile | PA | StateLegalDomicile |
| Activity Or Mission Description | PROVIDE INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR RESIDENTS OF JERSEY SHORE AREA. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 352 | TotalNbrEmployees |
| Total Nbr Volunteers | 11 | TotalNbrVolunteers |
| Total Gross UBI | 994442 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 8820 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 130721 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 202636 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 30076603 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 29702490 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -6695 | InvestmentIncomePriorYear |
| Investment Income Current Year | 7186 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 316625 | OtherRevenuePriorYear |
| Other Revenue Current Year | 526999 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 30517254 | TotalRevenuePriorYear |
| Total Revenue Current Year | 30439311 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 2971067 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 12260092 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 14393091 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 207986 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 17463238 | OtherExpensePriorYear |
| Other Expenses Current Year | 16767536 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 29723330 | TotalExpensesPriorYear |
| Total Expenses Current Year | 34131694 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 793924 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -3692383 | RevenuesLessExpensesCY |
| Total Assets BOY | 30259484 | TotalAssetsBOY |
| Total Assets EOY | 26311495 | TotalAssetsEOY |
| Total Liabilities BOY | 20267058 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 22403553 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 9992426 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 3907942 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | JERSEY SHORE HOSPITAL IS A RURAL HEALTHCARE FACILITY COMMITTED TO PROVIDING QUALITY HEALTH SERVICES WITH AN EFFICIENT BALANCE OF OUTPATIENT CARE, ACUTE AND SUB-ACUTE INPATIENT CARE AND OUTREACH SERVICES. THE HOSPITAL MAXIMIZES THE EFFECTIVENESS OF ITS PROGRAM THROUGH INTEGRATION WITH OTHER HEALTHCARE PROVIDERS TO ASSURE THE COMMUNITY ACCESS TO A BROAD ARRAY OF HEALTH CARE SERVICES. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 31294859 | Expense |
| Revenue | 28708521 | Revenue |
| Description | AS A RURAL HEALTHCARE FACILITY AND DEDICATED COMMUNITY HOSPITAL WITH A COMMITMENT TO PROVIDING A HIGH QUALITY CIRCLE OF CARE, JERSEY SHORE HOSPITAL HAS DEVELOPED DELIVERY SYSTEMS THAT PROVIDE AN EFFICIENT BALANCE OF OUTPATIENT CARE, ACUTE AND SUB-ACUTE INPATIENT CARE, PRIMARY CARE, AND OUTREACH SERVICES. THE HOSPITAL MAXIMIZES THE EFFECTIVENESS OF ITS PROGRAMS FOR QUALITY, EFFICIENCY, AND ACCESSIBILITY BY INTEGRATING WITH OTHER PROVIDERS AND ALTERNATIVE CARE ORGANIZATIONS IN THE SERVICE COMMUNITY TO ASSURE THE COMMUNITY ACCESS TO A BROAD ARRAY OF SERVICE OPTIONS.THE HOSPITAL PROVIDES AN ENVIRONMENT OF CARE THAT IS COMPASSIONATE, HIGHLY PERSONALIZED, AND FOCUSED ON THE PHYSICAL, PSYCHO-SOCIAL, AND SPIRITUAL NEEDS OF ITS PATIENTS THROUGH THE USE OF SKILLED NURSES, PHYSICIANS, TECHNICAL AND SUPPORT STAFF, MANAGEMENT, AND COMMUNITY LEADERS. THE HOSPITAL ALSO PROVIDES HEALTH EDUCATION, PROGRAMS IN PREVENTION, AND RELATED SUPPORT SERVICES TO THE COMMUNITY WITH THE GOAL OF IMPROVING THE OVERALL WELLNESS OF ITS RESIDENTS. THE HOSPITAL ENSURES THAT THE NECESSARY RESOURCES ARE AVAILABLE TO PROVIDE FOR COMPREHENSIVE, MANAGED HEALTH PROGRAMS IN THE MOST COST EFFECTIVE MANNER WHILE MAINTAINING A SAFE, PLEASANT, AND MEANINGFUL WORK AND PATIENT CARE ENVIRONMENT.THE HOSPITAL PROVIDES CHARITY CARE TO PATIENTS WHO MEET CERTAIN CRITERIA WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. CHARGES FORGONE FOR SERVICES RENDERED AND SUPPLIES FURNISHED UNDER THE CHARITY CARE POLICY AMOUNTED TO APPROXIMATELY $637,510 DURING THE YEAR ENDED JUNE 30, 2012. | Description |
| Total Program Service Expense | 31294859 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 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 | 0 | 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 | 116 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 352 | 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 | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| 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 | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | PA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAREY W PLUMMER - PRESIDENTCEO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5703983101 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1020 THOMPSON STREET | AddressLine1 |
| City | JERSEY SHORE | City |
| State | PA | State |
| ZIP Code | 17740 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (18 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| CAREY PLUMMER | |||||||
| PRESIDENT & CEO | 39.00 | X | X | 300374 | 0 | 0 | |
| LEROY H KEILER III | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| WILLIAM R CAMERER III | |||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| CARMEN SPINNEY MD | |||||||
| SECRETARY | 1.00 | X | X | 0 | 170211 | 19167 | |
| JAMES REESER | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| RICHARD BEATTY DMD | |||||||
| CHAIRPERSON | 1.00 | X | X | 0 | 0 | 0 | |
| WALTER EISENHAUER | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JAMES ELY | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| SEAN SIMCOX | |||||||
| VICE CHAIRPERSON | 1.00 | X | X | 0 | 0 | 0 | |
| ROB GLUNK | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DOROTHY CHAPPEL PHD | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| LISA STRAWSER DO | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DEAN FLEMING 103111-83112 | |||||||
| CFO | 39.00 | X | 20925 | 0 | 1047 | ||
| AARON KOLB MD | |||||||
| MEDICAL DIRECTOR ER, PHYSICIAN | 40.00 | 286179 | 0 | 28054 | X | ||
| THOMAS BURGE | |||||||
| CRNA | 40.00 | 172639 | 0 | 14077 | X | ||
| RONALD EISTER | |||||||
| ER PHYSICIAN | 40.00 | 242438 | 0 | 26034 | X | ||
| SHAIRKO MISSOURI | |||||||
| DIRECTOR OF ANESTHESIOLOGY | 40.00 | 432128 | 0 | 20008 | X | ||
| CHRISTINE HAAS | |||||||
| CIO | 39.00 | 117982 | 0 | 13026 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1572665 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 170211 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 121413 | TotalOtherCompensation |
| Number Individuals GT100 K | 7 | 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 |
|---|---|---|---|---|---|
| SUSQUEHANNA HEALTH SYSTEM | |||||
| 1205 GRAMPIAN BOULEVARD | WILLIAMSPORT | PA | 17701 | IT SUPPORT/LAB TEST INTERPRETATION | 591729 |
| QUORUM HEALTH SYSTEM | |||||
| 105 CONTINENTAL PLACE | BRENTWOOD | TN | 370275014 | MANAGEMENT FEES | 563473 |
| STAFF CARE | |||||
| PO BOX 281923 | ATLANTA | GA | 303841923 | ER PHYSICIAN LOCUMS | 466575 |
| MEDICAL STAFFING NETWORK CO | |||||
| 2300 VALLEY LANE | IRVING | TX | 75062 | ER PHYSICIAN LOCUMS | 453481 |
| QUEST DIAGNOSTICS | |||||
| 315 BOULEVARD NE STE 240 | ATLANTA | GA | 30312 | LAB SERVICES | 233847 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
| Fundraising Events | 15008 | FundraisingEvents |
| Government Grants | 183333 | GovernmentGrants |
| All Other Contributions | 4295 | AllOtherContributions |
| Total Contributions | 202636 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICE REV | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 29702490 | TotalRevenueColumn |
| Related Or Exempt Function Income | 28708048 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 994442 | UnrelatedBusinessRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 29702490 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4724 | TotalRevenueColumn |
| Exclusion | $4,724 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 36198 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 42040 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -5842 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -5842 | TotalRevenueColumn |
| Exclusion | -$5,842 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 2462 | 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 | 2462 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2462 | TotalRevenueColumn |
| Exclusion | $2,462 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 20337 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 15008 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 16471 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3866 | TotalRevenueColumn |
| Exclusion | $3,866 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| CAFETERIA/VENDING REV | 722210 | 112304 | $112,304 |
| REBATES/REFUNDS | 900099 | 50190 | $50,190 |
| OUTREACH/STAFF DEV REV | 611710 | 2886 | $2,886 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 363595 | TotalRevenueColumn |
| Related Or Exempt Function Income | 473 | RelatedOrExemptFunctionIncome |
| Exclusion | $363,122 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 528975 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 30439311 | TotalRevenueColumn |
| Related Or Exempt Function Income | 28708521 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 994442 | UnrelatedBusinessRevenue |
| Exclusion | $533,712 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2971067 | Total |
| Program Services | 2971067 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 390446 | Total |
| Management And General | 390446 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11227607 | Total |
| Program Services | 9445475 | ProgramServices |
| Management And General | 1692566 | ManagementAndGeneral |
| Fundraising | 89566 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 391721 | Total |
| Program Services | 320665 | ProgramServices |
| Management And General | 68015 | ManagementAndGeneral |
| Fundraising | 3041 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1420775 | Total |
| Program Services | 1228181 | ProgramServices |
| Management And General | 180948 | ManagementAndGeneral |
| Fundraising | 11646 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 962542 | Total |
| Program Services | 787942 | ProgramServices |
| Management And General | 167128 | ManagementAndGeneral |
| Fundraising | 7472 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 330374 | Total |
| Program Services | 330374 | ProgramServices |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 68459 | Total |
| Management And General | 68459 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 61287 | Total |
| Management And General | 61287 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3054 | Total |
| Program Services | 3054 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4893642 | Total |
| Program Services | 4885764 | ProgramServices |
| Fundraising | 7878 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 71408 | Total |
| Program Services | 2027 | ProgramServices |
| Fundraising | 69381 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4356713 | Total |
| Program Services | 4341927 | ProgramServices |
| Fundraising | 14786 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 576301 | Total |
| Program Services | 576301 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 72413 | Total |
| Program Services | 69389 | ProgramServices |
| Fundraising | 3024 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 68537 | Total |
| Program Services | 68015 | ProgramServices |
| Fundraising | 522 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 822877 | Total |
| Program Services | 822877 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2017025 | Total |
| Program Services | 2017025 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 310890 | Total |
| Program Services | 310890 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | FundraisingFundraising |
|---|---|---|---|
| BAD DEBT EXPENSE | 2739988 | 2739988 | |
| EMPLOYEE RECOGNITION | 166631 | 166631 | |
| DUES & BOOKS | 127832 | 127390 | 442 |
| BANK SERVICE FEES | 24732 | 24732 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 55373 | Total |
| Program Services | 55145 | ProgramServices |
| Fundraising | 228 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34131694 | Total |
| Program Services | 31294859 | ProgramServices |
| Management And General | 2628849 | ManagementAndGeneral |
| Fundraising | 207986 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1427 | BOY |
| EOY | 2175 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3340805 | BOY |
| EOY | 1156008 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 94823 | BOY |
| EOY | 70945 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3132916 | BOY |
| EOY | 3798829 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 309635 | BOY |
| EOY | 277097 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 515880 | BOY |
| EOY | 329609 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 37885502 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 20435527 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17198631 | BOY |
| EOY | 17449975 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5665367 | BOY |
| EOY | 3226857 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30259484 | BOY |
| EOY | 26311495 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2691694 | BOY |
| EOY | 3256150 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14656196 | BOY |
| EOY | 14417074 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2919168 | BOY |
| EOY | 4730329 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20267058 | BOY |
| EOY | 22403553 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9469982 | BOY |
| EOY | 3581965 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 522444 | BOY |
| EOY | 325977 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9992426 | BOY |
| EOY | 3907942 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30259484 | BOY |
| EOY | 26311495 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -3692383 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -2392101 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $3,054 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 3054 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | THE HOSPITAL PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE HOSPITAL ASSOCIATION OF PENNSYLVANIA (HAP). A PORTION OF THE DUES PAID TO THESE TWO ORGANIZATIONS ($3,054 DURING THE YEAR ENDED JUNE 30, 2012) WAS USED FOR LOBBYING PURPOSES. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 154956 | OtherCostOrOtherBasis |
| Book Value | 154956 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 17991958 | OtherCostOrOtherBasis |
| Depreciation | 5135874 | Depreciation |
| Book Value | 12856084 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 17322035 | OtherCostOrOtherBasis |
| Depreciation | 15089332 | Depreciation |
| Book Value | 2232703 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2416553 | OtherCostOrOtherBasis |
| Depreciation | 210321 | Depreciation |
| Book Value | 2206232 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 17449975 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | 505836 |
| DEFERRED FINANCING COSTS, NET | 116688 |
| DUE FROM AFFILIATES | 1689381 |
| FUNDED DEPRECIATION | 914952 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 3226857 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (5 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| OBLIGATIONS UNDER CAPITAL LEASES | $805,033 |
| PATIENT REFUNDS PAYABLE | $51,517 |
| BLUE CROSS CURRENT FINANCING ADVANCE | $158,704 |
| FAIR VALUE OF DERIVATIVE INSTRUMENT | $332,042 |
| ACCRUED PENSION COST | $3,383,033 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 4730329 | TotalOfAmounts |
| Total Revenue | 30439311 | TotalRevenue |
| Total Expenses | 34131694 | TotalExpenses |
| Excess Or Deficit For Year | -3692383 | ExcessOrDeficitForYear |
| Other | -$2,392,101 | OtherAmount |
| Total Adjustments | -2392101 | TotalAdjustments |
| Excess Or Deficit Per FS | -6084484 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 25134654 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -5363168 | OtherRevenues |
| Revenue Not Rptd F990 | -5363168 | RevenueNotRptdF990 |
| Revenue Subtotal | 30497822 | RevenueSubtotal |
| Other Revenues Not Included | -58511 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -58511 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 30439311 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 31219138 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 58511 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 58511 | ExpensesNotRptdF990 |
| Expenses Subtotal | 31160627 | ExpensesSubtotal |
| Other Expenses Not Included | 2971067 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 2971067 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 34131694 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE HOSPITAL ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD IS MET. MANAGEMENT DETERMINED THERE WERE NO TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2012 AND 2011. THE HOSPITAL'S FEDERAL RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, EXEMPT ORGANIZATION BUSINESS TAX RETURN, AND CORPORATE INCOME TAX RETURNS FOR THE YEARS ENDED JUNE 2011, 2010, AND 2009 REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | PENSION LIABILITY ADJUSTMENT -2,478,012. CHANGE IN FAIR VALUE OF DERIVATIVE INSTRUMENT 85,911. TOTAL TO SCHEDULE D, PART XI, LINE 8: -2,392,101. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | CHANGE IN FAIR VALUE OF DERIVATIVE INSTRUMENT 85,911. PENSION LIABILITY ADJUSTMENT -2,478,012. REVENUE OF AFFILIATES CONSOLIDATED ON FINANCIAL STATEMENTS TRANSFER TO AFFILIATE -2,971,067. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | RENTAL EXPENSE -42,040. FUNDRAISING EXPENSE -16,471. | |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 42,040. FUNDRAISING EXPENSE 16,471. | |
| PART XIII, LINE 4B - OTHER ADJUSTMENTS: | TRANSFER TO AFFILIATE 2,971,067. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF TOURNAMENT | NameOfEvent1 |
| Gross Receipts Event1 | 23411 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 9941 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 13470 | GrossRevenueEvent1 |
| Food And Beverage Event1 | 1632 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 5411 | OtherDirectExpensesEvent1 |
| Name Of Event2 | CRAB FEST | NameOfEvent2 |
| Gross Receipts Event2 | 11934 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 5067 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 6867 | GrossRevenueEvent2 |
| Food And Beverage Event2 | 5900 | FoodAndBeverageEvent2 |
| Entertainment Event2 | 250 | EntertainmentEvent2 |
| Other Direct Expenses Event2 | 3278 | OtherDirectExpensesEvent2 |
| Gross Receipts Total | 35345 | GrossReceiptsTotal |
| Charitable Contributions Total | 15008 | CharitableContributionsTotal |
| Gross Revenue Total Events | 20337 | GrossRevenueTotalEvents |
| Food And Beverage Total Events | 7532 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 250 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 8689 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 16471 | DirectExpenseSummaryEvents |
| Net Income Summary | 3866 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent250 | X | Pcent250 |
| 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 | 254807 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 254807 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00810 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2778457 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1754453 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1024004 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03260 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3033264 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1754453 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1278811 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04070 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 248550 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 20200 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 228350 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00730 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3006 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 3006 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 251556 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 20200 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 231356 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00740 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3284820 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1774653 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1510167 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04810 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,095,149 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 6532846 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 4776789 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 1756057 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JERSEY SHORE HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1020 THOMPSON STREET | AddressLine1 |
| City | JERSEY SHORE | City |
| State | PA | State |
| ZIP Code | 17740 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| 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 | JERSEY SHORE HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 250.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Medical Indigency | X | MedicalIndigency |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 0 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 7: THE HOSPITAL USED THE COST TO CHARGE RATIO. | |
| PART I, L7 COL(F): AMOUNT OF BAD DEBT EXPENSE FROM PART IX SUBTRACTED IN ORDER TO CALCULATE PERCENT OF TOTAL EXPENSE IN PART I LINE 7 COLUMN F WAS $2,739,988. | |
| PART III, LINE 4: ACCOUNTS RECEIVABLE, PATIENTS ARE REPORTED AT NET REALIZABLE VALUE. ACCOUNTS ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE BASED UPON MANAGEMENT'S ASSESSMENT OF INDIVIDUAL ACCOUNTS. THE ALLOWANCE FOR DOUBTFUL COLLECTIONS IS ESTIMATED BASED UPON A PERIODIC REVIEW OF THE ACCOUNTS RECEIVABLE AGING, PAYOR CLASSIFICATIONS, AND APPLICATION OF HISTORICAL WRITE-OFF PERCENTAGES.BAD DEBT EXPENSE IS BASED ON A PERCENTAGE OF REVENUE DURING THE YEAR. THE ALLOWANCE IS EVALUATED AT THE END OF THE YEAR AND ANY ADJUSTMENTS ARE MADE TO BAD DEBT EXPENSE.PATIENT DISCOUNTS ARE NOT INCLUDED IN BAD DEBT - THEY ARE INCLUDED IN CONTRACTUAL ADJUSTMENTS. PAYMENTS ON PATIENT ACCOUNTS ARE INCLUDED IN THE ALLOWANCE FOR BAD DEBTS.THE HOSPITAL IS DILIGENT IN THE CLASSIFICATION OF AMOUNTS AS CHARITY CARE OR BAD DEBT. WE BELIEVE NONE OF THE AMOUNTS IN BAD DEBT WOULD BE RECLASSIFIED TO CHARITY CARE GIVEN ADDITIONAL INFORMATION. | |
| PART III, LINE 8: THERE IS NO MEDICARE SHORTFALL - AS A CRITICAL ACCESS HOSPITAL, WE ARE REIMBURSED AT 101% OF COST FROM MEDICARE.ALLOWABLE COSTS WERE DETERMINED USING THE COST-TO-CHARGE RATIO FROM MEDICARE COST REPORT. | |
| PART III, LINE 9B: COLLECTIONS ARE PURSUED UP TO THE POINT THAT A PATIENT COMPLETES AND IS APPROVED FOR CHARITY CARE. ONCE CHARITY CARE IS APPROVED, NO FURTHER COLLECTION EFFORTS ARE MADE. | |
| PART V, SECTION B, LINE 3: DURING FY 2013, THE COMMUNITY NEEDS ASSESSMENT PROCESS WAS BEGUN. A COMMITTEE WAS ESTABLISHED TO REVIEW EXISTING DATA AND COMPLETE THE COMMUNITY ASSESSMENT. THE ASSESSMENT IS COMPLETED, THE HOSPITAL IS CURRENTLY WORKING ON THEIR IMPLEMENTATION PLAN. | JERSEY SHORE HOSPITAL |
| PART V, SECTION B, LINE 13G: POLICY WAS REFERENCED ON INVOICES AND VERBALLY DISCUSSED WITH PATIENTS. | JERSEY SHORE HOSPITAL |
| PART V, SECTION B, LINE 19D: JERSEY SHORE HOSPITAL DISCOUNTED AMOUNTS CHARGED TO ELIGIBLE PATIENTS ACCORDING TO THE FINANCIAL ASSISTANCE POLICY. | JERSEY SHORE HOSPITAL |
| PART VI, LINE 2: SEVERAL GROUPS REQUEST HEALTH FAIRS. THE BOARD AND MANAGEMENT CONSIDERED THE HEALTH NEEDS OF THE COMMUNITY. COMMUNITY MEMBERS HAVE REQUESTED THE PROGRAM. | |
| PART VI, LINE 3: PATIENTS ARE COUNSELED ON AN INDIVIDUAL BASIS IN PERSON OR PHONE CONVERSATION AS TO THE AVAILABILITY OF STATE OR CORPORATE PROGRAMS. AT THE TIME OF REGISTRATION, SELF-PAY PATIENTS ARE INFORMED OF ASSISTANCE AVAILABLE. PATIENT STATEMENTS INDICATE ASSISTANCE THAT IS AVAILABLE.THERE IS ALSO SIGNAGE INDICATING THAT ASSISTANCE PROGRAMS ARE AVAILABLE AND PATIENTS ARE PROVIDED A PAMPHLET AT REGISTRATION WITH THIS INFORMATION.PATIENTS ARE INFORMED OF WHAT CHARITY CARE IS AND THAT IS EXISTS. IF THE PATIENT IS INTERESTED THE PROCESS IS EXPLAINED. | |
| PART VI, LINE 4: JERSEY SHORE HOSPITALS PRIMARY SERVICE AREA (PSA) COVERS EASTERN CLINTON COUNTY AND WESTERN LYCOMING COUNTY - AN AREA WITH A POPULATION OF APPROXIMATELY 41,000. THE PSA FOR JERSEY SHORE HOSPITAL CONSISTS OF FOUR ZIP CODES: 17720 - JERSEY SHORE, 17745 - LOCK HAVEN, 17779 - WOOLRICH AND 17751 MILL HALL. JERSEY SHORE HOSPITAL IS CONSIDERED TO BE IN A MEDICALLY UNDERSERVED AREA (MUA). JERSEY SHORE AND JERSEY SHORE HOSPITAL IS LOCATED IN LYCOMING COUNTY, WHICH HAS AN AREA OF 1,237 SQUARE MILES. IT IS THE LARGEST COUNTY IN PENNSYLVANIA AND OCCUPIES A HILLY AND HEAVILY FORESTED PART OF THE STATE. THE WEST BRANCH OF THE SUSQUEHANNA RIVER FLOWS THROUGH THE SOUTHERN PART OF THE COUNTY. JERSEY SHORE IS APPROXIMATELY 45 MILES NORTHEAST OF STATE COLLEGE PENNSYLVANIA AND APPROXIMATELY 15 MILES WEST OF WILLIAMSPORT, PENNSYLVANIA. ABOUT SIXTEEN PERCENT (16%) OF INPATIENT STAYS IN THE PSA OCCUR AT JERSEY SHORE HOSPITAL. ABOUT FORTY PERCENT (40%) OF OUTPATIENT VISITS IN THE PSA OCCUR AT JERSEY SHORE HOSPITAL. JERSEY SHORE HOSPITAL RELIES UPON A RELATIVELY SMALL GEOGRAPHIC AREA TO SUPPORT THE HOSPITAL.THE SSA (SECONDARY SERVICE AREA) CONSISTS OF 9 ADDITIONAL ZIP CODES WHICH ARE IMPORTANT TO THE HOSPITAL. THESE ZIP CODES ARE PRIMARILY TO THE WEST AND NORTH OF THE PSA. ABOUT TWO PERCENT (2%) OF INPATIENT STAYS IN THE PSA OCCUR AT JERSEY SHORE HOSPITAL. ABOUT ELEVEN PERCENT (11%) OF OUTPATIENT VISITS IN THE PSA OCCUR AT JERSEY SHORE HOSPITAL.WITHIN THE PSA, THE TOTAL POPULATION IS EXPECTED TO INCREASE BY 1.8% BY 2017. A MAJOR DEMOGRAPHIC ISSUE AFFECTING JERSEY SHORE HOSPITAL IS THE AGING POPULATION. THE NUMBER OF INDIVIDUALS LIVING IN THE PSA OVER THE AGE OF 65 IS EXPECTED TO INCREASE 11.2% BY 2017. THIS AGE GROUP CURRENTLY MAKES UP OVER 16% OF THE POPULATION IN THE PSA COMPARED TO ABOUT 13% FOR THE U.S. THIS GROWING ELDERLY SEGMENT SHOULD GENERATE A FUTURE DEMAND FOR HEALTH CARE SERVICES, SINCE INDIVIDUALS OVER AGE 65 USE HEALTHCARE AND HOSPITAL SERVICES AT 2.7 TIMES THE RATE OF THE UNDER AGE 65 POPULATION.A DEMOGRAPHIC REALITY IS THE LOW INCOME LEVEL OF AREA HOUSEHOLDS. CURRENTLY, THE MEDIAN HOUSEHOLD INCOME IN THE PSA IS $40,477, COMPARED TO PA ($47,478) AND THE U.S. ($47,529). THE MEDIAN HOUSEHOLD INCOME IN THE SSA IS $39,660.THE SERVICE AREA IS NOT RACIALLY DIVERSIFIED TO A SIGNIFICANT DEGREE, WITH 98.6 % OF THE POPULATION CONSIDERED WHITE. THE EDUCATIONAL PROFILE OF THE SERVICE AREA DEMONSTRATES THAT 44% OF THE POPULATION HAS A HIGH SCHOOL EDUCATION AND 7.1% OF THE POPULATION HAS AN ASSOCIATE DEGREE. THE PERCENTAGE ACHIEVING A BACHELOR OR PROFESSIONAL DEGREE IS LESS THAN PENNSYLVANIA OR THE U.S. AS A WHOLE. A HIGHER PERCENTAGE OF THE LABOR FORCE IN THE AREA IS ENGAGED IN MANUFACTURING / CONSTRUCTION WHEN COMPARED TO THE STATE AND US AS A WHOLE.IN TERMS OF PATIENTS SERVED, COMBINED INPATIENT AND OUTPATIENT PAYER MIX IN 2012 REMAINED FAIRLY CONSISTENT. MEDICARE AND MEDICARE ADVANTAGE MAKE UP ABOUT 43% OF OUR PAYERS IN TERMS OF GROSS CHARGES. MEDICAL ASSISTANCE BUSINESS CONTINUED TO HAVE A SIGNIFICANT IMPACT ON JSH AS A CRITICAL ACCESS HOSPITAL. MEDICAL ASSISTANCE CHARGES ACCOUNT FOR OVER 10% OF OUR PAYERS. SELF-PAY CHARGES ACCOUNTED FOR ALMOST 4% OF OUR PAYERS. | |
| PART VI, LINE 5: ALL OF THE PERSONS SERVING ON OUR BOARD LIVE IN THE PRIMARY COMMUNITIES BEING SERVED BY THE HOSPITAL. THE BOARD CONSISTS OF SOME PHYSICIANS WHO ARE EMPLOYEES OF A RELATED ENTITY, A FEW CONTRACTORS, AND SEVERAL OTHER COMMUNITY MEMBERS.THE HOSPITAL EXTENDS STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE AREA. AS APPLICABLE, THE HOSPITAL APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE THROUGH NEW AND UPDATED EQUIPMENT PURCHASES, MAJOR FACILITY IMPROVEMENTS, AND COMMUNITY HEALTH PROGRAMS.THE HOSPITAL PARTICIPATES IN MEDICARE, MEDICAID, CHAMPUS, AND TRICARE. | |
| PART VI, LINE 6: THE HOSPITAL IS PART OF JERSEY SHORE HOSPITAL FOUNDATION, INC. THIS AFFILIATION INCLUDES A NON-PROFIT PHYSICIAN PRACTICE WITH FAMILY PRACTICE PHYSICIANS AND SURGEONS, AS WELL AS AN URGENT CARE CENTER.PART VI, LINE 7: N/A |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JERSEY SHORE HOSPITAL FOUNDATION INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1020 THOMPSON STREET | AddressLine1 |
| City | JERSEY SHORE | City |
| State | PA | State |
| ZIP Code | 17740 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 232480603 | EINOfRecipient |
| IRC Section | 501(C)(3) | IRCSection |
| Amount Of Cash Grant | 2971067 | AmountOfCashGrant |
| Amount Of Non Cash Assistance | 0 | AmountOfNonCashAssistance |
| Method Of Valuation | N/A | MethodOfValuation |
| Description Of Non Cash Assistance | N/A | DescriptionOfNonCashAssistance |
| Purpose Of Grant | TO FUND OPERATIONS AT JERSEY SHORE HOSPITAL FOUNDATION, INC. | PurposeOfGrant |
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 RELATED ENTITIES FOR FINANCIAL SUPPORT. MANAGEMENT OF THE HOSPITAL OVERSEES THE USE OF FUNDS AT THE RELATED ORGANIZATION. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CAREY PLUMMER | |||||||||||||
| 223507 | 0 | 0 | 0 | 76867 | 0 | 0 | 0 | 0 | 0 | 300374 | 0 | 0 | 0 |
| CARMEN SPINNEY MD | |||||||||||||
| 0 | 170211 | 0 | 0 | 0 | 0 | 0 | 8562 | 0 | 10605 | 0 | 189378 | 0 | 0 |
| AARON KOLB MD | |||||||||||||
| 286179 | 0 | 0 | 0 | 0 | 0 | 11514 | 0 | 16540 | 0 | 314233 | 0 | 0 | 0 |
| THOMAS BURGE | |||||||||||||
| 172639 | 0 | 0 | 0 | 0 | 0 | 3472 | 0 | 10605 | 0 | 186716 | 0 | 0 | 0 |
| RONALD EISTER | |||||||||||||
| 242438 | 0 | 0 | 0 | 0 | 0 | 10022 | 0 | 16012 | 0 | 268472 | 0 | 0 | 0 |
| SHAIRKO MISSOURI | |||||||||||||
| 432128 | 0 | 0 | 0 | 0 | 0 | 360 | 0 | 19648 | 0 | 452136 | 0 | 0 | 0 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | LISA STRAWSER | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | MEDICAL STAFF DIRECTOR AND BOARD MEMBER | Relationship |
| Amount Of Transaction | 1295567 | AmountOfTransaction |
| Description Of Transaction | LISA STRAWSER IS A PART OWNER OF JERSEY SHORE RADIOLOGISTS. JERSEY SHORE RADIOLOGISTS HAS A CONTRACT WITH THE HOSPITAL TO PERFORM RADIOLOGY SERVICES FOR THE HOSPITAL. THE SERVICES ARE PROVIDED AT FMV. IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY, LISA STRAWSER ABSTAINS FROM ANY DECISION MAKING AS IT RELATES TO THIS TRANSACTION. | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | CAREY W. PLUMMER IS A NON-VOTING MEMBER. | |
| FORM 990, PART VI, SECTION A, LINE 2 | MEMBERS LEROY KEILER, III, AND ROB GLUNK HAVE A BUSINESS RELATIONSHIP. . | |
| FORM 990, PART VI, SECTION A, LINE 3 | THE HOSPITAL UTILIZES THE MANAGEMENT SERVICES OF QUORUM HEALTH RESOURCES. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 WAS REVIEWED IN DETAIL BY MANAGEMENT BEFORE FILING WITH THE IRS. A COPY OF THE 990 WAS PROVIDED TO ALL BOARD MEMBERS PRIOR TO ISSUANCE. | |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL BOARD MEMBERS AND EMPLOYEES ARE REQUIRED TO ANNUALLY COMPLETE A CONFLICT OF INTEREST STATEMENT. THE CEOS OFFICE MONITORS THE PROCESS AND COMPLETION OF THE STATEMENTS. THE COMPLETED STATEMENTS ARE REVIEWED BY MANAGEMENT. BOARD MEMBERS ARE REQUIRED TO RECUSE THEMSELVES FROM VOTING ON MATTERS THAT ARE RELATED TO ANY POTENTIAL CONFLICTS. THERE HAS NEVER BEEN AN ISSUE INVOLVING CONFLICTS OF INTEREST. | |
| FORM 990, PART VI, SECTION B, LINE 15 | ON AN ANNUAL BASIS, THE PERSONNEL SALARY COMMITTEE AND QUORUM (MANAGEMENT COMPANY) REVIEWS AN EXECUTIVE COMPENSATION STUDY PERFORMED BY YAFFE, AN INDEPENDENT THIRD PARTY WHO IS EMPLOYED BY HOSPITAL ASSOCIATION OF PENNSYLVANIA TO CONDUCT A COMPENSATION STUDY. HUMAN RESOURCES ALSO PROVIDES A COMPENSATION STUDY FROM ACRS WHICH IS BASED ON THE APPALACHIAN REGION. THESE TWO STUDIES ARE USED TO DETERMINE FMV. THE RECOMMENDATIONS FOR COMPENSATION LEVELS ARE PASSED ON TO THE BOARD FOR THEIR APPROVAL. APPROVAL IS DOCUMENTED IN THE MINUTES. THE ACTUAL AMOUNT OF COMPENSATION IS NOT INCLUDED IN THE MINUTES FOR PRIVACY PURPOSES. | |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. | |
| FORM 990, PART VII, SECTION A: | CERTAIN INDIVIDUALS LISTED ON 990 PART VII SPENT TIME ON RELATED ORGANIZATIONS ACTIVITIES. THE FOLLOWING SUMMARIZES THOSE INDIVIDUALS AND THE ESTIMATED AVERAGE NUMBER OF HOURS SPENT ON RELATED ORGANIZATIONS' ACTIVITIES: CAREY PLUMMER - 1 HOUR DEAN FLEMING - 1 HOUR CARMEN SPINNEY - 39 HOURS LEROY H. KEILER, III - .5 HOUR RICHARD BEATTY, DMD - .5 HOUR JAMES ELY - .5 HOUR ROB GLUNK - .5 HOUR | |
| FORM 990, PART VII, SECTION A: | THE PRESIDENT AND CEO IS AN EMPLOYEE OF QUORUM (MANAGEMENT COMPANY). THE HOSPITAL PAYS QUOROM FOR THE PRESIDENT/CEOS SALARY. | |
| FORM 990, PART XI, LINE 5: | PENSION LIABILITY ADJUSTMENT -2,478,012. CHANGE IN FAIR VALUE OF DERIVATIVE INSTRUMENT 85,911. TOTAL TO FORM 990, PART XI, LINE 5: -2,392,101. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JERSEY SHORE HOSPITAL FOUNDATION INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1020 THOMPSON STREET | AddressLine1 |
| City | JERSEY SHORE | City |
| State | PA | State |
| ZIP Code | 17740 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 232480603 | EIN |
| Primary Activities | HEALTHCARE | PrimaryActivities |
| Legal Domicile State | PA | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 3 | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 1 | LoansOrGuaranteesFromOtherOrg |
| 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 | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |