DEACONESS MEMORIAL MEDICAL CENTER INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- DEACONESS MEMORIAL MEDICAL CENTER INC (EIN 35-0985964)
- Tax period
- 2010-07-01 to 2011-06-30
- Filed
- 2012-05-14
- IRS object ID
- 201211359349305496
- Schema version
- 2010v3.4
- 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 I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-05-14T15:55:54-05:00 | Timestamp |
| Tax Period End Date | 2011-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUE & CO LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE AMERICAN SQUARE 2200 | AddressLine1 |
| City | INDIANAPOLIS | City |
| State | IN | State |
| ZIP Code | 46282 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 350985964 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LITTLE COMPANY OF MARY HOSPITAL OF INDIANA INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | LITT | NameControl |
| Phone | 8124822345 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 WEST NINTH STREET | AddressLine1 |
| City | JASPER | City |
| State | IN | State |
| ZIP Code | 47546 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | E KYLE BENNETT | Name |
| Title | EXECUTIVE V/P & CFO | Title |
| Phone | 8124822345 | Phone |
| Date Signed | 2012-05-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CARRIE A MERRILL CPA | Name |
| Phone | 3176334705 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOSPITAL & HEALTH CARE CENT | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | E KYLE BENNETT | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 WEST NINTH STREET | AddressLine1 |
| City | JASPER | City |
| State | IN | State |
| ZIP Code | 47546 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 154049486 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.MHHCC.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1950 | YearFormation |
| State Legal Domicile | IN | StateLegalDomicile |
| Activity Or Mission Description | PROVIDE HEALTH SERVICES CONSISTENT WITH THE NEEDS OF THE COMMUNITY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 18 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1486 | TotalNbrEmployees |
| Total Nbr Volunteers | 267 | TotalNbrVolunteers |
| Total Gross UBI | 80792 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 51381 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 245685 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 651769 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 139415841 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 147163536 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1711000 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1296860 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 2313461 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2508040 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 143685987 | TotalRevenuePriorYear |
| Total Revenue Current Year | 151620205 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 166819 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 136707 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 72427532 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 75183427 | 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 | 65042620 | OtherExpensePriorYear |
| Other Expenses Current Year | 68732289 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 137636971 | TotalExpensesPriorYear |
| Total Expenses Current Year | 144052423 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 6049016 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 7567782 | RevenuesLessExpensesCY |
| Total Assets BOY | 185905708 | TotalAssetsBOY |
| Total Assets EOY | 200080236 | TotalAssetsEOY |
| Total Liabilities BOY | 78838616 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 75929324 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 107067092 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 124150912 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | WE, THE BOARD, PHYSICIANS, STAFF, VOLUNTEERS AND AUXILIARY OF MEMORIAL HOSPITAL AND HEALTH CARE CENTER WILL PROVIDE EXCELLENT HEALTH CARE SERVICES TO THE PEOPLE OF THE COMMUNITIES WE SERVE. WE WILL PLEDGE OURSELVES TO CARE FOR EACH INDIVIDUAL IN A MANNER THAT REFLECTS THE PHYSICAL, PSYCHOLOGICAL AND SPIRITUAL HEALING MINISTRY OF JESUS CHRIST. WE WILL WORK TOGETHER TO CREATE AN ATMOSPHERE OF MUTUAL RESPECT, DIGNITY, COMPASSION AND JOY. WE WILL EFFECTIVELY AND EFFICIENTLY UTILIZE OUR RESOURCES IN PROVIDING HEALTH CARE. WE WILL BE GUIDED BY THE NEEDS OF THOSE WE SERVE AND AS NEEDS CHANGE, WE WILL CHANGE. WE WILL "BE FOR OTHERS!" | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 129775985 | Expense |
| Grants | 136707 | Grants |
| Revenue | 147525310 | Revenue |
| Description | GENERAL PRIMARY ACUTE CARE HOSPITAL EXPENSES INCURRED IN PROVIDING EXCELLENT HEALTH CARE SERVICES CONSISTENT WITH THE NEEDS OF THE COMMUNITY. SEE FORM 990, SCHEDULE H FOR ADDITIONAL SERVICES PROVIDED TO THE COMMUNITY. | Description |
| Total Program Service Expense | 129775985 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 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 | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| 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 | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 1 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 184 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1486 | NumberOfEmployees |
| Employment Tax Returns Filed | 0 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 18 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | 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 | 0 | 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 |
| States Where Copy Of Return Is Filed | IN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | E KYLE BENNETT | NamePerson |
| Telephone Number | 8124820506 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 WEST NINTH STREET | AddressLine1 |
| City | JASPER | City |
| State | IN | State |
| ZIP Code | 47546 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| SR ADRIAN DAVIS | |||||||
| BOARD CHAIRPERSON | 30.00 | X | 0 | 0 | 931 | ||
| ROBERT DISINGER | |||||||
| BOARD VICE CHAIRPERSON | 1.00 | X | 0 | 0 | 0 | ||
| KENNETH SENDELWECK | |||||||
| BOARD TREASURER | 1.00 | X | 0 | 0 | 0 | ||
| SR RENEE CUNNINGHAM | |||||||
| BOARD SECRETARY | 1.00 | X | 0 | 0 | 8641 | ||
| ROBERT EHRHARD MD | |||||||
| MEDICAL STAFF PRESIDENT | 1.00 | X | 0 | 0 | 0 | ||
| SCOTT BECKMAN MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DOUGLAS BIES MD | |||||||
| BOARD MEMBER | 1.00 | X | 393688 | 0 | 15217 | ||
| BRENDA STALLINGS | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JOSEPH STEURER | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| MICHAEL UEBELHOR | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| SR SHARON ANN WALSH | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| WILLIAM RUBINO | |||||||
| FOUNDATION BOARD CHAIRPERS | 1.00 | X | 0 | 0 | 0 | ||
| SR KATHLEEN MCINTYRE | |||||||
| EX-OFFICIO PROVINCE LEADER | 1.00 | X | 0 | 0 | 0 | ||
| RAYMOND SNOWDEN | |||||||
| PRESIDENT & CEO | 40.00 | X | 393540 | 0 | 30323 | X | |
| LISA ARVESEN | |||||||
| VP MED. PRACTICE MGMT | 40.00 | X | 163064 | 0 | 16474 | X | |
| E KYLE BENNETT | |||||||
| EXECUTIVE VP, CFO | 40.00 | X | 259497 | 0 | 16320 | X | |
| JOHN DILLON | |||||||
| VP AMBULATORY SERVICES | 40.00 | X | 156136 | 0 | 14003 | X | |
| TONYA HEIM | |||||||
| VP PATIENT SERVICES | 40.00 | X | 40667 | 0 | 2754 | X | |
| DR ROBERT MANDAL | |||||||
| ONCOLOGIST | 40.00 | 866514 | 0 | 0 | X | ||
| DR MICHAEL RUFF | |||||||
| PEDIATRICIAN | 40.00 | 481052 | 0 | 13729 | X | ||
| DR JASON VAUGHAN | |||||||
| EMERGENCY PHYSICIAN | 40.00 | 423100 | 0 | 19500 | X | ||
| DR JERRY AMMON | |||||||
| ANESTHESIA PHYSICIAN | 40.00 | 419555 | 0 | 21870 | X | ||
| DR STEPHEN DEWITT | |||||||
| EMERGENCY PHYSICIAN | 40.00 | 416130 | 0 | 33966 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 4012943 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 193728 | TotalOtherCompensation |
| Number Individuals GT100 K | 60 | 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 |
|---|---|---|---|---|---|
| AMERICAN RED CROSS | |||||
| 29 SOUTH STOCKWELL ROAD | EVANSVILLE | IN | 47714 | HEALTH SERVICES | 826004 |
| MATRIX INTEGRATION LLC | |||||
| 417 MAIN ST | JASPER | IN | 47546 | COMPUTER SERVICES | 789152 |
| VANTAGE ONCOLOGY TREATMENT | |||||
| PO BOX 15040 IN 47716 | EVANSVILLE | IN | 47716 | ONCOLOGY SERVICES | 733055 |
| WEATHERBY LOCUMS INC | |||||
| 6451 NORTH FEDERAL HWY STE 800 | FT LAUDERDALE | FL | 33308 | LOCUM TENUM SERVICES | 683562 |
| OUTSOURCE BILLING SERVICES | |||||
| 1039 SHELBY ST | INDIANAPOLIS | IN | 46203 | OUTSOURCED BILLING | 631478 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 40 | NumberOfContractorsGT100K |
| Related Organizations | 301255 | RelatedOrganizations |
| All Other Contributions | 350514 | AllOtherContributions |
| Total Contributions | 651769 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE RE | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 147163536 | TotalRevenueColumn |
| Related Or Exempt Function Income | 147163536 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 147163536 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1134655 | TotalRevenueColumn |
| Exclusion | $1,134,655 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1042886 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 798373 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 244513 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 244513 | TotalRevenueColumn |
| Exclusion | $244,513 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1793113 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1630908 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 162205 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 162205 | TotalRevenueColumn |
| Exclusion | $162,205 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|
| LABORATORY SERVICES | 621500 | 77413 | 77413 |
| CLINICAL ENGINEERING R | 811000 | 2642 | 2642 |
| LINEN SERVICES REVENUE | 812300 | 737 | 737 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2182735 | TotalRevenueColumn |
| Related Or Exempt Function Income | 361774 | RelatedOrExemptFunctionIncome |
| Exclusion | $1,820,961 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 2263527 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 151620205 | TotalRevenueColumn |
| Related Or Exempt Function Income | 147525310 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 80792 | UnrelatedBusinessRevenue |
| Exclusion | $3,362,334 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 136707 | Total |
| Program Services | 136707 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1511255 | Total |
| Management And General | 1511255 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 60172160 | Total |
| Program Services | 55564420 | ProgramServices |
| Management And General | 4607740 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2277232 | Total |
| Program Services | 2051331 | ProgramServices |
| Management And General | 225901 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7317598 | Total |
| Program Services | 6591692 | ProgramServices |
| Management And General | 725906 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3905182 | Total |
| Program Services | 3517788 | ProgramServices |
| Management And General | 387394 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 192763 | Total |
| Program Services | 173641 | ProgramServices |
| Management And General | 19122 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 101500 | Total |
| Program Services | 91431 | ProgramServices |
| Management And General | 10069 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11392512 | Total |
| Program Services | 10262375 | ProgramServices |
| Management And General | 1130137 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 216305 | Total |
| Program Services | 194848 | ProgramServices |
| Management And General | 21457 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25069005 | Total |
| Program Services | 22582160 | ProgramServices |
| Management And General | 2486845 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7629143 | Total |
| Program Services | 6872332 | ProgramServices |
| Management And General | 756811 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 585546 | Total |
| Program Services | 527460 | ProgramServices |
| Management And General | 58086 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2442812 | Total |
| Program Services | 2200485 | ProgramServices |
| Management And General | 242327 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9650709 | Total |
| Program Services | 8693359 | ProgramServices |
| Management And General | 957350 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1091299 | Total |
| Program Services | 983042 | ProgramServices |
| Management And General | 108257 | ManagementAndGeneral |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBTS | 7373802 | 6642321 | 731481 |
| DUES & SUB. | 334958 | 301730 | 33228 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2651935 | Total |
| Program Services | 2388863 | ProgramServices |
| Management And General | 263072 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 144052423 | Total |
| Program Services | 129775985 | ProgramServices |
| Management And General | 14276438 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30820232 | BOY |
| EOY | 38473639 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17790769 | BOY |
| EOY | 18102387 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1686674 | BOY |
| EOY | 1242511 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2370315 | BOY |
| EOY | 2319909 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1649098 | BOY |
| EOY | 1331653 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 167161322 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 85040000 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 85827409 | BOY |
| EOY | 82121322 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43679219 | BOY |
| EOY | 54402742 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1696988 | BOY |
| EOY | 1606069 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 385004 | BOY |
| EOY | 480004 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 185905708 | BOY |
| EOY | 200080236 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10389735 | BOY |
| EOY | 12331440 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 53765978 | BOY |
| EOY | 52304666 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14682903 | BOY |
| EOY | 11293218 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 78838616 | BOY |
| EOY | 75929324 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 107067092 | BOY |
| EOY | 124150912 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 107067092 | BOY |
| EOY | 124150912 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 185905708 | BOY |
| EOY | 200080236 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 7567782 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 9516038 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement 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 | 694781 | OtherCostOrOtherBasis |
| Book Value | 694781 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 73161966 | OtherCostOrOtherBasis |
| Depreciation | 26237321 | Depreciation |
| Book Value | 46924645 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 93304575 | OtherCostOrOtherBasis |
| Depreciation | 58802679 | Depreciation |
| Book Value | 34501896 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 82121322 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| THIRD PARTY PAYABLE | $3,397,123 |
| PENSION LIABILITY | $7,896,095 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 11293218 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE CORPORATION AND RECOGNIZE A TAX LIABILITY IF THE CORPORATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE CORPORATION, AND HAS CONCLUDED THAT AS OF JUNE 30, 2011 AND 2010, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE CORPORATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. |
| PART XI, XII, AND XIII ARE NOT REQUIRED AS THE ORGANIZATION IS PART OF A CONSOLIDATED FINANCIAL STATEMENT. THE CONSOLIDATED FINANCIAL STATEMENTS ARE AUDITED BY AN INDEPENDENT ACCOUNTING FIRM AND PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 1 | UnableToProvideCare |
| 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 | 2311159 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2311159 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01690 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 58515346 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 44002870 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 14512476 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10620 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 60826505 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 44002870 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 16823635 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.12310 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 811550 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 811550 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00590 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 811550 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 811550 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00590 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 61638055 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 44002870 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 17635185 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.12900 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $3,644,907 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 36965022 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 34403652 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 2561370 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOSPITAL & HEALTH CARE CENTER | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 W 9TH ST | AddressLine1 |
| City | JASPER | City |
| State | IN | State |
| ZIP Code | 47546 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MHHCC - NOT REQUIRED FOR 2010 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 0 | EligibilityCriteriaExplained |
| Uses FPG Free | 0 | UsesFPGFree |
| Uses FPG Discounted | 0 | UsesFPGDiscounted |
| Explains Basis | 0 | ExplainsBasis |
| Explains Application Method | 0 | ExplainsApplicationMethod |
| Includes Publicity Measures | 0 | IncludesPublicityMeasures |
| Actions On Nonpayment | 0 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 0 | NondiscrimEmergencyCarePolicy |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 24 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (24 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| MEMORIAL HOSPITAL SLEEP CENTER | ||||
| 721 W 13TH ST STE 202 | JASPER | IN | 47546 | DIAGNOSIS AND TREATMENT CENTER |
| DALE FAMILY MEDICINE | ||||
| 4 W VINE ST | DALE | IN | 47523 | PHYSICIAN OFFICE |
| FERDINAND FAMILY MEDICINE | ||||
| 115 S MAIN ST | FERDINAND | IN | 47532 | PHYSICIAN OFFICE |
| LOOGOOTEE FAMILY MEDICINE | ||||
| 105 COOPER ST | LOOGOOTEE | IN | 47553 | PHYSICIAN OFFICE |
| MARTIN COUNTY HEALTH CENTER | ||||
| 229 HIGH ST | SHOALS | IN | 47581 | PHYSICIAN OFFICE |
| MEMORIAL FAMILY CARE | ||||
| 709 W 9TH ST | JASPER | IN | 47546 | PHYSICIAN OFFICE |
| JASPER NEUROLOGY | ||||
| 721 W 13TH ST STE 221 | JASPER | IN | 47546 | PHYSICIAN OFFICE |
| PETERSBURG FAMILY MEDICINE | ||||
| 1003 E ILLINOIS ST | PETERSBURG | IN | 47567 | PHYSICIAN OFFICE |
| ENT | ||||
| 251 S TRUMAN RD | JASPER | IN | 47546 | PHYSICIAN OFFICE |
| WOUND CARE CENTER | ||||
| 507 E 19TH ST | HUNTINGBURG | IN | 47542 | TREATMENT CENTER |
| SANTA CLAUS FAMILY MEDICINE | ||||
| 92 W CHRISTMAS BLVD | SANTA CLAUS | IN | 47579 | PHYSICIAN OFFICE |
| MEDICAL PRACTICE MGMT AND SUPPORT SRVS | ||||
| 800 W 9TH ST | JASPER | IN | 47546 | MANAGEMENT AND SUPPORT SERVICES |
| WOMELDORF | ||||
| 721 W 13TH ST STE 205 | JASPER | IN | 47546 | PHYSICIAN OFFICE |
| LANGE FUHS CANCER CENTER - MEDICAL ONCOL | ||||
| 800 W 9TH ST | JASPER | IN | 47546 | TREATMENT CENTER |
| HUNTINGBURG URGENT CARE | ||||
| 507 E 19TH ST | HUNTINGBURG | IN | 47542 | URGENT CARE CENTER |
| JASPER PEDIATRICS | ||||
| 721 W 13TH ST STE 321 | JASPER | IN | 47546 | PHYSICIAN OFFICE |
| HOLLAND FAMILY MEDICINE | ||||
| 303 MERIDIAN ST | HOLLAND | IN | 47541 | PHYSICIAN OFFICE |
| HUNTINGBURG CLINIC | ||||
| 407 E 22ND ST | HUNTINGBURG | IN | 47542 | CLINIC |
| DR MUNNING | ||||
| 721 W 13TH ST STE 102 | JASPER | IN | 47546 | PHYSICIAN OFFICE |
| FRENCH LICK FAMILY MEDICINE | ||||
| 522 SOUTH MAPLE ST | FRENCH LICK | IN | 47432 | PHYSICIAN OFFICE |
| DR RICHARD D'MELLO | ||||
| 721 W 13TH ST STE 225 | JASPER | IN | 47546 | PHYSICIAN OFFICE |
| DR SOHAIL QADIR | ||||
| 721 W 13TH ST STE 225 | JASPER | IN | 47546 | PHYSICIAN OFFICE |
| CULLEN MEDICAL PROFESSIONALS | ||||
| 2005 STATE ST STE A | WASHINGTON | IN | 47501 | PHYSICIAN OFFICE |
| DR CHARLES TOLLETT JR | ||||
| 407 E 22ND ST | HUNTINGBURG | IN | 47542 | PHYSICIAN OFFICE |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 3C: A PATIENT MAY QUALIFY FOR PARTIAL FINANCIAL ASSISTANCE IF THE PATIENT'S HOUSEHOLD INCOME IS BETWEEN 200% AND 400% OF THE FEDERAL POVERTY GUIDELINES. | ||
| PART I, LINE 7G: THE ORGANIZATION DOES NOT PROVIDE ANY SUBSIDIZED HEALTH SERVICES ATTRIBUTABLE TO PHYSICIAN CLINICS. | ||
| PART I, L7 COL(F): TOTAL BAD DEBT EXPENSE OF $7,373,802 INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) HAS BEEN EXCLUDED FROM THE DENOMINATOR FOR THE PERCENTAGE CALCULATION PER IRS INSTRUCTIONS. | ||
| PART II: PROGRAMS WERE OFFERED AT LOW OR DISCOUNTED PRICES. SOME SERVICES SUCH AS SCREENING RESULT SESSIONS OR SUPPORT GROUPS WERE OFFERED FREE TO PARTICIPANTS. THE FOLLOWING IS A LIST OF SERVICES PROVIDED THROUGH THE COMMUNITY RELATIONS DEPARTMENT.HEALTH SCREENINGS INCLUDING WEIGHT, BMI, WAIST CIRCUMFERENCE, BLOOD PRESSURE, LIPID PROFILE, CHEMISTRY PANEL, TOBACCO STATUS, GLUCOSE, PSA AND COLON KITS: 8315 PARTICIPATED AT 44 DIFFERENT LOCATIONS. 1477 PSA'S WERE PERFORMED WHICH INCLUDED THE ANNUAL PSA SCREENING FOR MEN 50 AND OLDER, 754 COLON KITS DISTRIBUTED. 29 DEPARTMENT OF TRANSPORTATION PRE-PHYSICALS WERE CONDUCTED. 143 BODY FAT ANALYSES AND 71 CARBON MONOXIDE SCREENINGS WERE PERFORMED.HEALTH RISK APPRAISALS WERE PROVIDED FOR IMED PATIENTS AND PARTICIPANTS IN HEALTH SCREENINGS WITH 2962 COMPLETED.OVER 3198 PARTICIPANTS ATTENDED SCREENING RESULT SESSIONS TO LEARN ABOUT THE IMPORTANCE OF THEIR SCREENING RESULTS AT THE VARIOUS WORK-SITES.SMOKING CESSATION PROGRAMS AND PRESENTATIONS WERE PROVIDED FOR THE COMMUNITY AND COMPANY WORK-SITES AT NO COST WITH ONE WEEK OF NICOTINE PATCHES AWARDED FOR COMPLETION THANKS TO A GRANT FROM THE DUBOIS COUNTY SUBSTANCE ABUSE COUNCIL AND MEMORIAL HOSPITAL SPONSORSHIP FOR 106 PARTICIPANTS. AMERICAN CANCER SOCIETY AND THE INDIANA TOBACCO PREVENTION AND CESSATION COUNCIL ALSO PROVIDED EDUCATION MATERIALS AT NO CHARGE. MEMORIAL HOSPITAL PROVIDED STAFF TO PROMOTE AND TEACH THE CLASSES.46 PARTICIPANTS WERE TAUGHT STRESS MANAGEMENT SKILLS THROUGH THE SPEAKERS BUREAU SERVICES.673 HOSPITAL EMPLOYEES PARTICIPATED IN WELLNESS CLAENDARS AND CHECK-INS, AND OTHER WELLNESS ACTIVITIES THROUGHOUT THE YEAR AT NO CHARGE.WE PROVIDED WELLNESS COACHING FOR 87 INDUSTRY PARTICIPANTS. THE COMPANIES PAID A FEE FOR THIS SERVICE. HOSPITAL EMPLOYEES PARTICIPATED FOR FREE.CANCER EDUCATION INFORMATION AND HEALTH EDUCATION INFORMATION WAS DISTRIBUTED AT NO COST TO PARTICIPANTS AT SCREENINGS AND THROUGH EMPLOYEE WELLNESS PROGRAMS.NUTRITION AND HEALTH DISPLAYS WERE PROVIDED FOR 5 COMPANIES.MATERNITY CENTER PROGRAMS WERE OFFERED INCLUDING THE CHILDBIRTH AND CHILDBIRTH REFRESHER CLASSES, BREAST-FEEDING, GETTING READY FOR BABY BROTHER OR SISTER, PAPA PAGERS PARTICIPANTS AT NO CHARGE. 320 PARTICIPANTS ATTENDED THE VARIOUS CHILDBIRTH CLASSES, 66 BREAST-FEEDING CLASSES, AND 23 CHILDREN AND THEIR PARENTS IN THE GETTING READY FOR BABY BROTHER AND SISTER CLASSES. SESSIONS WERE RECORDED WITH 22 COUPLES PARTICIPATING IN THE FERTILITY CARE (NATURAL FAMILY PLANNING) PROGRAM FOR A SMALL FEE. PROGRAMS ARE AVAILABLE AT REDUCED RATE FOR THOSE UNABLE TO PAY FOR THE SERVICES.MEDIC FIRST AID, CPR PROGRAMS, AED, AND BLOOD BORNE PATHOGENS, WERE PROVIDED FOR 672 INDUSTRY WORKERS, SCOUT TROUPS, SCHOOLS AND THE GENERAL PUBLIC FOR A FEE.WE PARTICIPATED IN FREE COMMUNITY EXHIBITS AND FAIRS INCLUDING THE WBDC SENIOR FAIR AND RELAY FOR LIFE SPONSORSHIP WITH 87 PARTICIPANTS. WRIST BANDS WERE DONATED FOR RELAY PARTICIPANTS AND CANCER SURVIVOR GIFTS WERE DONATED.THE LANGE-FUHS CANCER CENTER CONDUCTED THE MAN TO MAN PROGRAM, THE LOOK GOOD, FEEL BETTER PROGRAM, MEN'S GROUP AND WOMEN'S GROUP, AND THE CELEBRATE LIFE PROGRAM TO AREA CANCER PATIENTS AT NO COST.THE BARIATRIC FORUM AND SUPPORT GROUP WERE OFFERED MONTHLY AT NO COST.THE MEMORIAL HOSPITAL COUNSELING CENTER PROVIDED MONTHLY SUPPORT GROUPS FOR FAMILIES WITH ALZHEIMER'S DISEASE AND DEMENTIA, HEART DISEASE, AND PARKISONS'S DISEASE. THE DIABETES EDUCATION STAFF PROVDED FREE MONTHLY SUPPORT GROUPS FOR THOSE WITH DIABETES. THE PASTORAL CARE DEPARTMENT PROVIDED TWO 5-WEEK PROGRAMS FOR THOSE SUFFERING WITH GRIEF.SUPERSITTER (BABYSITTING) CLASSES WERE OFFERED FOR A FEE TO 71 YOUTH TO LEARN ABOUT SAFE BABYSITTING PRACTICES.ATTENDANCE OF 859 WAS RECORDED AT MONTHLY HEALTH CHECK-INS WHICH PROVIDED ONE-ON-ONE EDUCATION AND SUPPORT FOR PEOPLE CREATING HEALTHY LIFESTYLES.1 CLIENT WAS EDUCATED IN DISEASE MANAGEMENT: HYPERTENSION AND DIABETES WITH WEEKLY PHONE CALLS FROM A DISEASE EDUCATION NURSE.472 PARTICIPANTS ATTENDED WELLNESS CLASSES AND LUNCH AND LEARN PROGRAMS SPONSORED BY THEIR EMPLOYER, INCLUDING MEMORIAL HOSPITAL EMPLOYEES AND OTHER COMMUNTIY PROGRAMS OFFERED BY THE HOSPITAL.113 PARTICIPANTS TOOK PART IN THE WEIGHT MANAGEMENT CLASSES AND AT A GROUP RATE. HOSPITAL EMPLOYEES PARTICIPATED FREE. 390 PARTICIPATED IN WEIGHT CHALLENGES.MANY PARTICIPATED IN THE MONTHLY FITNESS CLASSES HELD AT THE HOSPITAL WITH AVERAGE WEEKLY ATTENDANCE BEING: 9 PER WEEKLY CLASS AT STEP IT AWAY, 71 AT THE THREE WEEKLY CLASSES OF ZUMBA, 22 AT THE WEEKLY CLASS OF ABSOLUTE ABS, 20 AT THE FIT IT IN CLASSES (TWO COURSES), 64 AT THE CORPORATE FIT IT IN PROGRAMS.323 PARTICIPATED IN SCHOOL AND COMMUNITY FITNESS DEMOSNTRATIONS AT NO COST.1076 YOUTH ATTENDED BREAST SELF EXAM CLASSES, YOUTH FAIRS AT SCHOOLS, AND THE HEALTHY ME WELLNESS PROGRAM AT THE HOSPITAL.THE LIFELINE PROGRAM MAINTAINS AN AVERAGE OF 219 LIFELINE UNITS FOR AREA RESIDENTS TO PROVIDE A SAFE ENVIRONMENT FOR THE ELDERLY MAINTAINING THEIR INDEPENDENCE AT HOME. SOME OF THOSE ARE DISCOUNTED THROUGH THE GENERATIONS AND MEDICAID WAIVER PROGRAM.BI-MONTHLY WELLNESS TIPS HAVE BEEN PROVIDED FOR THE AREA CHAMBER OF COMMERCE AND 14 LOCAL BUSINESSES TO SHARE WITH THEIR MEMBERS/EMPLOYEES.COMMUNITY EDUCATION STAFF PARTICIPATED IN LOCAL COMMUNITY COMMITTEES SUCH AS THE MEMORIAL HOSPITAL FOUNDATION OUTREACH COMMITTEE, THE DUBOIS COUNTY SUBSTANCE ABUSE COUNCIL, THE HOSPITAL ERGONOMIC COMMITTEE, THE DUBOIS COUNTY PARTNERSHIP SENIOR FOCUS COMMITTEE, AND THE HOSPITAL CANCER COMMITTEE WITH OVER 40 HOURS OF STAFF TIME DONATED. FREE WELLNESS INFORMATION WAS PROVIDED QUARTERLY TO AREA INDUSTRIES ON HEALTH INFORMATION FOR THEM TO USE IN THEIR NEWSLETTERS AND ON BULLETIN BOARDS TO IMPROVE THE HEALTH OF THEIR EMPLOYEES ALONG WITH FREE WELLNESS PAYCHECK STUFFERS TO OVER 44 COMPANIES. 23 CHOOSE 8 TO LOSE WEIGHT NUTRITION PROGRAMS WERE TAUGHT AT SALEM CHURCH WITH 23 WEIGHT SUPPORT SESSIONS HELD AT HUNTINGBURG, DALE, AND JASPER. THE PROGRAM DOCUMENTED 469 IN ATTENDANCE AT THE COMBINED NUTRITION CLASSES AND 203 AT THE SUPPORT SESSIONS. 78 DIFFERENT PEOPLE WERE PARTICIPATING IN 2010 AND 92 IN 2011. 61 OF THOSE PARTICIPANTS ALSO PARTICIPATED IN THE CHOOSE 8 FITNESS CLASSES AT A REDUCED PRICE.141 ATTENDED CPR DEMONSTRATIONS AT NO COST. 94 ATTENDED FREE WELLNESS PRESENTATIONS. 140 ATTENDED FREE CLASSES TO BETTER UNDERSTAND HEALTH RISKS AND HEALTH SCREENINGS. | ||
| PART III, LINE 4: SECTION A. BAD DEBT EXPENSE. LINE 2 FOOTNOTE TO ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE: NOT APPLICABLE. NO FOOTNOTE.PART III, LINE 4: SECTION A. BAD DEBT EXPENSE. LINE 3 EXPLANATION FOR RATIONAL FOR INCLUDING OTHER BAD DEBT AMOUNT IN COMMUNITY BENEFIT: NO OTHER BAD DEBT AMOUNTS HAVE BEEN INCLUDED AS COMMUNITY BENEFIT. THE HOSPITAL HAS A DETAILED FINANCIAL ASSISTANCE POLICY AND EDUCATES PATIENTS WITH LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THIS REASON, THE ORGANIZATION BELIEVES IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE. | ||
| PART III, LINE 8: THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED JUNE 30, 2011: HOSPITAL STATEMENT OF REIMBURSABLE COST. | ||
| PART III, LINE 9B: THE ORGANIZATION'S WRITTEN DEBT COLLECTION POLICY INCLUDES PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED DURING THE FOLLOW-UP PERIOD AFTER A PATIENT IS DISCHARGED AND INCLUDES SPECIFIC INSTRUCTIONS FOR SELF-PAY WHO MAY QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. | ||
| PART VI, LINE 2: THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES THROUGH THE USE OF HOSPITAL COMMITTEES DEVELOPING STRATEGIC PLANS FOR THE HOSPITAL TO PROVIDE QUALITY CARE TO THE COMMUNITY MEMBERS. | ||
| PART VI, LINE 3: IF DURING PATIENT FINANCIAL SERVICES' FINANCIAL COUNSELING OR COLLECTION PROCESS, IT APPEARS THAT AN INDIVIDUAL MAY NOT HAVE THE FINANCIAL RESOURCES TO PAY FOR SERVICES NOT COVERED BY A THIRD PARTY PAYOR, THEN A FINANCIAL DISCLOSURE FORM SHOULD BE COMPLETED BY THE PATIENT. IN ADDITION, OTHER MEMBERS OF THE HOSPITAL STAFF MAY IDENTIFY INDIVIDUALS WHO MAY QUALIFY FOR CHARITY CARE. THE INFORMATION IS FORWARDED TO THE PATIENT FINANCIAL SERVICES DEPARTMENT. APPROPRIATE SIGNAGE IS VISIBLE IN THE HOSPITAL AND ALL HOSPITAL-OWNED FACILITIES, SPECIFICALLY IN PATIENT ACCESS AREAS, CREATING AWARENESS FOR THE FINANCIAL ASSISTANCE PROGRAM AND THE FINANCIAL ASSISTANCE THAT IS AVAILABLE. IN ADDITION THE HOSPITAL HAS ANNOUNCED A NEW PAYMENT PLAN WHICH ALLOWS PATIENTS TO PAY FOR THEIR HOSPITAL SERVICES AT 0% INTEREST OVER A 25-MONTH PERIOD. REGARDLESS OF INSURANCE COVERAGE, CREDIT HISTORY OR EMPLOYMENT, THE HOSPITAL WILL REFER PATIENTS AUTOMATICALLY TO THE CAREPAYMENT OPTION IF THEY HAVE A BALANCE ON THEIR HOSPITAL ACCOUNT TWO MONTHS AFTER RECEIVING THEIR FIRST STATEMENT. THROUGH A PRE-APPROVED APPLICATION PROCESS, THE PATIENT WILL RECEIVE A 0% INTEREST HOSPITAL-SPONSORED LOYALTY CARD WITH A MINIMUM OF 4% OF THE BALANCE OR $25. | ||
| PART VI, LINE 4: AS A REGIONAL HEALTH CENTER, THE STAFF PROVIDES A COMPREHENSIVE RANGE OF MEDICAL CARE FOR RESIDENTS OF DUBOIS AND SURROUNDING COUNTIES INCLUDING MORE THAN 7,700 INPATIENTS AND 172,000 OUTPATIENTS. OVER 1,000 BABIES WERE BORN AT MEMORIAL HOSPITAL DURING THE PAST YEAR, WHICH SET THE ALL-TIME RECORD! | ||
| PART VI, LINE 6: THE ORGANIZATION FURTHERS ITS EXEMPT PURPOSE BY PROMOTING HEALTH OF THE COMMUNITY THROUGH THE FOLLOWING: THE MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. ANY SURPLUS FUNDS ARE APPLIED DIRECTLY OR INDIRECTLY TO IMPROVE PATIENT CARE SERVICES. ALSO, THE ORGANIZATION OPERATES UNDER THE PREMISE OF AN OPEN MEDICAL STAFF WITH REGARD TO QUALIFIED PHYSICIANS IN THE 9 COUNTY COMMUNITY IT SERVES, HOWEVER IT DOES NOT ACTIVELY PURSUE THOSE PHYSICIANS WHO HAVE NOT APPROACHED THE ORGANIZATION REGARDING THESE PRIVILEGES. | ||
| PART VI, LINE 7: NOT APPLICABLE. THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. | ||
| IN | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII (3 entries)
| Type Of GrantTypeOfGrant | Number Of RecipientsNumberOfRecipients | Amount Of Cash GrantAmountOfCashGrant |
|---|---|---|
| STUDENT LOAN BUY BACK PROGRAM TO OFFSET EDUCATIONAL EXPENSES FOR CRITICALLY NEEDED HEALTH CARE FIELDS. | 41 | 56431 |
| TUITION REIMBURSEMENT PROGRAM FOR THE COST OF TUITION AND BOOKS. | 36 | 64533 |
| SCHOLARSHIP PROGRAM TO ASSIST STAFF MEMBERS PURSUING AN UNDERGRADUATE DEGREE TO WORK IN DEFINED CRITICAL SHORTAGE AREAS. | 13 | 15743 |
Form990 Schedule I Part IV Form990ScheduleIPartIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | PART I, LINE 2: | SCHEDULE I, PART I, LINE 2: FOR THE STUDENT LOAN BUY-BACK PROGRAM APPLICATIONS ARE SUBMITTED TO THE HUMAN RESOURCE DEPARTMENT; AND REVIEWED FOR DENIAL OR APPROVAL. FOR THE TUITION REIMBURSMENT PROGRAM APPLICATIONS MUST BE APPROVED BY THE DIRECTORS IN CHARGE OF THE EMPLOYEE BEFORE SUBMITTING TO HUMAN RESOURCE DEPARTMENT FOR APPROVAL. IN ADDITION GRADES MUST BE SUBMITTED TO THE HUMAN RESOURCE DEPARTMENT FOR GRADE VERIFICATION. FOR THE SCHOLARSHIP PROGRAM THE SCHOLARSHIP COMMITTEE EXERCISES AUTHORITY IN THE SELECTION PROCESS AND RECIPIENTS MUST RE-APPLY EACH SEMESTER. |
| OTHER INFORMATION: | PART IV: | SEE SCHEDULE O FOR ELIGIBILITY AND PROCEDURES FOR STUDENT LOAN BUY-BACK, TUITION REIMBURSEMENT, AND SCHOLARSHIP PROGRAMS. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | X | TravelForCompanions |
| Discretionary Spending Account | X | DiscretionarySpendingAccount |
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | 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 | 1 | 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 (10 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DOUGLAS BIES MD | |||||||||||||
| 393688 | 0 | 0 | 0 | 0 | 0 | 4337 | 0 | 10880 | 0 | 408905 | 0 | 0 | 0 |
| RAYMOND SNOWDEN | |||||||||||||
| 393540 | 0 | 0 | 0 | 0 | 0 | 20513 | 0 | 9810 | 0 | 423863 | 0 | 0 | 0 |
| LISA ARVESEN | |||||||||||||
| 163064 | 0 | 0 | 0 | 0 | 0 | 9367 | 0 | 7107 | 0 | 179538 | 0 | 0 | 0 |
| E KYLE BENNETT | |||||||||||||
| 259497 | 0 | 0 | 0 | 0 | 0 | 6879 | 0 | 9441 | 0 | 275817 | 0 | 0 | 0 |
| JOHN DILLON | |||||||||||||
| 156136 | 0 | 0 | 0 | 0 | 0 | 5073 | 0 | 8930 | 0 | 170139 | 0 | 0 | 0 |
| DR ROBERT MANDAL | |||||||||||||
| 866514 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 866514 | 0 | 0 | 0 |
| DR MICHAEL RUFF | |||||||||||||
| 481052 | 0 | 0 | 0 | 0 | 0 | 2916 | 0 | 10813 | 0 | 494781 | 0 | 0 | 0 |
| DR JASON VAUGHAN | |||||||||||||
| 423100 | 0 | 0 | 0 | 0 | 0 | 4900 | 0 | 14600 | 0 | 442600 | 0 | 0 | 0 |
| DR JERRY AMMON | |||||||||||||
| 419555 | 0 | 0 | 0 | 0 | 0 | 5284 | 0 | 16586 | 0 | 441425 | 0 | 0 | 0 |
| DR STEPHEN DEWITT | |||||||||||||
| 416130 | 0 | 0 | 0 | 0 | 0 | 17380 | 0 | 16586 | 0 | 450096 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 1A | MEMORIAL HOSPITAL HAS AN EXECUTIVE PERQUISITE PROGRAM WHICH INCLUDES REIMBURSEMENT FOR ALLOWABLE APPROVED PERQUISITE EXPENSES. REIMBURSEMENT MADE AS PART OF THE EXECUTIVE PERQUISITE PROGRAM IS REFLECTED ON THE EXECUTIVE'S W-2 FORM. |
| PART I, LINE 4B | NONQUALIFIED PARTICIPANTS IN 457B JERRY AMMON - $16,500 STEPHEN DEWITT - $15,00 JASON VAUGHAN - $15,000 |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOSPITAL AUTHORITY OF THE CITY OF JASPER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 351692946 | IssuerEIN |
| CUSIP Number | 471641AA8 | CUSIPNumber |
| Date Issued | 2008-05-20 | DateIssued |
| Issue Price | 15000000 | IssuePrice |
| Description Of Purpose | SEE BELOW | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Proceeds | 15000000 | TotalProceeds |
| Issuance Costs From Proceeds | 214398 | IssuanceCostsFromProceeds |
| Credit Enhancement | 70302 | CreditEnhancement |
| Capital Expenditures | 14715300 | CapitalExpenditures |
| Year Of Subst Completion | 2008 | YearOfSubstCompletion |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Bond Counsel Routinely Engaged | 1 | BondCounselRoutinelyEngaged |
| Post Issuance Compliance Procdrs | 1 | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | 0 | Form8038TFiled |
| Variable Rate Issue | 1 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Exception To Rebate | 0 | ExceptionToRebate |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PART I | Identifier |
| Return Reference | PURPOSE OF SERIES 2008 BONDS | ReturnReference |
| Explanation | THE PROCEEDS OF THE SERIES 2008 BONDS WERE USED FOR THE PURPOSE OF FINANCING A PORTION OF THE COSTS OF CONSTRUCTION OF AND EQUIPPING OF CARDIOLOGY LABS, PATIENT ROOMS, FOOD AND NUTRITION SERVICES AND OTHER ANCILLARY SPACES AND TO PAY INSURANCE COSTS OF THE SERIES 2008 BONDS. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (6 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| SR R CUNNINGHAM | |||
| BOARD MEMBERS | 263040 | SISTERS RENEE CUNNINGHAM AND ADRIAN DAVIS PROVIDE NURSING SERVICES TO THE HOSPITAL AND SERVE AS BOARD MEMBERS. THE HOSPITAL PAYS AMERICAN PROVIDENCE OF LITTLE COMPANY OF MARY SISTERS $263,040 AS A SPONSORSHIP FOR THE SISTERS. THE SISTERS DO NOT ACCEPT COMPENSATION AS THEY HAVE TAKEN A VOW OF POVERTY. THE AMERICAN PROVIDENCE OF LITTLE COMPANY OF MARY SISTERS IS THE CORPORATE MEMBER FOR THE HOSPITAL. | 0 |
| SR A DAVIS | |||
| BOARD MEMBERS | 263040 | SISTERS RENEE CUNNINGHAM AND ADRIAN DAVIS PROVIDE NURSING SERVICES TO THE HOSPITAL AND SERVE AS BOARD MEMBERS. THE HOSPITAL PAYS AMERICAN PROVIDENCE OF LITTLE COMPANY OF MARY SISTERS $263,040 AS A SPONSORSHIP FOR THE SISTERS. THE SISTERS DO NOT ACCEPT COMPENSATION AS THEY HAVE TAKEN A VOW OF POVERTY. THE AMERICAN PROVIDENCE OF LITTLE COMPANY OF MARY SISTERS IS THE CORPORATE MEMBER FOR THE HOSPITAL. | 0 |
| RAY SNOWDEN | |||
| CEO OF MEMORIAL HOSPITAL AND BOARD MEMBER OF GERMAN AMERICAN BANK | RAY SNOWDEN IS A BOARD MEMBER FOR GERMAN AMERICAN BANK WHICH PROVIDES BANKING NEEDS OF SAVINGS AND INTEREST ACCOUNTS TO THE HOSPITAL IN THE AMOUNT OF $69,077. | 0 | |
| KEN SENDELWECK | |||
| BOARD MEMBER OF MEMORIAL HOSPITAL & OFFICER AT GERMAN AMERICAN BANK | KEN SENDELWECK SERVICES AS OFFICER FOR GERMAN AMERICAN BANK WHICH PROVIDES BANKING NEEDS OF SAVINGS AND INTEREST ACCOUNTS TO THE HOSPITAL IN THE AMOUNT OF $69,077. | 0 | |
| MIKE UEBELHOR | |||
| BOARD MEMBER & OWNER OF UEBELHOR DEVELOPMENT | 124237 | MIKE UEBELHOR IS A PART OWNER OF UEBELHOR DEVELOPMENTS, WHICH IS THE LESSOR OF THE ORGANIZATION'S URGENT CARE BUILDING IN HUNTINGTON, IN. THE HOSPITAL PAID $124,237 IN LEASE PAYMENTS AND PROPERTY TAX PAYMENTS TO UEBELHOR DEVELOPMENTS IN THE CURRENT YEAR. | 0 |
| ROBERT EHRHARD MD | |||
| BOARD MEMBER & MEDICAL STAFF PRESIDENT | 18000 | DR. BECKMAN RECEIVES A STIPEND FOR MEDICAL DIRECTOR AND PAYMENT FOR PURCHASED PHYSICIAN SERVICES AS AN INDEPENDENT CONTRACTOR. | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | MR. BENNETT, SISTER DAVIS, MR. DISINGER, MR. RUBINO, MR. SENDELWECK AND MR. SNOWDEN HAVE A BUSINSS RELATIONSHIP AS THEY ARE ALL BOARD MEMBERS FOR THE MEMORIAL HOSPITAL FOUNDATION TOGETHER. | |
| FORM 990, PART VI, SECTION A, LINE 6 | THE MEMBERS OF THE CORPORATION ARE THE PROVIDENCE LEADER AND COUNCIL MEMBERS OF THE AMERICAN PROVIDENCE OF LITTLE COMPANY OF MARY SISTERS. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE FOLLOWING DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY THE MEMBERS: TO ESTABLISH/APPROVE THE MISSION/PHILOSOPHY OF THE CORPORATION; TO ADOPT, AMEND OR REPEAL THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION; TO FIX THE NUMBER OF DIRECTORS OF THE CORPORATION AND APPOINT THE CORPORATION'S BOARD OF DIRECTORS; TO REMOVE ANY MEMBER OF THE BOARD OF THE CORPORATION; TO APPOINT AND REMOVE THE PRESIDENT/CEO OF THE CORPORATION; TO APPOINT AND REMOVE THE CHAIRPERSON OF THE BOARD OF DIRECTORS; TO APPROVE FOR THE CORPORATION, THE ACQUISITION OF ASSETS, THE INCURRENCE OF INDEBTEDNESS OR THE LEASE, SALE, TRANSFER, ASSIGNMENT, OR ENCUMBERING OF THE ASSETS IN AN AMOUNT SET FROM TIME TO TIME BY THE MEMBERS; TO APPROVE THE MERGER, DISSOLUTION, AFFILIATION, OR CORPORATE RESTRUCTURING OF THE CORPORATION AND ANY SUBSIDIARY OF THE CORPORATION; TO ACCEPT A GIFT OR LEGACY IMPOSING A PERMANENT OR CONTINUING OBLIGATION ON THE CORPORATION; TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS; AND TO APPOINT THE AUDITORS OF THE CORPORATION. | |
| FORM 990, PART VI, SECTION B, LINE 11 | A COPY OF THE FORM 990 IS MADE AVAILABLE FOR THE BOARD OF DIRECTORS FOR REVIEW UPON REQUEST. | |
| THE BOARD CHAIRPERSON EVALUATES SITUATIONS WHERE POSSIBLE CONFLICTS MAY EXIST, AND TRIES TO DISCUSS THESE SITUATIONS WITH BOARD MEMBERS BEFORE DISCUSSIONS MAY TAKE PLACE AT THE BOARD MEETING. | FORM 990, PART VI, SECTION B, LINE 12C | |
| THE COMPENSATION COMMITTEE, COMPOSED OF THE EXECUTIVE COMMITTEE OF THE BOARD MINUS THE CEO, REVIEWS EXTERNAL SURVEY INFORMATION PROVIDED BY AN INDEPENDENT COMPENSATION CONSULTANT, AND VOTES ON ANY COMPENSATION AND BENEFIT CHANGES FOR THE CEO AND APPROVES THE SAME FOR OTHER MEMBERS OF ADMINISTRATIVE STAFF. THESE ACTIONS ARE DOCUMENTED IN MEETING MINUTES. | FORM 990, PART VI, SECTION B, LINE 15 | |
| THE ORGANIZATION DOES NOT MAKE THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. | FORM 990, PART VI, SECTION C, LINE 19 | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED GAINS ON INVESTMENTS: 3,586,517. CHANGE IN PENSION 5,533,022. CHANGE IN MINORITY INTEREST -26,933. LOSS ON DISPOSITION OF JV -135,205. RECORD NET ASSETS OF SLEEP LAB PARTNERSHIP 558,637. TOTAL TO FORM 990, PART XI, LINE 5: 9,516,038. | FORM 990, PART XI, LINE 5: |
| OVERSIGHT OF THE AUDIT | THE FINANCE COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS; NO PROCESSES HAVE CHANGED FROM THE PRIOR YEAR. THE AUDITORS ARE SELECTED BY THE COUNCIL MEMBERS OF THE AMERICAN PROVIDENCE OF LITTLE COMPANY OF MARY SISTERS. | PART XI, LINE 2C |
| STUDENT LOAN BUY-BACK PROGRAM | POLICY STATEMENT: MEMORIAL HOSPITAL AND HEALTH CARE CENTER STRIVES TO BE PROACTIVE IN RECRUITING, ASSISTING, AND ENCOURAGING QUALIFIED INDIVIDUALS TO ENTER INTO CRITICALLY NEEDED HEALTH CARE FIELDS. THIS PROGRAM WAS DESIGNED TO OFFSET EDUCATIONAL EXPENSES BY REIMBURSING APPROVED MONTHLY STUDENT LOAN OBLIGATIONS IN TRADE FOR TIME WORKED AT MEMORIAL HOSPITAL AND HEALTH CARE CENTER. PROCEDURE: 1. THE STUDENT LOAN BUY-BACK BENEFIT IS AVAILABLE TO EMPLOYEES RECRUITED BY MEMORIAL HOSPITAL AND HEALTH CARE CENTER FOR CRITICAL SHORTAGE AREAS WHO HAVE EXISTING LOANS. THIS BENEFIT MAY NOT BE USED IN CONJUNCTION WITH THE TUITION REIMBURSEMENT PROGRAM. 2. THE STUDENT LOAN MONIES MUST BE BORROWED BY THE EMPLOYEE FOR OBTAINING A FORMALIZED DEGREE IN A CRITICAL SHORTAGE AREA AS DEFINED BY THE HOSPITAL. EACH POTENTIAL EMPLOYEE MUST HAVE MADE HIS OR HER OWN ARRANGEMENTS FOR THE STUDENT LOAN FINANCING THROUGH AN APPROPRIATE LENDING INSTITUTION. THE HOSPITAL WILL IN NO WAY BE SIGNATORY OR BE HELD RESPONSIBLE FOR THE FINANCIAL CONTRACT OBTAINED THROUGH A LENDING INSTITUTION. 3. THE APPLICATION TITLED "STUDENT BUY-BACK APPLICATION" FOR QUALIFIED INDIVIDUALS MUST BE COMPLETED AND SUBMITTED TO THE HUMAN RESOURCE DEPARTMENT. IT SHALL BE THE RESPONSIBILITY OF HUMAN RESOURCES TO NOTIFY THE EMPLOYEE OF DENIAL OR APPROVAL. 4. THE ACTIVE LOAN BALANCE AT THE TIME OF APPLICATION WILL BE USED TO CALCULATE STUDENT LOAN BUY-BACK. 5. ELIGIBILITY FOR BUY-BACK PAYMENTS COMMENCES AT THE BEGINNING OF THE MONTH FOLLOWING COMPLETION OF THE 60 DAY INTRODUCTORY PERIOD. EMPLOYEES WITH A PRN STATUS ARE NOT ELIGIBLE TO PARTICIPATE IN THE STUDENT LOAN BUY-BACK PROGRAM. BUY-BACK PAYMENTS CEASE IMMEDIATELY WITH TERMINATION. 6. SHOULD AN EMPLOYEE REDUCE TO LESS THAN FULL TIME STATUS (1.0 FTE) THEN THE EMPLOYEE'S MAXIMUM REIMBURSEMENT WILL BE REDUCED PROPORTIONATELY(I.E. A .8 FTE WILL QUALIFY FOR 80% OF THE ALLOWABLE MONTHLY AND TOTAL REIMBURSEMENT AMOUNT). THE EMPLOYEE WILL BE REQUIRED TO COMPLETE A NEW APPLICATION AT THE TIME OF STATUS CHANGE. 7. IF AN INDIVIDUAL IS GIVEN ANY DISCIPLINARY ACTION, THE LOAN BUY-BACK PAYMENT WILL NOT BE MADE FOR THE MONTH IN WHICH THE DISCIPLINARY ACTION OCCURRED AND CONTINUATION OF THE BENEFIT WILL BE REVIEWED. 8. THE MAXIMUM AMOUNT FOR LOAN BUY-BACK WILL BE $250.00 PER MONTH FOR A TOTAL OF 24 MONTHS. 9. THE CRITICAL SHORTAGE AREAS WILL BE IDENTIFIED BY THE ADMINISTRATIVE STAFF OF MEMORIAL HOSPITAL AND THE HUMAN RESOURCE DEPARTMENT WILL HAVE THE LIST AVAILABLE UPON REQUEST. 10. SHOULD A POSITION BE REMOVED FROM THE CRITICAL SHORTAGE LIST, ANY APPROVED APPLICATION FOR THE STUDENT LOAN BUY-BACK SHALL CONTINUE TO BE VALID AND APPROVED EACH YEAR SO LONG AS ALL OTHER CRITERIA ARE MET. 11. STUDENT LOAN BUY-BACK PAYMENTS WILL BE MADE DIRECTLY TO THE EMPLOYEE. THE EMPLOYEE WILL CONTINUE TO BE RESPONSIBLE FOR THEIR OWN PAYMENTS TO THE LENDING INSTITUTION(S). 12. THE EMPLOYEE IS RESPONSIBLE FOR OBTAINING A LETTER STATING THE PURPOSE OF THE LOAN, AMOUNT OF THE LOAN, THE DATE OF ISSUANCE AND THE SIGNATURE OF THE LOAN OFFICER. | SCH I |
| TUITION REIMBURSEMENT PROGRAM | POLICY STATEMENT: MEMORIAL HOSPITAL AND HEALTH CARE CENTER STRIVES TO PROVIDE A WORKING ENVIRONMENT DESIGNED TO ATTRACT, REWARD AND RETAIN QUALIFIED PERSONNEL. TUITION REIMBURSEMENT IS DEFINED AS THE COST OF TUITION AND BOOKS ONLY FOR CLASSES TAKEN IN PURSUANCE OF AN UNDERGRADUATE DEGREE AT AN ACCREDITED INSTITUTION OF HIGHER EDUCATION. PROCEDURE: 1. ELIGIBILITY: EMPLOYEES MUST BE EMPLOYED AS A REGULAR EMPLOYEE AUTHORIZED TO WORK WEEKEND OPTION OR AT LEAST 64 HOURS PER PAY PERIOD FOR SIX CONSECUTIVE MONTHS. THE SIX MONTH REQUIREMENT IS WAIVED FOR EMPLOYEES TAKING ACADEMIC COURSES TOWARD A DEGREE FOR A CRITICAL SHORTAGE AREA. IF ACADEMIC COURSES ARE RECOMMENDED BY THE DIRECTOR OR VICE PRESIDENT AT THE TIME OF HIRE, THE EMPLOYEE MAY ENROLL IN THE CLASS BEFORE SIX MONTHS OF EMPLOYMENT IS COMPLETED; HOWEVER, TUITION REIMBURSEMENT MAY NOT BE RECEIVED BEFORE SIX MONTHS OF EMPLOYMENT HAS BEEN COMPLETED. THE PROGRAM OF STUDY MUST: (A) BENEFIT THE HOSPITAL, AND EITHER (B) BE RELATED TO THE EMPLOYEE'S PRESENT JOB, OR (C) ENHANCE THE EMPLOYEE'S POTENTIAL FOR ADVANCEMENT TO A POSITION TO WHICH THE EMPLOYEE CAN REASONABLY BE EXPECTED TO BE PROMOTED WITHIN MEMORIAL HOSPITAL AND HEALTH CARE CENTER. TUITION REIMBURSEMENT WILL BE CONSIDERED FOR GRADUATE COURSES IF THE APPLICABLE VICE PRESIDENT OF MEMORIAL HOSPITAL AND HEALTH CARE CENTER REQUESTS THE EMPLOYEE TO CONTINUE HIS/HER EDUCATION TO MEET JOB REQUIREMENTS OF THE CURRENT JOB, TO MEET QUALIFICATIONS OF A PLANNED PROMOTION OR SERVES A BUSINESS PURPOSE OF THE HOSPITAL. INDIVIDUAL SEMINARS AND WORKSHOPS ARE NOT COVERED UNDER THIS POLICY. CERTIFICATE PROGRAMS ARE ONLY COVERED IF COLLEGE CREDIT AND LETTER GRADES ARE PROVIDED FOR CLASSES TAKEN BY THE EMPLOYEE. THE COURSE(S) MUST BE ATTENDED DURING NON-WORKING HOURS OR DIRECTOR/VICE PRESIDENT APPROVAL IS REQUIRED FOR SCHEDULE CHANGES IF NEEDED TO ATTEND CLASSES. THIS ACCOMMODATION MAY NOT BE POSSIBLE IN SOME AREAS. THE HOSPITAL EXPECTS EACH EMPLOYEE INVOLVED IN THE TUITION REIMBURSEMENT PROGRAM TO CONTINUE TO FUNCTION AT AN ACCEPTABLE LEVEL OF PERFORMANCE. A LETTER GRADE OF C (OR EQUIVALENT) OR BETTER MUST BE OBTAINED FOR UNDERGRADUATE COURSES. A GRADE OF B (OR EQUIVALENT) OR BETTER MUST BE ATTAINED FOR GRADUATE CLASSES. GRADES AND CHECK REQUESTS FOR TUITION REIMBURSEMENT MUST BE RECEIVED BY THE HUMAN RESOURCES DEPARTMENT WITHIN TWO WEEKS AFTER GRADES ARE RECEIVED. 2. BENEFITS - FOR CLASSES TAKEN FOR ALL JOB TITLES THAT ARE NOT LISTED AS CRITICAL SHORTAGE: FULL TIME (72 HOURS OR MORE PER PAY PERIOD) UNDERGRADUATE - 90% WITH A MAXIMUM OF $3,000 GRADUATE - 90% WITH A MAXIMUM OF $5,000 PART TIME (WEEKEND OPTION OR MINIMUM OF 64 HOURS PER PAY PERIOD) UNDERGRADUATE - 70% WITH A MAXIMUM OF $2,000 GRADUATE - 70% WITH A MAXIMUM OF $3,000 3.BENEFITS - FOR CLASSES TAKEN FOR JOB TITLES THAT ARE LISTED AS CRITICAL SHORTAGE: FULL TIME (MINIMUM OF 72 HOURS PER PAY PERIOD) UNDERGRADUATE - 90% WITH A MAXIMUM OF $4,000 PART TIME (WEEKEND OPTION OR MINIMUM OF 64 HOURS PER PAY PERIOD) 70% WITH A MAXIMUM OF $4,000 4. APPLICATION PROCEDURE: EMPLOYEES THAT MEET ELIGIBILITY REQUIREMENTS MUST COMPLETE A TUITION REIMBURSEMENT REQUEST FORM. ALL REQUESTS MUST INCLUDE DIRECTOR RECOMMENDATIONS. THE PRESIDENT AND THE DIRECTOR OF HUMAN RESOURCES HAVE THE AUTHORITY FOR THE FINAL APPROVAL OF EACH INDIVIDUAL REQUEST FOR TUITION REIMBURSEMENT. IN CASES WHERE EMPLOYEES HAVE HAD WRITTEN COUNSELING/DISCIPLINARY ACTION WITHIN THE LAST TWELVE MONTHS, TUITION REIMBURSEMENT MAY NOT BE APPROVED. REQUESTS RECEIVED MAY BE DENIED AND THE EMPLOYEE WILL BE ADVISED TO APPLY FOR THE NEXT CLASS SESSION. AFTER CLASS COMPLETION, VERIFICATION OF A LETTER GRADE (OR EQUIVALENT)FOR EACH CLASS MUST BE SUBMITTED TO THE HUMAN RESOURCES DEPARTMENT WITHIN TWO WEEKS OF RECEIPT OF GRADES. REIMBURSEMENT WILL NOT BE OBTAINED WITHOUT GRADE VERIFICATION. IF AN EMPLOYEE WHO HAS RECEIVED TUITION REIMBURSEMENT TERMINATES EMPLOYMENT AT MEMORIAL HOSPITAL (VOLUNTARY OR INVOLUNTARY) OR IF AN EMPLOYEE REDUCES EMPLOYMENT STATUS TO BELOW .6 FTE ALL TUITION REIMBURSEMENT RECEIVED WITHIN THE LAST 24 MONTHS PRIOR TO DATE OF TERMINATION OR STATUS REDUCTION WILL BE REPAID TO MEMORIAL HOSPITAL AND HEALTH CARE CENTER. REPAYMENT IS DUE WITHIN 30 DAYS OF TERMINATION DATE OR STATUS REDUCTION. A STATEMENT AGREEING TO THIS ARRANGEMENT WILL BE SIGNED BY EACH EMPLOYEE AT THE TIME APPLICATION IS MADE. | SCH I |
| SCHOLARSHIP PROGRAM | POLICY STATEMENT: IN AN EFFORT TO PROMOTE PERSONAL AND PROFESSIONAL GROWTH OF STAFF, MEMORIAL HOSPITAL AND HEALTH CARE CENTER PROVIDES A SCHOLARSHIP PROGRAM TO ASSIST STAFF MEMBERS PURSUING AN UNDERGRADUATE DEGREE AT AN ACCREDITED INSTITUTION OF HIGHER EDUCATION TO WORK IN DEFINED CRITICAL SHORTAGE AREAS. PROCEDURE: 1. ELIGIBILITY: SCHOLARSHIP APPLICANTS MUST BE EMPLOYED BY MEMORIAL HOSPITAL AND HEALTH CARE CENTER PRIOR TO APPLYING FOR THE SCHOLARSHIP. WEEKEND OPTION EMPLOYEES ARE NOT ELIGIBLE TO PARTICIPATE IN THE SCHOLARSHIP PROGRAM. EMPLOYEES WITH WRITTEN COUNSELING/DISCIPLINARY ACTION WITHIN THE LAST TWELVE MONTHS WILL NOT BE ELIGIBLE FOR THE SCHOLARSHIP PROGRAM. THE HOSPITAL EXPECTS EACH EMPLOYEE INVOLVED IN THE SCHOLARSHIP PROGRAM TO CONTINUE TO FUNCTION AT AN ACCEPTABLE LEVEL OF PERFORMANCE. THE PROGRAM OF STUDY MUST BENEFIT SPECIFICALLY DEFINED CRITICAL SHORTAGE AREAS WITHIN THE HOSPITAL, AS DETERMINED BY THE SCHOLARSHIP COMMITTEE. THE NUMBER OF SCHOLARSHIPS FOR CRITICAL SHORTAGE AREAS WILL BE DETERMINED ANNUALLY. EMPLOYEES THAT MEET ELIGIBILITY REQUIREMENTS MUST COMPLETE AN APPLICATION FORM AND SUBMIT IT TO THEIR DEPARTMENT DIRECTOR. DIRECTOR RECOMMENDATIONS MUST ACCOMPANY ALL APPLICATIONS SENT TO THE HUMAN RESOURCES DEPARTMENT. THE SCHOLARSHIP COMMITTEE WILL EXERCISE AUTHORITY IN THE SELECTION PROCESS. MEMBERS OF THIS COMMITTEE INCLUDE THE PRESIDENT/CEO, TWO VICE PRESIDENTS, THE DIRECTOR OF HUMAN RESOURCES, AND A DIRECTOR FROM ALL THREE DIVISIONS. SCHOLARSHIP RECIPIENTS ARE REQUIRED TO MAINTAIN A 0.8 FTE WORK STATUS. BENEFITS WILL BE CONSISTENT WITH EMPLOYEE STATUS. CREDIT HOURS WILL BE APPLIED WEEKLY TOWARDS THE STUDENT'S WEEKLY REQUIRED HOURS. EXAMPLE: A STUDENT WITH NINE CREDIT HOURS WEEKLY WOULD BE REQUIRED TO WORK 23 HOURS PER WEEK AT THE HOSPITAL. IN THIS EXAMPLE, THE STUDENT WOULD WORK 24 HOURS AT THE HOSPITAL, AS STAFFING WILL NOT BE ADJUSTED MID-SHIFT TO RELEASE STUDENTS EARLY FROM THEIR RESPONSIBILITIES. COURSE(S) WILL BE ATTENDED DURING NON-WORKING HOURS IN COORDINATION WITH STUDENT'S DEPARTMENT DIRECTOR WHO WILL SCHEDULE THEIR HOSPITAL HOURS AS NEEDED FOR DEPARTMENTAL COVERAGE, WHILE NOT INTERFERING WITH HOURS OF CLASS. STUDENTS MUST SUPPLY A CLASS SCHEDULE TO THEIR DIRECTOR AS SOON AS AVAILABLE TO ENABLE THE SCHEDULING PROCESS. AFTER CLASS COMPLETION, VERIFICATION OF A LETTER GRADE (OR EQUIVALENT) FOR EACH CLASS MUST BE SUBMITTED TO THE HUMAN RESOURCES DEPARTMENT WITHIN TWO WEEKS OF RECEIPT OF GRADES. A GRADE POINT AVERAGE OF 2.5 OR GREATER MUST BE MAINTAINED TO REMAIN IN GOOD STANDING. IF A STUDENT'S GPA DROPS BELOW 2.5, THE INDIVIDUAL WILL NOT BE ELIGIBLE TO REMAIN IN THE SCHOLARSHIP PROGRAM AND MUST APPLY FOR AN OPEN POSITION IN THE HOSPITAL TO CONTINUE THEIR EMPLOYMENT. SCHOLARSHIP RECIPIENTS MUST RE-APPLY FOR EACH SEMESTER TO VERIFY ELIGIBILITY BASED ON GRADES AND WORK PERFORMANCE. IF A SCHOLARSHIP RECIPIENT TERMINATES EMPLOYMENT AT MEMORIAL HOSPITAL (VOLUNTARY OR INVOLUNTARY), REDUCES EMPLOYMENT STATUS TO BELOW .8 FTE, OR DOES NOT MAINTAIN SATISFACTORY PERFORMANCE, ALL SCHOLARSHIP ASSISTANCE RECEIVED WITH THE LAST 24 MONTHS PRIOR TO DATE OF TERMINATION, STATUS REDUCTION, OR DISCIPLINARY ACTION WILL BE REPAID TO MEMORIAL HOSPITAL AND HEALTH CARE CENTER. RE-PAYMENT IS DUE WITHIN 30 DAYS OF THIS DATE. STATEMENT AGREEING TO THIS ARRANGEMENT WILL BE SIGNED BY EACH EMPLOYEE EACH TIME APPLICATION IS MADE. 2. BENEFITS: SCHOLARSHIP RECIPIENTS WILL BE PAID MINIMUM WAGE PER CREDIT HOUR TO BE APPLIED TO THEIR 0.8 FTE COMMITMENT. NO ADDITIONAL HOURS WILL BE PAID TO COMPLETE HOMEWORK, CLINICAL HOURS, OR SPECIAL ASSIGNMENTS. CORRESPONDENCE COURSES WILL BE PAID AT MINIMUM WAGE PER CREDIT HOUR FOR A MAXIMUM OF 16 WEEKS. THE STUDENT WILL BE PAID AT THEIR REGULAR HOURLY RATE FOR HOURS WORKED IN THE FACILITY. SCHOLARSHIP ASSISTANCE DOES NOT APPLY WHEN SCHOOL IS NOT IN SESSION. SCHOLARSHIP RECIPIENTS ARE ALSO ELIGIBLE TO APPLY FOR TUITION | SCH I |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BARRETT HEALTHCARE CORP OF SW INDIANA | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 WEST 9TH ST | AddressLine1 |
| City | JASPER | City |
| State | IN | State |
| ZIP Code | 47546 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 352039829 | EIN |
| Primary Activities | HEALTHCARE | PrimaryActivities |
| Legal Domicile State | IN | LegalDomicileState |
| Total Income | 0 | TotalIncome |
| EOY Assets | 3074927 | EOYAssets |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOSPITAL FOUNDATION INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 WEST NINTH STREET | AddressLine1 |
| City | JASPER | City |
| State | IN | State |
| ZIP Code | 47546 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351359445 | EIN |
| Primary Activities | BENEFIT MEMORIAL HOSPITAL & HEALTH CARE CENTER | PrimaryActivities |
| Legal Domicile State | IN | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | LINE 11A, I | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOSPITAL AND HEALTH CARE CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 1 | 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 | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL HOSPITAL FOUNDATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionType |
| Amount Involved | 301255 | AmountInvolved |
| Method Of Amt Determination | FAIR VALUE | MethodOfAmtDetermination |
Form990 Schedule R Part VII Form990ScheduleRPartVII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | MEMORIAL HOSPITAL/ SETON HEALTH CORP SLEEP LAB, LLC | Identifier |
| Return Reference | PART III | ReturnReference |
| Explanation | MEMORIAL HOSPITAL/ SETON HEALTH CORP SLEEP LAB, LLC EIN 26-3635457 THE SLEEP CENTER'S MINORITY INTEREST WAS ACQUIRED BY THE HOSPITAL. THE HOSPITAL DISSOLVED THE CENTER AND HAS INCORPORATED THE CENTER INTO THE HOSPITAL AS A DEPARTMENT. | Explanation |