FAIRMONT GENERAL HOSPITAL INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- FAIRMONT GENERAL HOSPITAL INC (EIN 31-1156960)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-08
- IRS object ID
- 201233139349300973
- Schema version
- 2011v1.2
- 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 C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-08T11:00:20-07:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311156960 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAIRMONT GENERAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | FAIR | NameControl |
| Phone | 3043677100 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1325 LOCUST AVENUE | AddressLine1 |
| City | FAIRMONT | City |
| State | WV | State |
| ZIP Code | 26554 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Daniel Honerbrink | Name |
| Title | CFO/VP of Finance | Title |
| Phone | 3043677100 | Phone |
| Date Signed | 2012-11-08 | DateSigned |
| 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 | DANIEL C HONERBRINK | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1325 LOCUST AVENUE | AddressLine1 |
| City | FAIRMONT | City |
| State | WV | State |
| ZIP Code | 26554 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 96085535 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.FGHI.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1985 | YearFormation |
| State Legal Domicile | WV | StateLegalDomicile |
| Activity Or Mission Description | THE ORGANIZATION OPERATES A HOSPITAL THAT PROVIDES PATIENT CARE FOR THE COMMUNITY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 829 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 77070 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 27637 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 97231732 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 88876376 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 277399 | InvestmentIncomePriorYear |
| Investment Income Current Year | 337619 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1720313 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2389816 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 99306514 | TotalRevenuePriorYear |
| Total Revenue Current Year | 91631448 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 42379920 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 41178362 | 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 | 55608512 | OtherExpensePriorYear |
| Other Expenses Current Year | 50278688 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 97988432 | TotalExpensesPriorYear |
| Total Expenses Current Year | 91457050 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1318082 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 174398 | RevenuesLessExpensesCY |
| Total Assets BOY | 60859034 | TotalAssetsBOY |
| Total Assets EOY | 54563136 | TotalAssetsEOY |
| Total Liabilities BOY | 39420010 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 39856835 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 21439024 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 14706301 | NetAssetsOrFundBalancesEOY |
| Mission Description | THE ORGANIZATION IS A HOSPITAL WHICH PROVIDES INPATIENT AND OUTPATIENT CARE TO THE COMMUNITY, AS WELL AS HEALTH DIAGNOSTIC, INTERVENTION AND TREATMENT. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 51512647 | Expense |
| Grants | 0 | Grants |
| Revenue | 56783792 | Revenue |
| Description | PATIENT CARE: THE HOSPITAL PROVIDES INPATIENT AND OUTPATIENT HOSPITAL CARE TO THE COMMUNITY, INCLUDING GENERAL MEDICAL, INTENSIVE/CARDIAC CARE, WOMEN'S AND CHILDREN'S HEALTHCARE SERVICES AND INPATIENT DRUG AND ALCOHOL REHAB. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 4084733 | Expense |
| Grants | 0 | Grants |
| Revenue | 475817 | Revenue |
| Description | ANCILLARY SERVICES: THE HOSPITAL HAS ANCILLARY SERVICES WHICH PROVIDE THE NECESSARY DIRECT SUPPORT TO THE PATIENT CARE DEPARTMENTS. SOME OF THE ANCILLARY SERVICES INCLUDE HOUSEKEEPING, NUTRITION, AND STERILE SUPPLY. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 4340877 | Expense |
| Grants | 0 | Grants |
| Revenue | 17123817 | Revenue |
| Description | HEALTH DIAGNOSTIC, INTERVENTION, AND TREATMENT: THE HOSPITAL ALSO OFFERS OUTPATIENT DIAGNOSTIC IMAGING SERVICES. SOME OF THE RADIOLOGY DEPARTMENT SERVICES INCLUDE RADIOLOGY DIAGNOSTIC, EKG, ULTRASOUND, MRI, NUCLEAR MEDICINE, CT SCAN AND PET SCAN. | Description |
Activity Other ActivityOther (2 entries)
| ExpenseExpense | GrantsGrants | RevenueRevenue | DescriptionDescription |
|---|---|---|---|
| 4117585 | 0 | 14965889 | LABORATORY SERVICES: THE HOSPITAL ALSO HAS SEVERAL LABORATORY DEPARTMENTS INCLUDING PATHOLOGY, HEMATOLOGY, MICROBIOLOGY, CHEMISTRY, LAB DIAGNOSTIC AND BLOODBANK. |
| 1609466 | 0 | 1264015 | WELLNESS CENTER: THE HOSPITAL OPERATES A WELLNESS CENTER FOR THE BENEFIT OF THE COMMUNITY TO PROMOTE OVERALL PHYSICAL WELL-BEING. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 5727051 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 0 | TotalOfOtherProgramServiceGrnt |
| Total Of Other Program Service Rev | 16229904 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 65665308 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 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 | 0 | 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 | 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 | 36 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 829 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | DANIAL HONERBRINK CFO | NamePerson |
| Telephone Number | 3043677100 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1325 LOCUST AVENUE | AddressLine1 |
| City | FAIRMONT | City |
| State | WV | State |
| ZIP Code | 26554 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| MIKE MARTIN | ||||||||
| CHAIRMAN OF BOARD | 0 | X | 0 | 0 | 0 | |||
| TONI NESSELROTTE | ||||||||
| VICE-CHAIRMAN OF BOARD | 0 | X | 0 | 0 | 0 | |||
| PATRICK BONASSO MD | ||||||||
| SECRETARY OF BOARD | 0 | X | 0 | 0 | 0 | |||
| RANDY ELLIOTT | ||||||||
| TREASURER OF BOARD | 0 | X | 0 | 0 | 0 | |||
| JOEDY DARISTOTLE MD | ||||||||
| BOARD DIRECTOR | 0 | X | 0 | 0 | 0 | |||
| REV WESLEY DOBBS | ||||||||
| BOARD DIRECTOR | 0 | X | 0 | 0 | 0 | |||
| DAVID FOX | ||||||||
| BOARD DIRECTOR | 0 | X | 0 | 0 | 0 | |||
| JOHN PANZA | ||||||||
| BOARD DIRECTOR | 0 | X | 0 | 0 | 0 | |||
| ROBIN SMITH DC | ||||||||
| BOARD DIRECTOR | 0 | X | 0 | 0 | 0 | |||
| WALTER OSBORNE | ||||||||
| BOARD DIRECTOR | 0 | X | 0 | 0 | 0 | |||
| ROBERT MARQUARDT | ||||||||
| CEO/PRESIDENT | 40 | 294117 | 0 | 17588 | X | |||
| DANIEL HONERBRINK | ||||||||
| CFO/VP OF FINANCE | 40 | 193023 | 0 | 1974 | X | |||
| JOHN PETROV | ||||||||
| VICE PRESIDENT HUMAN RESOURCES | 40 | 166528 | 0 | 17058 | X | |||
| MARGARET COSTER | ||||||||
| VICE PRESIDENT PATIENT SERVICES | 40 | 133349 | 0 | 12711 | X | |||
| TERESA BONASSO | ||||||||
| VICE PRESIDENT QUALITY MANAGEMENT | 40 | 121114 | 0 | 25248 | X | |||
| KIMBERLY CHEUVRONT | ||||||||
| VICE PRESIDENT BUSINESS OPERATIONS | 40 | 116960 | 0 | 15378 | X | |||
| LORI HELMICK | ||||||||
| DIRECTOR SURGICAL SERVICES | 40 | 102468 | 0 | 23434 | X | |||
| CAROL WEBER | ||||||||
| DIRECTOR EMERGENCY SERVICES | 40 | 101973 | 0 | 24306 | X | |||
| MICHAEL SENGEWALT | ||||||||
| FORMER CFO | 0 | 105351 | 0 | 0 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1334883 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 137697 | TotalOtherCompensation |
| Number Individuals GT100 K | 9 | NumberIndividualsGT100K |
| Formers Listed | 1 | 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 |
|---|---|---|---|---|---|
| THEREX INC | |||||
| DEPT AT 952740 | ATLANTA | GA | 311922740 | THERAPY SERVICES | 1581869 |
| SODEXO | |||||
| PO BOX 536922 | ATLANTA | GA | 303536922 | DIETARY MANAGEMENT | 1095228 |
| DIAMOND HEALTHCARE CORP | |||||
| PO BOX 85050 | RICHMOND | VA | 23285 | BEHAVIORAL MEDICINE SERVICES | 929774 |
| PREMIER ANESTHESIA LLC | |||||
| 2655 NORTHWINDS PARKWAY | ALPHARETTA | GA | 30009 | ANESTHESIA SERVICES | 565414 |
| FAIRMONT HOME REHABILITATION | |||||
| 1126 WORTHINGTON DRIVE | BRIDGEPORT | WV | 26330 | HOME HEALTH REHABILITATION SERVICES | 520033 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 30 | NumberOfContractorsGT100K |
| Federated Campaigns | 0 | FederatedCampaigns |
| Membership Dues | 0 | MembershipDues |
| Fundraising Events | 0 | FundraisingEvents |
| Related Organizations | 0 | RelatedOrganizations |
| Government Grants | 0 | GovernmentGrants |
| All Other Contributions | 27637 | AllOtherContributions |
| Noncash Contributions | 0 | NoncashContributions |
| Total Contributions | 27637 | TotalContributions |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 88876376 | TotalRevenueColumn |
| Related Or Exempt Function Income | 88876376 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 88876376 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 133179 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $133,179 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 333609 | Real |
| Personal | 0 | Personal |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
| Personal | 0 | Personal |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 333609 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 333609 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $333,609 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 4045329 | Securities |
| Other | 0 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 3830961 | Securities |
| Other | 9928 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 214368 | Securities |
| Other | -9928 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 204440 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $204,440 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrbtns Rprtd Fundraising Events | 0 | CntrbtnsRprtdFundraisingEvents |
| Gross Sales Of Inventory | 472938 | GrossSalesOfInventory |
| Cost Of Goods Sold | 613198 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -140260 | TotalRevenueColumn |
| Related Or Exempt Function Income | -140260 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|---|
| HEALTHPLEX FITNESS CENTER REVENUES | 624100 | 1264015 | 1264015 | 0 | $0 |
| LIFELINE REVENUE | 624100 | 66583 | 66583 | 0 | $0 |
| MEDICAID ELECTRONIC HEALTH RECORD REVENUE | 624100 | 757597 | 757597 | 0 | $0 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 108272 | TotalRevenueColumn |
| Related Or Exempt Function Income | 108272 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 2196467 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 91631448 | TotalRevenueColumn |
| Related Or Exempt Function Income | 90932583 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $671,228 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1334883 | Total |
| Management And General | 1334883 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26912890 | Total |
| Program Services | 19797750 | ProgramServices |
| Management And General | 7115140 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1279848 | Total |
| Program Services | 896995 | ProgramServices |
| Management And General | 382853 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9520603 | Total |
| Program Services | 6672615 | ProgramServices |
| Management And General | 2847988 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2130138 | Total |
| Program Services | 1492930 | ProgramServices |
| Management And General | 637208 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 531997 | Total |
| Program Services | 498437 | ProgramServices |
| Management And General | 33560 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 447673 | Total |
| Management And General | 447673 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 252731 | Total |
| Management And General | 252731 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9617264 | Total |
| Program Services | 6546561 | ProgramServices |
| Management And General | 3070703 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 441953 | Total |
| Program Services | 40238 | ProgramServices |
| Management And General | 401715 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 512537 | Total |
| Program Services | 130202 | ProgramServices |
| Management And General | 382335 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2200836 | Total |
| Program Services | 676650 | ProgramServices |
| Management And General | 1524186 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 92442 | Total |
| Program Services | 55967 | ProgramServices |
| Management And General | 36475 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1239187 | Total |
| Program Services | 868546 | ProgramServices |
| Management And General | 370641 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4395045 | Total |
| Program Services | 2855772 | ProgramServices |
| Management And General | 1539273 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 798148 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 798148 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| BAD DEBT EXPENSE | 13028753 | 13028753 | 0 | 0 |
| REPAIRS AND MAINTENANCE | 2006969 | 1056163 | 950806 | |
| TAXES AND ASSESSMENTS | 1525388 | 0 | 1525388 | |
| SUPPLIES AND MATERIALS | 10839253 | 9794820 | 1044433 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2348512 | Total |
| Program Services | 1252909 | ProgramServices |
| Management And General | 1095603 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 91457050 | Total |
| Program Services | 65665308 | ProgramServices |
| Management And General | 25791742 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 77517 | BOY |
| EOY | 2923367 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11972777 | BOY |
| EOY | 11308707 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1902660 | BOY |
| EOY | 205208 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1670504 | BOY |
| EOY | 1797893 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1568906 | BOY |
| EOY | 1029642 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 93793331 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 63848857 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33528448 | BOY |
| EOY | 29944474 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9186381 | BOY |
| EOY | 6429722 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 951841 | BOY |
| EOY | 924123 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 60859034 | BOY |
| EOY | 54563136 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12244253 | BOY |
| EOY | 14520835 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16708035 | BOY |
| EOY | 16068946 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5568121 | BOY |
| EOY | 3435648 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4899601 | BOY |
| EOY | 5831406 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 39420010 | BOY |
| EOY | 39856835 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21439024 | BOY |
| EOY | 14706301 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21439024 | BOY |
| EOY | 14706301 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 60859034 | BOY |
| EOY | 54563136 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 174398 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -6907121 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 1 | GrantsOtherOrganizations |
| Grants Other Organizations | $11,085 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 0 | OtherActivities |
| Total Lobbying Expenditures IIB | 11085 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SchC_P2B_S00_L01 | Identifier |
| Return Reference | Schedule C, Part II-B, Line 1 | ReturnReference |
| Explanation | THE HOSPITAL PAYS MEMBERSHIP DUES TO AN ORGANIZATION THAT HAS VARIOUS LOBBYING EFFORTS. A PERCENTAGE OF THE TOTAL DUES IS ATTRIBUTED TO POLITICAL ACTIVITIES. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 1169709 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 1442806 | OtherCostOrOtherBasis |
| Book Value | 2612515 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 36538522 | OtherCostOrOtherBasis |
| Depreciation | 18034269 | Depreciation |
| Book Value | 18504253 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 3194115 | OtherCostOrOtherBasis |
| Depreciation | 1803008 | Depreciation |
| Book Value | 1391107 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 51378179 | OtherCostOrOtherBasis |
| Depreciation | 44011580 | Depreciation |
| Book Value | 7366599 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 70000 | OtherCostOrOtherBasis |
| Depreciation | 0 | Depreciation |
| Book Value | 70000 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 29944474 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| THIRD PARTY SETTLEMENTS | $4,417,597 |
| RELATED PARTY PAYABLE | $50,809 |
| PROFESSIONAL & GENERAL INS. LIABILITY | $1,363,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 5831406 | TotalOfAmounts |
| Total Revenue | 91631448 | TotalRevenue |
| Total Expenses | 91457050 | TotalExpenses |
| Excess Or Deficit For Year | 174398 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -414289 | NetUnrealizedGLOnInvestments |
| Donated Services And Facilities | 0 | DonatedServicesAndFacilities |
| Investment Expenses | 0 | InvestmentExpenses |
| Prior Period Adjustments | 0 | PriorPeriodAdjustments |
| Other | $0 | OtherAmount |
| Total Adjustments | -414289 | TotalAdjustments |
| Excess Or Deficit Per FS | -239891 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 91830489 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -414289 | NetUnrealizedGainsInvestments |
| Donated Srvc And Use Of Facilities | 0 | DonatedSrvcAndUseOfFacilities |
| Recoveries Of Prior Year Grants | 0 | RecoveriesOfPriorYearGrants |
| Other Revenues | 0 | OtherRevenues |
| Revenue Not Rptd F990 | -414289 | RevenueNotRptdF990 |
| Revenue Subtotal | 92244778 | RevenueSubtotal |
| Investment Expenses Not Included | 0 | InvestmentExpensesNotIncluded |
| Other Revenues Not Included | -613330 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -613330 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 91631448 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 92070380 | TotExpensesEtcAuditedFinclStmt |
| Donated Services Use Of Facilities | 0 | DonatedServicesUseOfFacilities |
| Prior Year Adjustments | 0 | PriorYearAdjustments |
| Losses Reported | 0 | LossesReported |
| Other Expenses Included | 613330 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 613330 | ExpensesNotRptdF990 |
| Expenses Subtotal | 91457050 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 0 | InvestmentExpensesNotIncluded2 |
| Other Expenses Not Included | 0 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 91457050 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SchD_P12_S00_L04b | Schedule D, Part XII, Line 4b | COST OF GOODS SOLD - FOOD: -613,198 CLASSIFICATION OF REVENUES AS EXPENSES: -132 |
| SchD_P13_S00_L02d | Schedule D, Part XIII, Line 2d | COST OF GOODS SOLD - FOOD: 613,198 REVENUES CLASSIFIED AS EXPENSES: 132 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $13,028,849 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 26635564 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 32037416 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -5401852 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 0 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAIRMONT GENERAL HOSPITAL INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1325 LOCUST AVENUE | AddressLine1 |
| City | FAIRMONT | City |
| State | WV | State |
| ZIP Code | 26554 | 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 | FAIRMONT GENERAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part VI Form990ScheduleHPartVI (7 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SchH_P01_S00_L07 | Schedule H, Part I, Line 7 | COSTING METHODOLOGY IS COST TO CHARGE RATIO USING THE 2011 FILED MEDICARE COST REPORT. |
| SchH_P03_S0A_L04 | Schedule H, Part III, Section A, Line 4 | PATIENT ACCOUNTS RECEIVABLE ARE CARRIED AT THE ORIGINAL CHARGE LESS AN ESTIMATE MADE FOR DOUBTFUL OR UNCOLLECTIBLE ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. THE ALLOWANCE IS BASED UPON A REVIEW OF THE OUTSTANDING BALANCES AGED BY FINANCIAL CLASS. MANAGEMENT USES COLLECTION PERCENTAGES BASED UPON HISTORICAL COLLECTION EXPERIENCE TO DETERMINE COLLECTIBILITY. MANAGEMENT ALSO REVIEW TROUBLED, AGED ACCOUNTS TO DETERMINE COLLECTION POTENTIAL. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ONT HE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFERTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. RECOVERIES OF ACCOUNTS PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION TO THE PROVISION FOR BAD DEBT EXPENSE WHEN RECEIVED. INTEREST IS NOT CHARGED ON PATIENT ACCOUNTS RECEIVABLE. |
| SchH_P03_S0B_L08 | Schedule H, Part III, Section B, Line 8 | THE HOSPITAL PROVIDES CARE TOT HE COMMUNITY AT A COST IN EXCESS OF THE PAYMENT RECEIVED FOR MEDICARE PATIENTS. THIS ABSORPTION OF COSTS BENEFITS THE COMMUNITY THE ORGANIZATION SERVES. LINE 6 WAS DETERMINED USING THE COST TO CHARGE RATIO OF 1.202806 FROM THE 2011 MEDICARE COST REPORT FROM WORKSHEET D-1. THE TITLE XVIII PPS HOSPITAL GENERAL INPATIENT ROUTINE SERVICE COST TO CHARGE RATIO WAS MULTIPLIED BY THE MEDICARE RECEIPTS IN LINE 5. |
| SchH_P03_S0C_L09b | Schedule H, Part III, Section C, Line 9b | THE ORGANIZATION'S DEBT COLLECTION POLICY IS TITLED TEH CREDIT ADN COLLECTION POLICY. IT DISCUSSSES NON-DISCRIMINATION OF SERVICE, PAYMENT RESPONSIBILITIES, INSURED PATIENTS, PRE-ADMISSION PROGRAM, PRE-ADMISSION DEPOSITS, THIRD PARTY LITIGATION, PAYMENT ARRANGEMENTS, PAYMENT AGREEMENTS AND REFERRED FOR OUTSIDE COLLECTION AND LEGAL ACTION. THERE IS NO DISCUSSION OF CHARITY CARE IN THIS POLICY. HOWEVER, THE ORGANIZATION DOES HAVE A SEPARATE CHARITY CARE POLICY. |
| SchH_P06_S00_L02 | Schedule H, Part VI, Line 2 | THE ORGANIZATION WORKS WITH OTHER VARIOUS ORGANIZATIONS IN THE COMMUNITY TO PROVIDE MULTI-PHASIC AND LAB TESTING FOR THE PUBLIC. THE ORGANIZATION ALSO UTILIZES STELLITE LOCATIONS AND ADJUSTS ITS HOURS OF SERVICE TO APPROPRIATELY SERVICE THE COMMUNITY'S NEEDS. THE ORGANIZATION ALSO CONDUCTS HEALTH FAIRS AT VARIOUS LOCATIONS THROUGHOUT THE COMMUNITY DURING THE YEAR. |
| SchH_P06_S00_L03 | Schedule H, Part VI, Line 3 | THE ORGANIZATION EMPLOYS A PATIENT ELIGIBILITY ADVOCATE IN ITS PATIENT ACCOUNTING DEPARTMENT. THIS EMPLOYEE WORKS WITH PATIENTS TO ASSIST THEM WITH THEIR ELIGIBILITY AND FILING FOR STATE AND FEDERAL GOVERNMENTAL PROGRAMS. THIS EMPLOYEE ALSO WORKS WITH OTHER INDIVIDUALS WHO ARE ON THE ORGANIZATION'S FINANCIAL COUNSELING STAFF. IF A PATIENT IS DETERMINED NOT ELIGIBLE FOR GOVERNMENT PROGRAMS, THEY ARE TAKEN TO A FINANCIAL COUNSELOR WHO WILL ASSESS HIS OR HER ELIGIBILITY FOR FINANCIAL ASSISTANCE OR CHARITY CARE. |
| SchH_P06_S00_L04 | Schedule H, Part VI, Line 4 | THE ORGANIZATION SERVES MARION COUNTY AND OTHER SURROUNDING AREAS IN NORTH CENTRAL WEST VIRGINIA. THE AREA SERVED IS A SMALL, RURAL COMMUNITY. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 1 | 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 (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROBERT MARQUARDT | |||||||||||||
| 294117 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 17588 | 0 | 311705 | 0 | 0 | 0 |
| DANIEL HONERBRINK | |||||||||||||
| 193023 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1974 | 0 | 194997 | 0 | 0 | 0 |
| JOHN PETROV | |||||||||||||
| 166528 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 17058 | 0 | 183586 | 0 | 0 | |
| MARGARET COSTER | |||||||||||||
| 133349 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 12711 | 0 | 146060 | 0 | 0 | 0 |
| TERESA BONASSO | |||||||||||||
| 121114 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 25248 | 0 | 146362 | 0 | 0 | 0 |
| KIMBERLY CHEUVRONT | |||||||||||||
| 116960 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 15378 | 0 | 132338 | 0 | 0 | 0 |
| MICHAEL SENGEWALT | |||||||||||||
| 105351 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 105351 | 0 | 0 | 0 |
| LORI HELMICK | |||||||||||||
| 102468 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 23434 | 0 | 125902 | 0 | 0 | 0 |
| CAROL WEBER | |||||||||||||
| 101973 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 24306 | 0 | 126279 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SchJ_P01_S00_L04 | Identifier |
| Return Reference | Schedule J, Part I, Line 4 | ReturnReference |
| Explanation | MICHAEL SENGEWALT, FORMER VP FINANCE/CFO, RECEIVED $105,351 IN SEVERANCE PAY IN FISCAL YEAR 2011. MR. SENGEWALT WAS NO LONGER EMPLOYED BY THE ORGANIZATION IN MID 2010. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Issuer EINIssuerEIN | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|
| MARION COUNTY COMMISSION | ||||||
| 556000346 | 2007-07-01 | 13700000 | DESIGN, CONSTRUCTION AND EQUIPPING OF HEALTHPLEX FACILITY | 0 | 1 | 0 |
| WEST VIRGINIA HOSPITAL FINANCE AUTHORITY | ||||||
| 621256910 | 2008-02-01 | 4385000 | REFUND THE SERIES 1994 BONDS, FUND DEBT SERVICE RESERVE FUND, PAY ISSUANCE COSTS | 0 | 1 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Amount RetiredAmountRetired | Amount Bond DefeasedAmountBondDefeased | Total ProceedsTotalProceeds | Amount In Reserve FundAmountInReserveFund | Capitalized InterestCapitalizedInterest | Refunding EscrowRefundingEscrow | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Credit EnhancementCreditEnhancement | Working Capital ExpendituresWorkingCapitalExpenditures | Capital ExpendituresCapitalExpenditures | Other Spent ProceedsOtherSpentProceeds | Amount UnspentAmountUnspent | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
| 0 | 0 | 0 | 0 | 1 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI | Total Private Business UseTotalPrivateBusinessUse | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 | 0 |
| 0 | 0 | 0 | 0 | 0 | 0 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| PATRICK BONASSO MD | |||
| DR BONASSO IS THE SECRETARY OF THE BOARD OF DIRECTORS | 2241 | THE ORGANIZATION PROVIDES PHYSICIAN STAFFING TO THE PRIVATE MEDICAL PRACTICE OF DR BONASSO. THE NET REVENUES GENERATED BY THESE PHYSICIANS ARE OFFSET BY PRIVATE PHYSICIAN EXPENSES. | 0 |
| JOEDY DARISTOTLE MD | |||
| DR DARISTOTLE IS ON THE BOARD OF DIRECTORS | 2241 | DR DARISTOTLE HAS MEDICAL STAFF PRIVILEGES AT THE ORGANIZATION. | 0 |
| J MIKE MARTIN | |||
| MR MARTIN IS THE CHAIRMON OF THE ORGANIZATIONS BOARD OF DIRECTORS | 59145 | MR MARTIN IS THE PRESIDENT OF FK EVEREST, AN ELECTRICAL CONTRACTING VENDOR. THE ORGANIZATION UTILIZES THIS VENDOR FOR SPECIAL PROJECTS. | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| F990_P06_S0B_L11b | Form 990, Part VI, Section B, Line 11b | THE TAX RETURN IS PREPARED BY THE HOSPITAL ACCOUNTING DEPARTMENT. THE RETURN IS REVIEWED BY BOTH THE CONTROLLER AND THE CHIEF FINANCIAL OFFICER. |
| F990_P06_S0B_L12c | Form 990, Part VI, Section B, Line 12c | ANNUALLY, THE ORGANIZATION WILL RECEIVE A CONFLICT OF INTEREST DISCLOSURE FROM ALL BOARD MEMBERS, HOSPITAL DIRECTORS, MANAGERS, AND OTHER SENIOR MANAGEMETN LEADERSHIP TEAM MEMBERS. THE BOARD WILL REVIEW THESE TO DETERMINE IF ANYONE HAS A POTENTIAL CONFLICT OF INTEREST. |
| F990_P06_S0B_L15 | Form 990, Part VI, Section B, Line 15 | THE COMPENSATION COMMITTEE OF THE BOARD REVIEW ANNUALLY THE COMPENSATION OF THE CEO. THE CEO WILL REVIEW ANNUALLY THE COMPENSATION OF SENIOR MANAGEMENT. |
| F990_P06_S0C_L19 | Form 990, Part VI, Section C, Line 19 | THE HOSPITAL'S FORMS 1023 AND ANNUAL 990 ARE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. ANY INQUIRIES FROM THE PUBLIC ARE TOLD TO ADDRESS THEIR REQUEST IN WRITING TO THE CHIEF FINANCIAL OFFICER, AND THE HOSPITAL WILL PROVIDE COPIES AS REQUESTED. |
| F990_P11_S00_L05 | Form 990, Part XI, Line 5 | EQUITY TRANSFERS TO RELATED ORGANIZATIONS (FAIRMONT PHYSICIANS NETWORK AND FAIRMONT MANAGEMENT SERVICES ORGANIZATION): $6,592,832; CHANGE IN UNREALIZED GAINS/LOSSES: $414,289; JOINT VENTURE REVENUE NOT INCLUDED IN 990 (DUE TO SEPARATE ENTITY - MHE): ($100,000) |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Total IncomeTotalIncome | EOY AssetsEOYAssets | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| FAIRMONT MANAGEMENT SERVICES ORGANIZATION | |||||||||
| 211 MARION SQUARE | FAIRMONT | WV | 26554 | 550739131 | OFFICE MANAGEMENT SERVICES FOR PHYSICIANS IN MARION COUNTY | WV | 699692 | 420373 | FAIRMONT GENERAL HOSPITAL INC |
| MARION COUNTY PHYSICIANS-HOSPITAL ORGANIZATION INC | |||||||||
| 1325 LOCUST AVENUE | FAIRMONT | WV | 26554 | 550737630 | NETWORK OF PHYSICIAN AND HOSPITAL SERVICE CONTRACTING | WV | 0 | 0 | FAIRMONT GENERAL HOSPITAL INC |
| MARION HEALTH ENTERPRISES INC | |||||||||
| 1325 LOCUST AVENUE | FAIRMONT | WV | 26554 | 541916408 | 50% OF JOINT VENTURE OF DURABLE HOME MEDICAL EQUIPMENT COMPANY | WV | 100000 | 957305 | 50 PERCENT OWNED BY FAIRMONT GENERAL HOSPITAL INC |
| FAIRMONT PHYSICIANS NETWORK | |||||||||
| 211 MARION SQUARE | FAIRMONT | WV | 26554 | 550738905 | NETWORK OF PHYSICIANS | WV | 6678803 | 1328551 | FAIRMONT GENERAL HOSPITAL INC |
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|
| FAIRMONT GENERAL HOSPITAL VOLUNTEER ASSOCIATION INC | |||||||
| 1325 LOCUST AVENUE | FAIRMONT | WV | 26554 | 550369033 | ORGANIZES VOLUNTEER SERVICES FOR THE HOSPITAL | WV | N/A |
| PROFESSIONAL AND GENERAL LIABILITY SELF-COVERAGE | |||||||
| 1325 LOCUST AVENUE | FAIRMONT | WV | 26554 | 550622861 | ADMINISTERS THE SELF-INSURANCE COVERAGE FOR THE HOSPITAL AND ITS EMPLOYEES | WV | N/A |
| FAIRMONT GENERAL HOSPITAL FOUNDATION INC | |||||||
| 1325 LOCUST AVENUE | FAIRMONT | WV | 26554 | 550666256 | FUNDRAISING ORGANIZATION FOR THE HOSPITAL | WV | N/A |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | 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 |