MID VALLEY HOSPITAL ASSOC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- MID VALLEY HOSPITAL ASSOC (EIN 24-0795458)
- Tax period
- 2011-07-01 to 2011-12-31
- Filed
- 2012-11-15
- IRS object ID
- 201243209349306489
- 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 D
- Schedule H
- Schedule J
- Schedule L
- Schedule N
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-15T14:43:04-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 250988255 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARBIS WALKER LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5700 CORPORATE DRIVE STE 650 | AddressLine1 |
| City | PITTSBURGH | City |
| State | PA | State |
| ZIP Code | 15237 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 240795458 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MID VALLEY HOSPITAL ASSOCIATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MIDV | NameControl |
| Phone | 7173835500 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 S MAIN STREET | AddressLine1 |
| City | PECKVILLE | City |
| State | PA | State |
| ZIP Code | 18452 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KAREN M MURPHY RN PHD | Name |
| Title | PRESIDENT & CEO | Title |
| Phone | 7173835500 | Phone |
| Date Signed | 2012-11-15 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JEFFREY J PETRELL CPA | Name |
| PTIN | P00138808 | PTIN |
| Phone | 4126356270 | Phone |
| Date Prepared | 2012-11-15 | DatePrepared |
| 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) |
|---|---|---|
| Terminated Return | X | TerminatedReturn |
| Name Of Principal Officer Person | KAREN M MURPHY RN PHD | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 S MAIN STREET | AddressLine1 |
| City | PECKVILLE | City |
| State | PA | State |
| ZIP Code | 18452 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 6758346 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.MTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1908 | YearFormation |
| State Legal Domicile | PA | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE MEDICAL AND NURSING CARE SERVICES TO PATIENTS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 178 | TotalNbrEmployees |
| Total Nbr Volunteers | 9 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 172779 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 2952 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 13672286 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 6678524 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 2982 | InvestmentIncomePriorYear |
| Investment Income Current Year | 2338 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 188890 | OtherRevenuePriorYear |
| Other Revenue Current Year | 74532 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 14036937 | TotalRevenuePriorYear |
| Total Revenue Current Year | 6758346 | 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 | 6806409 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 3883799 | 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 | 7382423 | OtherExpensePriorYear |
| Other Expenses Current Year | 2950839 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 14188832 | TotalExpensesPriorYear |
| Total Expenses Current Year | 6834638 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -151895 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -76292 | RevenuesLessExpensesCY |
| Total Assets BOY | 4652895 | TotalAssetsBOY |
| Total Assets EOY | 0 | TotalAssetsEOY |
| Total Liabilities BOY | 1900393 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 0 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 2752502 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 0 | NetAssetsOrFundBalancesEOY |
| Mission Description | MID VALLEY HOSPITAL, THROUGH ITS COMMUNITY HEALTH ASSESSMENT, WILL BE ACCOUNTABLE FOR MEETING COMMUNITY NEEDS IN A MANNER THAT REFLECTS EXCELLENCE IN CARE AND WITH RESPECT AND DIGNITY TO THE PATIENT. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 5742977 | Expense |
| Revenue | 6753056 | Revenue |
| Description | NON-PROFIT CRITICAL ACCESS HOSPITAL LOCATED IN PECKVILLE, PENNSYLVANIA OPERATING 25 INPATIENT CARE BEDS AND PROVIDING OUTPATIENT, HOME HEALTH, AND EMERGENCY CARE SERVICES TO RESIDENTS OF THE REGION.TOTAL PATIENT DAYS - 2,452EMERGENCY ROOM VISITS - 3,927OUTPATIENT VISITS (EXCLUDING EMERGENCY ROOM) - 11,396 | Description |
| Total Program Service Expense | 5742977 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | 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 | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 1 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 14 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 178 | 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 |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Excess Business Holdings | 0 | ExcessBusinessHoldings |
| Taxable Distributions | 0 | TaxableDistributions |
| Distribution To Donor | 0 | DistributionToDonor |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 0 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | PA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | THOMAS KELLY | NamePerson |
| Telephone Number | 5703402991 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 700 QUINCY AVE | AddressLine1 |
| City | SCRANTON | City |
| State | PA | State |
| ZIP Code | 18510 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (14 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | FormerFormer |
|---|---|---|---|---|---|---|---|
| KAREN M MURPHY RN PHD | |||||||
| PRESIDENT & CEO | 4.00 | X | X | 0 | 331400 | 4495 | |
| ANN MARIE STEVENS RN BSN | |||||||
| DIRECTOR OF OPERATIONS | 40.00 | X | X | 100687 | 0 | 150 | |
| MARIA A MARSILI ESQ | |||||||
| CHAIRPERSON | 1.00 | X | X | 0 | 0 | 0 | |
| ROBERT A MAZZONI ESQ | |||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 | |
| RAJAN MULLOTH MD | |||||||
| MEDICAL STAFF PRESIDENT | 1.00 | X | X | 0 | 322116 | 18336 | |
| R SEAN BUCKMAN | |||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| LOUIS RAPOCH | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| ENRICO CESARINI | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| DAVID MORAN | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| JEFFREY HEMAK | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| JOHN LEMONCELLI PHD | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| FRANCES TARAMELLI | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| THOMAS KELLY | |||||||
| CFO | 4.00 | X | 0 | 199614 | 2242 | ||
| JAMES BRITTAIN | |||||||
| FORMER ACTING CFO | 4.00 | 0 | 157851 | 4806 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 100687 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1010981 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 30029 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EPMG | BusinessNameLine1 |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 182 S FRANKLIN STREET | AddressLine1 |
| City | WILKES BARRE | City |
| State | PA | State |
| ZIP Code | 18701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | EMERGENCY RM PHYS. | DescriptionOfServices |
| Compensation | 255341 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
| Government Grants | 2629 | GovernmentGrants |
| All Other Contributions | 323 | AllOtherContributions |
| Total Contributions | 2952 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE RE | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 6678524 | TotalRevenueColumn |
| Related Or Exempt Function Income | 6678524 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 6678524 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2338 | TotalRevenueColumn |
| Exclusion | $2,338 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 45694 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 45694 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 45694 | TotalRevenueColumn |
| Related Or Exempt Function Income | 45694 | RelatedOrExemptFunctionIncome |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| LABORATORY & X-RAY REV | 900099 | 18493 | 18493 |
| MEDICAL TRANSCRIPTS RE | 900099 | 3973 | 3973 |
| CAFETERIA REVENUE | 900099 | 2959 | 2959 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3413 | TotalRevenueColumn |
| Related Or Exempt Function Income | 3413 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 28838 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6758346 | TotalRevenueColumn |
| Related Or Exempt Function Income | 6753056 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $2,338 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 100837 | Total |
| Management And General | 100837 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3086420 | Total |
| Program Services | 2730427 | ProgramServices |
| Management And General | 355993 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 104284 | Total |
| Program Services | 89337 | ProgramServices |
| Management And General | 14947 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 592258 | Total |
| Program Services | 507370 | ProgramServices |
| Management And General | 84888 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1980 | Total |
| Management And General | 1980 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50950 | Total |
| Management And General | 50950 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 626962 | Total |
| Program Services | 315293 | ProgramServices |
| Management And General | 311669 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 91253 | Total |
| Program Services | 69225 | ProgramServices |
| Management And General | 22028 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 119451 | Total |
| Program Services | 87104 | ProgramServices |
| Management And General | 32347 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 539 | Total |
| Program Services | 470 | ProgramServices |
| Management And General | 69 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22024 | Total |
| Program Services | 12529 | ProgramServices |
| Management And General | 9495 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 152408 | Total |
| Program Services | 86705 | ProgramServices |
| Management And General | 65703 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 41985 | Total |
| Program Services | 23885 | ProgramServices |
| Management And General | 18100 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 928909 | 928909 | |
| SUPPLIES | 566467 | 556325 | 10142 |
| PHYSICIANS FEES | 307838 | 307838 | |
| REPAIRS AND MAINTENANCE | 23974 | 22961 | 1013 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16099 | Total |
| Program Services | 4599 | ProgramServices |
| Management And General | 11500 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6834638 | Total |
| Program Services | 5742977 | ProgramServices |
| Management And General | 1091661 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15550 | BOY |
| EOY | 0 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 593175 | BOY |
| EOY | 0 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1234448 | BOY |
| EOY | 0 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 55545 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 288409 | BOY |
| EOY | 0 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 179338 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 0 | LandBuildingsEquipmentBasis |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2204195 | BOY |
| EOY | 0 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 79835 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2400 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4652895 | BOY |
| EOY | 0 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 653771 | BOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 802540 | BOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 444082 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1900393 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2751857 | BOY |
| EOY | 0 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 645 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2752502 | BOY |
| EOY | 0 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4652895 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -76292 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -2676210 | 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 |
| General Explanation | SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: THE 2011 990 IS A SHORT YEAR RETURN FROM JULY 1, 2011 TO DECEMBER 31, 2011 SINCE THE ORGANIZATION CEASED OPERATIONS ON DECEMBER 31, 2011. | GeneralExplanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
| Total Revenue | 6758346 | TotalRevenue |
| Total Expenses | 6834638 | TotalExpenses |
| Excess Or Deficit For Year | -76292 | ExcessOrDeficitForYear |
| Other | -$2,676,210 | OtherAmount |
| Total Adjustments | -2676210 | TotalAdjustments |
| Excess Or Deficit Per FS | -2752502 | ExcessOrDeficitPerFS |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE SYSTEM FOLLOWS THE GUIDANCE FOR ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS THAT PRESCRIBES A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. THE GUIDANCE ALSO ADDRESSES DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, AND DISCLOSURE. GENERALLY, TAX RETURNS FOR YEARS ENDED JUNE 30, 2008, AND THEREAFTER REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | TEMPORARILY RESTRICTED - NET ASSETS RELEASED FROM RESTRICTIONS -645. EQUITY TRANSFER FROM AFFILIATE 242,959. TRANSFER OF NET ASSETS - DISSOLUTION -2,918,524. TOTAL TO SCHEDULE D, PART XI, LINE 8: -2,676,210. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent250 | X | Pcent250 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4417 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 4417 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 483735 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 147751 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 335984 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05690 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 488152 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 147751 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 340401 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05760 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 488152 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 147751 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 340401 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05760 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $227,778 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 2837060 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 3467110 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -630050 | 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 | MID VALLEY HOSPITAL ASSOCIATION | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 S MAIN STREET | AddressLine1 |
| City | PECKVILLE | City |
| State | PA | State |
| ZIP Code | 18452 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MID VALLEY HOSPITAL ASSOCIATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 256.000000000000 | FPGDiscountPercent |
| Explains Basis | 0 | ExplainsBasis |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 0 | IncludesPublicityMeasures |
| Actions On Nonpayment | 0 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 7: A COST-TO-CHARGE RATIO CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COSTS-TO-CHARGES IS THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON PART I, LINE 7. | |
| PART I, L7 COL(F): THE BAD DEBT EXPENSE OF 928,909 INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN A WAS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE OF TOTAL EXPENSES. | |
| PART III, LINE 4: MID VALLEY HOSPITAL'S FINANCIAL STATEMENTS DO NOT INCLUDE A BAD DEBT FOOTNOTE. THE BAD DEBT EXPENSE IS CALCULATED AS A PERCENTAGE OF MONTHLY REVENUE, BASED ON THE PERCENTAGE USED FOR THE BUDGET. THAT AMOUNT IS THEN ADJUSTED UP OR DOWN BASED UPON THE ACTUAL ACCOUNTS RECEIVABLE BALANCES, CASH COLLECTIONS, AND AMOUNTS WRITTEN OFF.A COST-TO-CHARGE RATIO CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COSTS-TO-CHARGES IS THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON LINES 2 AND 3 OF PART III. | |
| PART III, LINE 8: A COST-TO-CHARGE RATIO CALCULATED FROM WORKSHEET 2, RATIO OF PATIENT CARE COSTS-TO-CHARGES IS THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON PART III, LINE 6. | |
| PART V, SECTION B, LINE 19D: THE PREVAILING GROSS CHARGE FOR THE SERVICE RENDERED IS CHARGED TO THE PATIENT'S ACCOUNT. IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE THESE CHARGES ARE DISCOUNT ACCORDING TO HIS OR HER ABILITY TO PAY BASED UPON INCOME AND FAMILY SIZE. | MID VALLEY HOSPITAL ASSOCIATION |
| PART VI, LINE 2: MID VALLEY HOSPITAL DOES NOT CURRENTLY HAVE A FORMALIZED METHOD TO ASSESS THE COMMUNITY FOR ITS HEALTH NEEDS. IN THE NEXT YEAR, THE ORGANIZATION PLANS TO LAUNCH A MORE FORMALIZED PROCESS TO ASSESS OUR COMMUNITY NEEDS. | |
| PART VI, LINE 3: IN ACCORDANCE WITH THE FINANCIAL ASSISTANCE POLICY, WHEN INDIVIDUALS QUALIFY UNDER THIS POLICY, THE AMOUNT OF FREE OR DISCOUNTED SERVICE FOR WHICH THEY QUALIFY IS ADJUSTED OFF THE ACCOUNT AT THE TIME APPROVAL IS GRANTED. IF THEY QUALIFY FOR A DISCOUNT FROM ACTUAL CHARGES, THE ORGANIZATION WILL TRY TO SET THE PATIENT UP ON A MONTHLY PAYMENT PLAN. AS PART OF THE FINANCIAL ASSISTANCE POLICY, IF THEY HAVE BEEN APPROVED FOR FREE OR DISCOUNTED SERVICE IN THE PAST 6 MONTHS, THE APPROVAL WILL APPLY FOR THE CURRENT SERVICE AS WELL. FOR INDIVIDUALS THAT DO NOT QUALIFY UNDER THE FINANCIAL ASSISTANCE POLICY, THE NORMAL COLLECTION PRACTICES ARE FOLLOWED. | |
| PART VI, LINE 4: MID-VALLEY HOSPITAL IS A COMMUNITY BASED, CRITICAL ACCESS HOSPITAL, LOCATED IN PECKVILLE, PA. MID-VALLEY HOSPITAL SERVES THE RESIDENTS OF LACKAWANNA COUNTY, PENNSYLVANIA. LACKAWANNA COUNTY IS 459 SQUARE MILES AND HAS A POPULATION OF 208,801. THE 2009 ESTIMATED MEDIAN HOUSEHOLD INCOME WAS $44,481 WHICH IS BELOW THE PENNSYLVANIA ESTIMATED HOUSEHOLD INCOME OF $49,520. APPROXIMATELY 15% OF RESIDENTS LIVE IN POVERTY. | |
| PART VI, LINE 5: MID-VALLEY HOSPITAL IS A COMMUNITY BASED, CRITICAL ACCESS HOSPITAL, LOCATED AT 1400 MAIN ST., PECKVILLE, PA. A MEMBER OF THE MOSES TAYLOR HEALTH CARE SYSTEM, MID-VALLEY HOSPITAL'S CORE VALUE IS COMPASSIONATE, HIGH-QUALITY CARE. CONVENIENTLY LOCATED BETWEEN SCRANTON AND EYNON, PA., AND A STRONG SUPPORTER OF COMMUNITY PROGRAMS SUCH AS NUTRITION AND HEALTH FAIRS, AND THE ANNUAL HUNTERS' SCREENING PROGRAM, MID-VALLEY HOSPITAL HAS A WATCHFUL EYE ON THE HEALTH AND WELL-BEING OF ITS NEIGHBORS. SHOULD YOU HAVE AN EMERGENCY, OUTPATIENT SERVICES, OR NEED AN INPATIENT STAY, YOU CAN REST ASSURED THAT MID-VALLEY HOSPITAL WILL CARE FOR YOU LIKE FAMILY. SHOULD YOU NEED MORE EXTENSIVE SERVICES, ITS ASSOCIATION WITH THE MOSES TAYLOR HEALTH CARE SYSTEM AND PHYSICIANS HEALTH ALLIANCE WILL ASSURE THAT YOU WILL RECEIVE THE SAME ATTENTION THAT YOU HAVE COME TO EXPECT AT MID-VALLEY HOSPITAL. A MAJORITY OF ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS RESIDING IN PRIMARY SERVICE AREA AND ARE NOT EMPLOYEES OR CONTRACTORS OF THE ORGANIZATION OR FAMILY MEMBERS. THE ORGANIZATION USES SURPLUS FUNDS TO PROVIDE THE LATEST IN TECHNOLOGY TO IMPROVE PATIENT CARE. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (4 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KAREN M MURPHY RN PHD | |||||||||||||
| 0 | 325000 | 0 | 0 | 0 | 6400 | 0 | 0 | 0 | 4495 | 0 | 335895 | 0 | 0 |
| RAJAN MULLOTH MD | |||||||||||||
| 0 | 322116 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 18336 | 0 | 340452 | 0 | 0 |
| THOMAS KELLY | |||||||||||||
| 0 | 199614 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2242 | 0 | 201856 | 0 | 0 |
| JAMES BRITTAIN | |||||||||||||
| 0 | 157851 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 4806 | 0 | 162657 | 0 | 0 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| MARY CLAIRE CORNALL | |||
| FAMILY MEMBER OF ANN MARIE STEVENS, BOARD MEMBER/DIRECTOR OF OPERATIONS | 13199 | EMPLOYEE OF MID VALLEY HOSPITAL ASSOCIATION | 0 |
| ROBERT THOMAS | |||
| FAMILY MEMBER OF ANN MARIE STEVENS, BOARD MEMBER/DIRECTOR OF OPERATIONS | 26439 | EMPLOYEE OF MID VALLEY HOSPITAL ASSOCIATION | 0 |
Schedule N IRS990ScheduleN
Liquidation Table LiquidationTable
Liquidation Detail LiquidationDetail (7 entries)
| Description Of AssetDescriptionOfAsset | Date Of DistributionDateOfDistribution | FMV Of AssetFMVOfAsset | Method Of FMV DeterminationMethodOfFMVDetermination | EINEIN | Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode |
|---|---|---|---|---|---|---|---|---|
| PECKVILLE HOSPITAL COMPANY LLC | ||||||||
| CASH | 2011-12-31 | 678673 | BOOK VALUE | 452672049 | 4000 MERIDIAN BOULEVARD | FRANKLIN | TN | 37067 |
| PECKVILLE HOSPITAL COMPANY LLC | ||||||||
| ACCOUNTS RECEIVABLE | 2011-12-31 | 978210 | BOOK VALUE | 452672049 | 4000 MERIDIAN BOULEVARD | FRANKLIN | TN | 37067 |
| PECKVILLE HOSPITAL COMPANY LLC | ||||||||
| INVENTORY | 2011-12-31 | 288409 | BOOK VALUE | 452672049 | 4000 MERIDIAN BOULEVARD | FRANKLIN | TN | 37067 |
| PECKVILLE HOSPITAL COMPANY LLC | ||||||||
| BUILDING & EQUIPMENT | 2011-12-31 | 2058654 | BOOK VALUE | 452672049 | 4000 MERIDIAN BOULEVARD | FRANKLIN | TN | 37067 |
| PECKVILLE HOSPITAL COMPANY LLC | ||||||||
| LAND | 2011-12-31 | 38000 | BOOK VALUE | 452672049 | 4000 MERIDIAN BOULEVARD | FRANKLIN | TN | 37067 |
| PECKVILLE HOSPITAL COMPANY LLC | ||||||||
| INVESTMENTS | 2011-12-31 | 78903 | BOOK VALUE | 452672049 | 4000 MERIDIAN BOULEVARD | FRANKLIN | TN | 37067 |
| PECKVILLE HOSPITAL COMPANY LLC | ||||||||
| PREPAID EXPENSES | 2011-12-31 | 124114 | BOOK VALUE | 452672049 | 4000 MERIDIAN BOULEVARD | FRANKLIN | TN | 37067 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor | 0 | DirectorOfSuccessor |
| Employee Of Successor | 0 | EmployeeOfSuccessor |
| Owner Of Successor | 0 | OwnerOfSuccessor |
| Receive Compensation | 0 | ReceiveCompensation |
| Assets Distributed | 1 | AssetsDistributed |
| Required To Notify AG | 1 | RequiredToNotifyAG |
| AG Notified | 1 | AGNotified |
| Liabilities Paid | 1 | LiabilitiesPaid |
| Bonds Outstanding | 0 | BondsOutstanding |
| Bond Liabilities Discharged | 0 | BondLiabilitiesDischarged |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | MOSES TAYLOR FOUNDATION, INC. IS THE SOLE MEMBER OF THE CORPORATION. | |
| FORM 990, PART VI, SECTION A, LINE 7A | THE SOLE MEMBER (MOSES TAYLOR FOUNDATION, INC.) OF THE CORPORATION ELECTS THE BOARD MEMBERS. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE SOLE MEMBER (MOSES TAYLOR FOUNDATION, INC.) SHALL HAVE THE SOLE AND EXCLUSIVE RIGHT TO ACT WITH RESPECT TO THE FOLLOWING AFFAIRS OF THE CORPORATION: (A) AMENDMENT OF THE BYLAWS OR THE ARTICLES OF INCORPORATION OF THE CORPORATION (B) APPROVAL OF THE MERGER OR CONSOLIDATION OF THE CORPORATION WITH ANY OTHER ORGANIZATION OR ENTITY (C) ELECTION TO DISSOLVE AND WIND UP THE AFFAIRS OF THE CORPORATION (D) SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, THE PROPERTY AND ASSETS OF THE CORPORATION (E) APPROVAL OF ANNUAL OPERATING, CASH AND CAPITAL BUDGETS, AND MODIFICATIONS THEREOF (F) APPROVAL OF STRATEGIC PLANS (G) APPROVAL OF INCURRENCE OF DEBT OR CAPITAL EXPENDITURES WHICH ARE NOT OTHERWISE INCLUDED IN A BUDGET APPROVED BY THE MEMBERS (H) GUARANTEEING THE DEBTS OR OBLIGATIONS OF ANY OTHER PERSON, FIRM, CORPORATION, PARTNERSHIP, ASSOCIATION OR OTHER ENTITY (I) MATERIAL ADDITIONS OR DELETIONS OF SERVICES OR CESSATION OF SERVICES (J) SELECTION OR REMOVAL OF THE CHIEF OPERATING OFFICER (K) DEVELOPMENT OF MANAGED CARE STRATEGY FOR THE CORPORATION | |
| FORM 990, PART VI, SECTION B, LINE 11 | MID VALLEY HOSPITAL ASSOCIATION HAS A CPA FIRM PREPARE ITS FORM 990. THE RETURN IS COMPLETED IN DRAFT FORM AND REVIEWED BY MANAGEMENT OF THE ORGANIZATION. | |
| FORM 990, PART VI, SECTION B, LINE 12C | MID VALLEY HOSPITAL ANNUALLY REQUIRES ITS BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES TO FILL OUT A CONFLICTS OF INTEREST FORM. DURING BOARD MEETINGS, IF AN INTERESTED PARTY HAS A CONFLICT, HE OR SHE RECUSES THEMSELVES FROM VOTING. | |
| FORM 990, PART VI, SECTION B, LINE 15A | MID VALLEY HOSPITAL'S BOARD OF DIRECTORS ANNUALLY REVIEWS AND APPROVES THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT. | |
| FORM 990, PART VI, SECTION C, LINE 18 | MID VALLEY HOSPITAL MAKES ITS FORM 990 AND FORM 1023 AVAILABLE TO THE PUBLIC UPON REQUEST. | |
| FORM 990, PART VI, SECTION C, LINE 19 | MID VALLEY HOSPITAL DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC. | |
| FORM 990, PART XI, LINE 5: | TEMPORARILY RESTRICTED - NET ASSETS RELEASED FROM RESTRICTIONS -645. EQUITY TRANSFER FROM AFFILIATE 242,959. TRANSFER OF NET ASSETS - DISSOLUTION -2,918,524. TOTAL TO FORM 990, PART XI, LINE 5: -2,676,210. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C: | THE ORGANIZATION'S BOARD OF DIRECTORS ASSUME RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. THE PROCESS IS CONSISTENT WITH PRIOR YEARS AND HAS NOT CHANGED. | |
| FORM 990, PART VII, COLUMN B | THE OFFICER KAREN M. MURPHY, RN, PHD, PRESIDENT & CEO SPLITS THE HOURS WORKED PER WEEK BETWEEN EACH OF THE MOSES TAYLOR ENTITIES IN THE FOLLOWING MANNER: MOSES TAYLOR HOSPITAL - 30 HOURS MID VALLEY HOSPITAL ASSOCIATION - 4 HOURS MOSES TAYLOR FOUNDATION, INC - 1 HOUR MTH RESOURCES, INC. - 1 HOUR PHYSICIANS HEALTH ALLIANCE, INC. - 4 HOURS THE OFFICER JAMES G. BRITTAIN, FORMER ACTING CFO SPLITS THE HOURS WORKED PER WEEK BETWEEN EACH OF THE MOSES TAYLOR ENTITIES IN THE FOLLOWING MANNER: MOSES TAYLOR HOSPITAL - 32 HOURS MID VALLEY HOSPITAL ASSOCIATION - 4 HOURS MOSES TAYLOR FOUNDATION, INC - 1 HOUR MTH RESOURCES, INC. - 1 HOUR PHYSICIANS HEALTH ALLIANCE, INC. - 2 HOURS THE OFFICER THOMAS KELLY, CFO SPLITS THE HOURS WORKED PER WEEK BETWEEN EACH OF THE MOSES TAYLOR ENTITIES IN THE FOLLOWING MANNER: MOSES TAYLOR HOSPITAL - 32 HOURS MID VALLEY HOSPITAL ASSOCIATION - 4 HOURS MOSES TAYLOR FOUNDATION, INC - 1 HOUR MTH RESOURCES, INC. - 1 HOUR PHYSICIANS HEALTH ALLIANCE, INC. - 2 HOURS |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|
| MOSES TAYLOR FOUNDATION INC | ||||||||||
| PO BOX 992 | SCRANTON | PA | 18501 | 232281586 | HEALTH CARE | PA | 501(C)(3) | LINE 7 | 0 | |
| MTH RESOURCES INC | ||||||||||
| PO BOX 1428 | SCRANTON | PA | 18501 | 232281585 | HEALTH CARE | PA | 501(C)(3) | LINE 11A, I | 0 | MOSES TAYLOR FOUNDATION INC |
| MOSES TAYLOR HOSPITAL | ||||||||||
| 700 QUINCY AVE | SCRANTON | PA | 18510 | 240795461 | HEALTH CARE | PA | 501(C)(3) | LINE 3 | 0 | MOSES TAYLOR FOUNDATION INC |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PHYSICIANS HEALTH ALLIANCE INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1401 ELECTRIC STREET | AddressLine1 |
| City | DUNMORE | City |
| State | PA | State |
| ZIP Code | 18509 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 232824685 | EIN |
| Primary Activity | HEALTH CARE | PrimaryActivity |
| Legal Domicile State | PA | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MTH RESOURCES INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| 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 | 1 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |