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MID VALLEY HOSPITAL ASSOC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
MID VALLEY HOSPITAL ASSOC (EIN 24-0795458)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-05-13
IRS object ID
201131339349303138
Schema version
2009v1.7
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-05-13T14:07:10-05:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Carbis Walker LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line15700 Corporate Drive Ste 650AddressLine1
CityPittsburghCity
StatePAState
ZIP Code15237ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN240795458EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MID VALLEY HOSPITAL ASSOCIATIONBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMIDVNameControl
Phone7173835500Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11400 S MAIN STREETAddressLine1
CityPECKVILLECity
StatePAState
ZIP Code18452ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameKaren M Murphy RN PhDName
TitlePresident & CEOTitle
Phone7173835500Phone
Date Signed2011-05-09DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJeffrey J Petrell CPAName
Phone4126356270Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonKaren M Murphy RN PhDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11400 S MAIN STREETAddressLine1
CityPECKVILLECity
StatePAState
ZIP Code18452ZIPCode
FieldValueIRS element (for citing)
Gross Receipts14884350GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitewww.mth.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1908YearFormation
State Legal DomicilePAStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE MEDICAL AND NURSING CARE SERVICES TO PATIENTS.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees200TotalNbrEmployees
Total Nbr Volunteers13TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year164166ContributionsGrantsPriorYear
Contributions Grants Current Year137329ContributionsGrantsCurrentYear
Program Service Revenue Prior Year13556775ProgramServiceRevenuePriorYear
Program Service Revenue CY14576753ProgramServiceRevenueCY
Investment Income Prior Year9628InvestmentIncomePriorYear
Investment Income Current Year7638InvestmentIncomeCurrentYear
Other Revenue Prior Year113060OtherRevenuePriorYear
Other Revenue Current Year149286OtherRevenueCurrentYear
Total Revenue Prior Year13843629TotalRevenuePriorYear
Total Revenue Current Year14871006TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year6860848SalariesEtcPriorYear
Salaries Etc Current Year7047239SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year5908916OtherExpensePriorYear
Other Expenses Current Year7614862OtherExpensesCurrentYear
Total Expenses Prior Year12769764TotalExpensesPriorYear
Total Expenses Current Year14662101TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1073865RevenuesLessExpensesPriorYear
Revenues Less Expenses CY208905RevenuesLessExpensesCY
Total Assets BOY5467978TotalAssetsBOY
Total Assets EOY5447654TotalAssetsEOY
Total Liabilities BOY2718716TotalLiabilitiesBOY
Total Liabilities EOY2525076TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY2749262NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY2922578NetAssetsOrFundBalancesEOY
Mission DescriptionMID 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 Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense11857042Expense
Revenue14607202Revenue
DescriptionNon-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 - 4,455Emergency Room Visits - 7,476Outpatient visits (excluding Emergency Room) - 28,450Description
Total Program Service Expense11857042TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109610NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees200NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Form8899 Filed0Form8899Filed
Form1098 C Filed0Form1098CFiled
Excess Business Holdings0ExcessBusinessHoldings
Taxable Distributions0TaxableDistributions
Distribution To Donor0DistributionToDonor
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledPAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonJAMES BRITTAINNamePerson
Telephone Number5703402991TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1700 QUINCY AVEAddressLine1
CitySCRANTONCity
StatePAState
ZIP Code18510ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (13 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
Karen M Murphy RN PhD
President & CEO4.00XX017873828503
Ann Marie Stevens
director of operations40.00XX96490021855
James Brittain
Acting CFO4.00XX015594335403
maria A marsili esq
chairperson1.00XX000
Robert A Mazzoni esq
secretary1.00XX000
Rajan Mulloth MD
medical staff president1.00XX026921116893
R Sean Buckman
Treasurer1.00XX000
louis Rapoch
director1.00X000
enrico cesarini
director1.00X000
David Moran
Director1.00X000
Jeffrey Hemak
Director1.00X000
John Lemoncelli Phd
Director1.00X000
HAROLD E ANDERSON
PRESIDENT & CEO4.00XX037785956470
FieldValueIRS element (for citing)
Total Reportable Comp From Org96490TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs981751TotalReportableCompFrmRltdOrgs
Total Other Compensation159124TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
EPMG
182 S Franklin StreetWILKES BARREPA18701EMERGENCY RM PHYS.470214
Lab Corp
20 Johnson DriveRaritanNJ08869Lab Services102975
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
Government Grants127579GovernmentGrants
All Other Contributions9750AllOtherContributions
Total Contributions137329TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
Descriptionnet patient service reDescription
Business Code900099BusinessCode
Total Revenue Column14576753TotalRevenueColumn
Related Or Exempt Function Income14576753RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue14576753TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column7638TotalRevenueColumn
Exclusion$7,638ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real107721Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real107721Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column107721TotalRevenueColumn
Exclusion$107,721ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events24460GrossIncomeFundraisingEvents
Fundraising Direct Expenses13344FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column11116TotalRevenueColumn
Exclusion$11,116ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Laboratory & X-Ray rev9000991274012740
Medical Transcripts Re90009988018801
Cafeteria revenue90009954535453

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column3455TotalRevenueColumn
Related Or Exempt Function Income3455RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue30449TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column14871006TotalRevenueColumn
Related Or Exempt Function Income14607202RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$126,475ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total96490Total
Program Services79986ProgramServices
Management And General16504ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total5464003Total
Program Services4529410ProgramServices
Management And General934593ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total209143Total
Program Services173370ProgramServices
Management And General35773ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total850202Total
Program Services704779ProgramServices
Management And General145423ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total427401Total
Program Services354296ProgramServices
Management And General73105ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total6264Total
Management And General6264ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total33830Total
Management And General33830ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1804852Total
Program Services1207679ProgramServices
Management And General597173ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total24922Total
Program Services19029ProgramServices
Management And General5893ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total254355Total
Program Services185476ProgramServices
Management And General68879ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total21563Total
Program Services18795ProgramServices
Management And General2768ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total78269Total
Program Services46343ProgramServices
Management And General31926ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total394715Total
Program Services233710ProgramServices
Management And General161005ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total320059Total
Program Services189507ProgramServices
Management And General130552ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Bad Debt17834091783409
SUPPLIES1426945140939617549
PHYSICIAN FEES550549550549
Overhead527664527664
EQUIPMENT RENTAL & MAIN3676803639593721

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total19786Total
Program Services7349ProgramServices
Management And General12437ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total14662101Total
Program Services11857042ProgramServices
Management And General2805059ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
EOY5500EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1029134BOY
EOY805903EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1561661BOY
EOY1765493EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY22575EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY291504BOY
EOY303630EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY96781BOY
EOY76437EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis12499936LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec10132482LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY2391582BOY
EOY2367454EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY93316BOY
EOY97462EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY4000BOY
EOY3200EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY5467978BOY
EOY5447654EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY935811BOY
EOY695565EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY362791BOY
EOY1111836EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1420114BOY
EOY717675EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY2718716BOY
EOY2525076EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY2694847BOY
EOY2903752EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY54415BOY
EOY18826EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2749262BOY
EOY2922578EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY5467978BOY
EOY5447654EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis38000OtherCostOrOtherBasis
Book Value38000BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis6294210OtherCostOrOtherBasis
Depreciation4706830Depreciation
Book Value1587380BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis4243867OtherCostOrOtherBasis
Depreciation3802206Depreciation
Book Value441661BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1923859OtherCostOrOtherBasis
Depreciation1623446Depreciation
Book Value300413BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2367454TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
Due to Third Party Payor$59,967
Due to Related Entities$657,708
FieldValueIRS element (for citing)
Total Of Amounts717675TotalOfAmounts
Total Revenue14871006TotalRevenue
Total Expenses14662101TotalExpenses
Excess Or Deficit For Year208905ExcessOrDeficitForYear
Other-$35,589OtherAmount
Total Adjustments-35589TotalAdjustments
Excess Or Deficit Per FS173316ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt14871006TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal14871006RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99014871006TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt14662101TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal14662101ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99014662101TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part X:Description of Uncertain Tax Positions Under FIN 48:The Hospital adopted the standard for accounting for uncertainty in income taxes recognized in an organization'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 not been met. The standard also provides guidance on derecognition, classification, interest and penalties, accounting for interim periods, and disclosure. Management has determined that the adoption of the standard did not have a material effect on the financial statements. The Hospital's policy is to recognize interest related to unrecognized tax benefits in interest expense and penalties in operating expenses. There were no interest or penalties recognized on the statements of operations as a result of the adoption. The Hospital's federal Forms 990, Return of Organization Exempt from Income Tax, filings for the years ended June 30, 2009, 2008, and 2007, remain subject to examination by the Internal Revenue Service and state agencies.
Part XI, Line 8 - Other Adjustments:temporarily restricted - grant revenue: 34063. TEMPORARILY RESTRICTED - FORFEITURE OF GRANT FUNDS: -33830. TEMPORARILY RESTRICTED - NET ASSETS RELEASED FROM RESTRICTIONS: -35822.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF TOURNAMENTNameOfEvent1
Gross Receipts Event124460GrossReceiptsEvent1
Gross Revenue Event124460GrossRevenueEvent1
Non Cash Prizes Event12730NonCashPrizesEvent1
Rent Facility Costs Event19341RentFacilityCostsEvent1
Other Direct Expenses Event11273OtherDirectExpensesEvent1
Gross Receipts Total24460GrossReceiptsTotal
Gross Revenue Total Events24460GrossRevenueTotalEvents
Non Cash Prizes Total Events2730NonCashPrizesTotalEvents
Rent Facility Costs Total Events9341RentFacilityCostsTotalEvents
Other Direct Expenses Total Events1273OtherDirectExpensesTotalEvents
Direct Expense Summary Events13344DirectExpenseSummaryEvents
Net Income Summary11116NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report0AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense3973TotalCommunityBenefitExpense
Net Community Benefit Expense3973NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense903581TotalCommunityBenefitExpense
Direct Offsetting Revenue518409DirectOffsettingRevenue
Net Community Benefit Expense385172NetCommunityBenefitExpense
Percent Of Total Expense0.02990PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense907554TotalCommunityBenefitExpense
Direct Offsetting Revenue518409DirectOffsettingRevenue
Net Community Benefit Expense389145NetCommunityBenefitExpense
Percent Of Total Expense0.03020PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense907554TotalCommunityBenefitExpense
Direct Offsetting Revenue518409DirectOffsettingRevenue
Net Community Benefit Expense389145NetCommunityBenefitExpense
Percent Of Total Expense0.03020PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$441,882BadDebtExpenseAmount
Amount Reimbursed By Medicare6663298AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare6617652CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall45646MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care0ProvisionForCharityCare

Form990 Schedule H Part V Form990ScheduleHPartV

Name Name

FieldValueIRS element (for citing)
Business Name Line1MID VALLEY HOSPITAL ASSOCIATIONBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11400 S MAIN STREETAddressLine1
CityPECKVILLECity
StatePAState
ZIP Code18452ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Costing Method UsedPart 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.CostingMethodUsed
Percent Of Total Expense ExplnPart I, Line 7f: The Bad debt expense of 1,783,409 included on Form 990, Part IX, line 25, column A was subtracted for purposes of calculating the percentage of total expenses.PercentOfTotalExpenseExpln
Bad Debt FootnotePart 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.BadDebtFootnote
Shortfall As Community BenefitPart 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.ShortfallAsCommunityBenefit
Needs AssessmentPart VI, Line 2: Mid Valley Hospital does not currently have a formalized method to assess the community for its health needs. In the next few years, the organization plans to launch a more formalized process to assess our community needs.NeedsAssessment
Patient Education AssistancePart 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.PatientEducationAssistance
Community InformationPart 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.CommunityInformation
Other InformationPart VI, Line 6: 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.OtherInformation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Karen M Murphy RN PhD
0178738000002738901114020724100
James Brittain
01559430000023513011890019134600
Rajan Mulloth MD
0269211000005500011393028610400
HAROLD E ANDERSON
03778590000044580011890043432900

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

IdentifierIdentifierExplanationExplanation
Form 990, Part VI, Section A, line 6Moses Taylor Foundation, Inc. is the sole member of the corporation.
Form 990, Part VI, Section A, line 7aThe sole Member (Moses Taylor Foundation, Inc.) of the corporation elects the board members.
Form 990, Part VI, Section A, line 7bThe 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 11MID 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 12cMID 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 15aMID 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 18MID VALLEY HOSPITAL MAKES ITS FORM 990 and form 1023 available TO THE PUBLIC upon request.
Form 990, Part VI, Section C, line 19MID 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 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 BTHE 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, 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

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Moses Taylor Foundation INC
PO Box 992ScrantonPA18501232281586health carePA501(c)(3)Line 7
MTH Resources Inc
PO Box 1428ScrantonPA18501232281585health carePA501(c)(3)Line 11a, IMoses Taylor Foundation INC
Moses Taylor Hospital
700 Quincy AveScrantonPA18510240795461health carePA501(c)(3)Line 3Moses Taylor Foundation INC

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1PHYSICIANS HEALTH ALLIANCE INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11401 ELECTRIC STREETAddressLine1
CityDUNMORECity
StatePAState
ZIP Code18509ZIPCode
FieldValueIRS element (for citing)
EIN232824685EIN
Primary Activityhealth carePrimaryActivity
Legal Domicile StatePALegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1MTH RESOURCES INCBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg