Fayette Memorial Hospital Association: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- Fayette Memorial Hospital Association (EIN 35-0900741)
- Tax period
- 2009-10-01 to 2010-09-30
- Filed
- 2011-07-29
- IRS object ID
- 201132109349300713
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-07-29T11:33:46-05:00 | Timestamp |
| Tax Period End Date | 2010-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Blue & Co LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | One American Square 2200 | AddressLine1 |
| City | Indianapolis | City |
| State | IN | State |
| ZIP Code | 46282 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 350900741 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fayette Memorial Hospital Association Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | FAYE | NameControl |
| Phone | 7658255131 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1941 Virginia Ave | AddressLine1 |
| City | Connersville | City |
| State | IN | State |
| ZIP Code | 47331 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Randall white | Name |
| Title | CEO | Title |
| Phone | 7658255131 | Phone |
| Date Signed | 2011-07-29 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Carrie A Merrill CPA | Name |
| Phone | 3176334705 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fayette Regional Hospital System | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Randall White | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1941 Virginia Ave | AddressLine1 |
| City | Connersville | City |
| State | IN | State |
| ZIP Code | 47331 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 58437009 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | www.FAYETTEREGIONAL.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1913 | YearFormation |
| State Legal Domicile | IN | StateLegalDomicile |
| Activity Or Mission Description | Fayette Regional Health System's (FRHS) vision is for our team to serve the health needs of the Whitewater Valley residents by providing compassionate, high quality, cost effective care. FRHS is committed to the healthcare that the community wants and deserves; achieving this goal by continuing to provide a full continuum of inpatient and outpatient healthcare services to Connersville and the surrounding area' residents. At FRHS, we are committed to providing the care for the needs of the community throughout its lifetime. Founded in 1913, FRHS has been providing quality and compassionate health care for almost 100 years. The main hospital is located in the heart of Connersville, Indiana, with facilities in three additional counties in order to provide quality services close to home. The equipment and facilities enables us to live our mission, "To care, to serve, to heal." | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 731 | TotalNbrEmployees |
| Total Nbr Volunteers | 78 | TotalNbrVolunteers |
| Total Gross UBI | -2332 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -2332 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 247693 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 911650 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 57974191 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 54725044 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -660984 | InvestmentIncomePriorYear |
| Investment Income Current Year | 797760 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1942666 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1343176 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 59503566 | TotalRevenuePriorYear |
| Total Revenue Current Year | 57777630 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 190763 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 161888 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 35237844 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 30934028 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 27439871 | OtherExpensePriorYear |
| Other Expenses Current Year | 28202630 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 62868478 | TotalExpensesPriorYear |
| Total Expenses Current Year | 59298546 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -3364912 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1520916 | RevenuesLessExpensesCY |
| Total Assets BOY | 62666061 | TotalAssetsBOY |
| Total Assets EOY | 61043758 | TotalAssetsEOY |
| Total Liabilities BOY | 32466604 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 33883764 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 30199457 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 27159994 | NetAssetsOrFundBalancesEOY |
| Mission Description | Fayette Regional Health System is a multi-faceted health care center which provides safe, accurate and compassionate health care through service excellence to the citizens of East Central Indiana to promote healing and healthy living. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 54420383 | Expense |
| Grants | 161888 | Grants |
| Revenue | 54799738 | Revenue |
| Description | The hospital provides inpatient and outpatient services and acute rehab services. Medicare and Medicaid amounted to approximately 70% of total services provided by the hospital. Uninsured care was approximately $1.76 million, as calculated by gross charges, for the year ended September 30, 2010. Total community benefit contributions are $161,888. | Description |
| Total Program Service Expense | 54420383 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | 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 |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 1 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 95 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 731 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Nbr Voting Governing Body Members | 10 | 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 | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Vicky Hopkins | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7658277709 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1941 VIRGINIA AVENUE | AddressLine1 |
| City | CONNERSVILLE | City |
| State | IN | State |
| ZIP Code | 47331 | 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 | FormerFormer | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| Charles Brochin | ||||||||
| Chairperson | 1.00 | X | 12000 | 0 | 0 | |||
| Louise Whitaker | ||||||||
| Vice Chairperson | 1.00 | X | 7500 | 0 | 0 | |||
| Jerry Smith | ||||||||
| Treasurer | 1.00 | X | 7500 | 0 | 0 | |||
| Malcolm Miles | ||||||||
| Secretary | 1.00 | X | 7500 | 0 | 0 | |||
| Arlene Bliven | ||||||||
| Member | 1.00 | X | 6000 | 0 | 0 | |||
| Joel Long | ||||||||
| Member | 1.00 | X | 6000 | 0 | 0 | |||
| Jim Thomas | ||||||||
| Member | 1.00 | X | 1500 | 0 | 0 | |||
| Dr Steven Johnson | ||||||||
| Member & Chief of Staff | 40.00 | X | 312078 | 0 | 11500 | |||
| Jag Patel MD | ||||||||
| Member & Medical Staff | 40.00 | X | 286090 | 0 | 11500 | |||
| David Brandon | ||||||||
| Former CEO | 0.00 | 385110 | 0 | 22703 | X | |||
| Randall White | ||||||||
| Interim CEO/Chief Operatin | 40.00 | X | 198987 | 0 | 18316 | X | ||
| John Jeffries | ||||||||
| Chief Financial Officer | 40.00 | 160519 | 0 | 16058 | X | |||
| Beth Wampler | ||||||||
| VP Patient Care Srvs | 40.00 | 161912 | 0 | 16862 | X | |||
| Rhonda McPherson | ||||||||
| VP Human Resources | 40.00 | 133853 | 0 | 11510 | X | |||
| John Landry | ||||||||
| Physician | 40.00 | 315099 | 0 | 11500 | X | |||
| Abdul Khan | ||||||||
| Physician | 40.00 | 308913 | 0 | 11500 | X | |||
| Petronio Ilagan | ||||||||
| Physician | 40.00 | 278468 | 0 | 11500 | X | |||
| Michael Rowe | ||||||||
| Physician | 40.00 | 275077 | 0 | 11500 | X | |||
| Thomas Skeen | ||||||||
| CRNA | 40.00 | 202984 | 0 | 10149 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3067090 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 164598 | TotalOtherCompensation |
| Number Individuals GT100 K | 32 | 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 |
|---|---|---|---|---|---|
| AMERISOURCE-Bergen | |||||
| 21978 Network PL | Chicago | IL | 60673 | Pharmaceutical Provider | 1873438 |
| Philips Medical Capital | |||||
| PO Box 92449 | Cleveland | OH | 44193 | Medical Leasing Company | 1227782 |
| Key Benefit Administrators | |||||
| PO Box 55210 | Indianapolis | IN | 46205 | Insurance Provider | 859804 |
| Cardinal Health | |||||
| PO Box 70539 | Chicago | IL | 60673 | Product Supplier | 717359 |
| Duke Energy | |||||
| PO Box 9001076 | Louisville | KY | 40290 | Electric Company | 709565 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 47 | NumberOfContractorsGT100K |
| All Other Contributions | 911650 | AllOtherContributions |
| Total Contributions | 911650 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Net Patient Revenue | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 54725044 | TotalRevenueColumn |
| Related Or Exempt Function Income | 54725044 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 54725044 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 553481 | TotalRevenueColumn |
| Exclusion | $553,481 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 119074 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 46712 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 72362 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 72362 | TotalRevenueColumn |
| Related Or Exempt Function Income | 74694 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | -2332 | UnrelatedBusinessRevenue |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 834737 | Securities |
| Other | 22209 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 385496 | Securities |
| Other | 227171 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 449241 | Securities |
| Other | -204962 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 244279 | TotalRevenueColumn |
| Exclusion | $244,279 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| Billing Services | 900099 | 353363 | $353,363 |
| Cafeteria Revenue | 900099 | 219685 | $219,685 |
| Employee Pharmacy Reve | 900099 | 135402 | $135,402 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 562364 | TotalRevenueColumn |
| Exclusion | $562,364 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1270814 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 57777630 | TotalRevenueColumn |
| Related Or Exempt Function Income | 54799738 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | -2332 | UnrelatedBusinessRevenue |
| Exclusion | $2,068,574 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 161888 | Total |
| Program Services | 161888 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 806853 | Total |
| Program Services | 742305 | ProgramServices |
| Management And General | 64548 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24938267 | Total |
| Program Services | 22943206 | ProgramServices |
| Management And General | 1995061 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 873886 | Total |
| Program Services | 803975 | ProgramServices |
| Management And General | 69911 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2470631 | Total |
| Program Services | 2272981 | ProgramServices |
| Management And General | 197650 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1844391 | Total |
| Program Services | 1696840 | ProgramServices |
| Management And General | 147551 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 343433 | Total |
| Program Services | 315958 | ProgramServices |
| Management And General | 27475 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 196365 | Total |
| Program Services | 180656 | ProgramServices |
| Management And General | 15709 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4270928 | Total |
| Program Services | 3929254 | ProgramServices |
| Management And General | 341674 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 256087 | Total |
| Program Services | 235600 | ProgramServices |
| Management And General | 20487 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6154375 | Total |
| Program Services | 5662025 | ProgramServices |
| Management And General | 492350 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4326581 | Total |
| Program Services | 3980455 | ProgramServices |
| Management And General | 346126 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 101348 | Total |
| Program Services | 93240 | ProgramServices |
| Management And General | 8108 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1415218 | Total |
| Program Services | 1302001 | ProgramServices |
| Management And General | 113217 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3655578 | Total |
| Program Services | 3363132 | ProgramServices |
| Management And General | 292446 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 798980 | Total |
| Program Services | 735062 | ProgramServices |
| Management And General | 63918 | ManagementAndGeneral |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Bad Debt | 6357976 | 5849338 | 508638 |
| Dues & Sub. | 135882 | 125011 | 10871 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 189879 | Total |
| Program Services | 27456 | ProgramServices |
| Management And General | 162423 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 59298546 | Total |
| Program Services | 54420383 | ProgramServices |
| Management And General | 4878163 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 641873 | BOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10046584 | BOY |
| EOY | 9891702 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 886622 | BOY |
| EOY | 583856 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 934480 | BOY |
| EOY | 907770 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 587541 | BOY |
| EOY | 1215190 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 75293523 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 45144038 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33216970 | BOY |
| EOY | 30149485 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13807419 | BOY |
| EOY | 13619983 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1897340 | BOY |
| EOY | 1059834 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 647232 | BOY |
| EOY | 3615938 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 62666061 | BOY |
| EOY | 61043758 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3586187 | BOY |
| EOY | 3213272 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22747577 | BOY |
| EOY | 21879540 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1000425 | BOY |
| EOY | 760055 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5132415 | BOY |
| EOY | 8030897 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32466604 | BOY |
| EOY | 33883764 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28352453 | BOY |
| EOY | 26154457 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1847004 | BOY |
| EOY | 1005537 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30199457 | BOY |
| EOY | 27159994 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 62666061 | BOY |
| EOY | 61043758 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $1,582 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 1582 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part II-B, Line 1i: | Identifier |
| Return Reference | Explanation of Other Lobbying Activities: | ReturnReference |
| Explanation | Pay membership dues to trade organizations of which a portion of the dues are used for lobby expenses by the trade organizations. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1410452 | OtherCostOrOtherBasis |
| Book Value | 1410452 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 52001745 | OtherCostOrOtherBasis |
| Depreciation | 28524619 | Depreciation |
| Book Value | 23477126 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 21842854 | OtherCostOrOtherBasis |
| Depreciation | 16619419 | Depreciation |
| Book Value | 5223435 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 38472 | OtherCostOrOtherBasis |
| Book Value | 38472 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 30149485 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Bond Issue Costs | 607948 |
| Estimated Third Party Settlement | 3007990 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 3615938 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Line of Credit | $4,382,268 |
| Deriviative Liability | $3,582,950 |
| Cash Overdraft | $65,679 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 8030897 | TotalOfAmounts |
| Total Revenue | 57777630 | TotalRevenue |
| Total Expenses | 59298546 | TotalExpenses |
| Excess Or Deficit For Year | -1520916 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -677079 | NetUnrealizedGLOnInvestments |
| Other | -$841,468 | OtherAmount |
| Total Adjustments | -1518547 | TotalAdjustments |
| Excess Or Deficit Per FS | -3039463 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 57155859 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -677079 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | -677079 | RevenueNotRptdF990 |
| Revenue Subtotal | 57832938 | RevenueSubtotal |
| Investment Expenses Not Included | 196365 | InvestmentExpensesNotIncluded |
| Other Revenues Not Included | -251673 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -55308 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 57777630 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 59353855 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 251674 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 251674 | ExpensesNotRptdF990 |
| Expenses Subtotal | 59102181 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 196365 | InvestmentExpensesNotIncluded2 |
| Expenses Not Rptd On Fin Stmt | 196365 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 59298546 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Part XI, Line 8 - Other Adjustments: | Change in Temporarily Restricted Net ASsets: -841468. |
| Part XII, Line 4b - Other Adjustments: | Loss on Fixed Assets : -204961. Rental Expenses: -46712. |
| Part XIII, Line 2d - Other Adjustments: | Rental Expenses: 46713. Loss on Fixed Assets: 204961. |
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 |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 0 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 810601 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 810601 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01530 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9153810 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3817831 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5335979 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10080 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9964411 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3817831 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6146580 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.11610 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 4 | PersonsServed |
| Total Community Benefit Expense | 5000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 5000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 44 | PersonsServed |
| Total Community Benefit Expense | 12543 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 12543 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 48 | PersonsServed |
| Total Community Benefit Expense | 17543 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 17543 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 48 | PersonsServed |
| Total Community Benefit Expense | 9981954 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3817831 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6164123 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.11640 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 5 | PersonsServed |
| Total Community Building Expense | 109710 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 109710 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00210 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 5 | PersonsServed |
| Total Community Building Expense | 109710 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 109710 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00210 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $2,748,753 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 11227409 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 11882703 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -655294 | 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 |
Form990 Schedule H Part V Form990ScheduleHPartV
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fayette Regional Hospital System | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1941 Virginia Ave | AddressLine1 |
| City | Connersville | City |
| State | IN | State |
| ZIP Code | 47331 | 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 VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Income Based Criteria | Part I, Line 3c: The hospital has a sliding scale based on the Federal Poverty Guidelines with free care to individuals who have income between 100% and 133% of poverty and provide discounted care up to income of 300% of poverty. The largest number of the organization's patients meet the Federal Poverty Guidelines for discounted care around 200% depending on the household size. | IncomeBasedCriteria |
| Annual Community Benefit Expln | Part I, Line 6a: Organization's community benefit report is available upon request. | AnnualCommunityBenefitExpln |
| Bad Debt Footnote | Part III, Line 4: Footnote to organization's financial statements that describes bad debt expenses: The System evaluates the collectability of its accounts receivable based on certain factors, such as payer type, historical collection trends and aging categories. The allowance that is applied to the receivable balances is based on the historical experience and time limits, if any, for each particular payer source, such as private, insurance, Medicare and Medicaid. Actual results could differ from the estimated allowances.Part III, Line 3: Rational for including other bad debt amount in community benefit: None has been included. The hospital has a detailed Charity Care Policy which states that to participate in charity care candidates must cooperate fully. In addition the hospital educates patients will limited ability to pay regarding financial assistance. For this reason the organization believes that it accurately captures all charity care deductions provided according to the financial assistance policy and the amount of bad debt expense attributable to patients eligible under the organization's charity care policy is negligible. | BadDebtFootnote |
| Shortfall As Community Benefit | Part III, Line 8: The source used to determine the amount of Medicare allowable costs reported for Part III, Section B, Medicare has been provided from the Year Ended September 30, 2010 report: Hospital Statement of Reimbursable Cost. | ShortfallAsCommunityBenefit |
| Needs Assessment | Part VI, Line 2: The organization assesses the health care needs of the communities it serves through ongoing communication with local community leaders and originations. The hospital team members regularly participate in community events and local civic organizations including Rotary, Kiwanis, and Chamber of Commerce. Community needs are disseminated through these local community organizations and events providing the Hospital with feedback regarding the needs of the community. In addition the hospital completes and submits annually a community benefit plan to the Indiana State Department of Health which addresses the goals set to focus on the needs of the community.FRHS recognizes five primary areas of concern facing its community as the FRHS emphasis in the implementation of the Community Benefit Plan: 1. Citizens who are medically underserved. 2. Issues that impact adolescents including education, pregnancy and general behavioral concepts specific to this age group. 3. Childhood growth and development, as well as abuse and neglect prevention. 4. Health issues that require increased awareness in the general community population. 5. Challenges impacting employment which directly relate to the community's ability to obtain comprehensive medical care | NeedsAssessment |
| Patient Education Assistance | Part VI, Line 3: Eligibility for assistance under Federal, State, or local government programs or under the organization's charity care policy is discussed with patients or guarantors to inform and educate patients and persons who may be billed for patient care. Charity Care Applications and Pamphlets detailing billing procedures and contact information for the billing office are made available to patients. Any questions regarding the organization's written charity care policy can be directed and answered by a member of the Patient Accounts' personnel. Patient Accounts' personnel will notify individuals with approved applications qualifying for reduced liability under the charity care policy | PatientEducationAssistance |
| Community Information | Part VI, Line 4: FRHS's main areas of service are Fayette, Franklin and Union counties serving an approximate population of 54,000. Fayette County has ranked in the top two counties for unemployment in the past several years and has a high number of private pay individuals. Union County and Franklin County have little to no industry. | CommunityInformation |
| Community Building Activities | Part VI, Line 5: FRHS employees participate in community building activities to promote the health of the communities it serves including:**Health Fair, Connersville, IN, 150 hrs; Brookville, IN, 68.5 hrs; Liberty, IN, 65.25hrs: FRHS team members sponsor a health fair for our community annually. Booths are set up for the screens and testing of blood pressure, cholesterol, computerized health risk appraisal, cataract, glaucoma, colorectal, blood sugar, peripheral vascular disease, TB, immunizations for children, body fat analysis, chemical dependency, and numerous educational and demonstration booths.**Blood Drive, Connersville, IN, 23.75 hrs: Donated blood.**Pretty in Pink Pajama Party, Connersville, IN, 129.5 hrs: Team members organized, set-up and participated in the pretty in pink pajama party event for breast cancer survivors.**Frazee Elementary School, Connersville, IN, 3 hrs: Team members visited Frazee Elementary School to demonstrate proper hand washing.**Junior Achievement bowl-a-thon, Connersville, IN, 5 hrs: Team member participated during bowling event and dietary department baked cookies for the event.Angel Food Ministries, Connersville, IN 18.5 hrs: Team member help distribute food.**Breast Cancer Awareness, Connersville, IN, 7.5 hrs: Team members helped register guests and provided tours at the Breast Cancer Awareness event at Fayette Regional Health System.**Volunteer Luncheon, Connersville, IN, 1 hr: Team members helped organizer and work the Fayette Regional Health System volunteer lunch at the Miller Building.**Diabetes Support Group, Connersville, IN, 2 hrs: Team member spoke at the diabetes support group November meeting on "Carb counting for Diabetics".**Public Speaking, Brookville & Laurel, IN, 3 hrs: Team member was guest speaker at the Brookville and laurel public libraries. Speaking on health, fitness/wellness, and nutrition; gave out information on ways to improve overall health and well-being.**Brookville High School, Brookville, IN, 14 hrs: Team member taught CPR to the students.**Senior Center, Connersville, IN, 3 hrs: Team member handed out programs for Nutrition Awareness Day.**Frazee Elementary School Connersville, IN, 16.5 hrs: Annual Bike Rodeo-instructed students on bike safety.**Fayette County Optimist Club, Connersville, IN, 1 hr: Team member was guest speaker at weekly meeting.** Connersville High School, Connersville, IN 10 hrs: Team member prepared presentation and spoke to students about career opportunities in health care.**Physical Night, Connersville, IN, 67.75 hrs: Team members assisted with High School and Middle school physical nights.**Optimist Club, Connersville, IN, 1.5 hrs: Team member spoke about Fayette Regional Health System Cancer Center and cancer issues at the Optimist Club meeting. **Relay for Life, Connersville, IN & Brookville, IN, 114 hrs: Team members walked, provided blood pressure screenings, and assisted in the events that were held in conjunction with the relay, as well as, taking photos of survivors.**Optimist Club, Connersville, IN 2 hrs: Team member spoke to the club on Rehab Services.**SAPA Health Fair, Connersville, IN 9 hrs: Dietary team donated time to prepare food items and work at the health fair.**Celebrate Women, Connersville, IN 5 hrs: Team member volunteered her time at the event to raise women health awareness.**SAPA Health Fair, Connersville, IN, 20 hrs: Team members volunteered time at health fair.**IWIN Foundation, Connersville, IN, 8 hrs: Team member spoke at fundraiser about breast cancer.*Tri-Kappa Sorority, Connersville, IN 1 hr: Team member spoke at benefit about breast cancer.**TV-3, Connersville, IN, .75 hrs: Team member did a community service spot for TV station.**Community Bike Rodeo, Robert Park Connersville, IN, 20.5 hrs: Team member volunteered time at the community bike rodeo giving safety tips.Part VI, Line 6: During the fiscal year FRHS has demonstrated continued community stewardship through the attainment of many goals that address the needs of our community. We continue to strive for excellence in the contributions and services that we provide to area citizens. Details for furthering FRHS's exempt purpose for **Medically underserved citizen: The Franklin Co. community has continued to benefit from the development and implementation of services at the Brookville HealthPlex facility with the latest healthcare technology including a 64 slice CT scan, ultrasound, open MRI and laboratory services. The lab participated in two major external inspections with improvements noted in the use of electronic data calculations, documentation of proficiencies and various quality controls to better serve the community. Multiple community meetings continue since 2009 including citizens of Franklin Co and FRHS leadership to discuss ways in which FRHS can better meet the health needs of this county. Sustained cardiology and oncology services with the FRHS Care Centers enabling patients to be seen locally for more accessible care with less travel, time and expense. Immediate care facilities have remained open in two local communities to assist patients in to better access care without expensive travel and transportation arrangements for those without vehicles. Sponsorship of the annual community health fairs in Fayette, Union and Franklin counties with extensive representation of FRHS services by staff. There was an increase in physician participation this year as well. A wide array of screenings offered included blood pressure, blood sugar, cholesterol, and bone density. Team members were available to help participants utilize health risk surveys as well as to educate them on a variety of health issues. All attempts are made to offer free health aides such as pill dispensers, nutritional guides for fast food restaurants, etc. Two cardiac scoring procedures, female wellness exam, and cholesterol screening certificates were among the booth prizes given away at the event. Multiple volunteer involvements in food pantries, and ministries to assist low income individuals with nutritional aid which impact their general health. A Food is held in February to assist with the post holiday need for food. This service cannot be undervalued at an economic time when many families have basic nutritional needs that are not being met in a more traditional fashion. A bake sale for Hospice was held in the Fall to assist those with end of Life needs. Fund raising for charitable organizations involved in educational assistance through scholarship programs. Increased participation for the Fayette and Franklin Co. Relay for Life Cancer Society events to raise funds to enable care/services for oncology patients and survivors of cancer. Raffle baskets were submitted by various FRHS departments with a total donation of $1500. Additionally, FRHS assisted further through advertisement for the Relay and a monetary gift. Many FRHS team members and leadership staff contributed time to walk during the 24 hour event as they did in 2009. Several community service groups including Psi Iota Xi and Eta Pi Kappa were assisted with programs and projects that directly improved the medical outcome for community members while also increasing health education. A donation was given to the Crossroads Shelter for their Day of Celebration event. Many hours were donated by FRHS staff to the local pregnancy crises center for programs and projects to help meet the needs of this population. A local Golf tourney and the Annual Gala event have raised funds to provide additional health services to the community. Area 9 Agency was given a donation for their Senior Picnic and Music event. FRHS team members enjoyed a Bowling Tournament with proceeds going to the Fayette Co. Cancer Society. **Adolescent population issues: The Whitewater Care Pavilion offers comprehensive behavioral health services for adolescents including residential, acute inpatient care and outpatient therapy options. Many local youth groups and individual children were assisted by FRHS staff through activities such as 4H Fair, Junior Achievement and the Drug Coalition for Fayette County School Corporation. Three sports physicals for local youth enabling them to participate in school sports programs were completed by FRHS physicians. A wide variety of community service opportunities including coaching sports for youth are regularly supported by FRHS staff volunteers. Health care professionals spoke at local classes, and participated in fundraising for scholarships. FRHS funds seven separate scholarships for area youth. FRHS purchased a new ice machine for the Connersville School Athletics Association to support healthy lifestyles for youth by participating in sports activities. Food, clothing, and shelter provisions are provided in cooperation with community churches, missions, Lions Club, sorority activities, Kiwanis and school corporation projects. | CommunityBuildingActivities |
| Other Information | Part VI, Line 6: **Continue** FRHS staff donated time to the local Hope Pregnancy Care Center for programs and projects to help meet the needs of this population. A Baby Formula program through the Hope Pregnancy Center is available for teen mothers for their baby's nutritional needs. A monetary donation from FRHS also supports this center. Fourteen AEDs are in use at Fayette Co schools as a results of a FRHS donation. Strong participation in the 4-H Fair by purchasing livestock from Team members children that participate in these programs as well as painting at the 4-H buildings. Also offered sponsorship in Franklin Co 4-H Fair activities. Sponsorship of a soccer team thru the Connersville Park and Recreation and area youth swim team. Donation of pies and cookies for the handicapped children's Christmas party. Quarterback Club Youth League was sponsored by FRHS. Sponsored After Prom for Union County High School students. Laurel Music Festival sponsorship thru the Laurel Youth Council. Team members took youth to various functions in Indianapolis including the symphony. Donation of time to help with the Free Speech Clinic for youth in Rush County.**Childhood issues: Christmas giving to the Division of Family and Children initiative where departments sponsor needy children at the holiday with shoes, clothing, books and toys. Community Bike Rodeo safety program and the Fayette Co. Basketball Camp were supported by FRHS staff through our dietary team contribution. Children's activities such as Bowling for Kids, church holiday programs, the 4H Fair, Girl Scouts and Cub Scouts, local festivals, and Head Start. Staff members assisted with the Speech and Hearing Clinic offered through collaboration with FRHS, Psi Beta Xi sorority and Fayette schools. Education opportunities that FRHS staff members supported include tutoring students, reading enhancement programs, Body Safety program, Boys and Girls Club reading program. Donated to the Ride for a Child Community Benefit. Purchased a table for the St Gabriel elementary school fund raiser. Cancer Education program presented to the students at St Gabriel School. A back to school program conducted by the Connersville FOP called Shop with a Cop was supported by FRHS to allow students to purchase needed school supplies.**Increasing healthcare-related issues awareness and education: FRHS presents ongoing updates on the local television station to assure that Fayette County residents are aware of healthcare changes. Speaking engagements by staff on a variety of health issues at local school, events and community groups. FRHS has coordinated Living through Grief and Living through Cancer groups for eight years to counsel and support families through difficult family situations. Provides monetary assistance as well as other types of support for the ministerial association's efforts to encourage spiritual well-being and meet community needs. Smoking Cessation program is available through the FRHS Health Works department. The FRHS Speaker's Bureau continued to offer services on health-related topics to community programs. Topics included stress management, stroke issues, smoking cessation, diabetes, and influenza. FRHS Home Health offers blood pressure and blood glucose clinics at various sites in Franklin, Fayette and Union county on a monthly basis. Maintained sponsorship of the Community Education Coalition including their annual Gala. Breast Cancer Awareness table in the atrium to educate as well as the Race for a Cure event. A Team member is on the local Cancer Society Board. Team member spoke at the Kiwanis Club benefit regarding the benefits of exercise and good posture. Nutritional programs at the Fayette Co Courthouse and several other community centers were presented in the past year. FRHS Health Works facility donated gift certificates to the FRHS Foundation Gala, for the Bowl for Kid's Sake and the Pet Walk in the Park events and a Wii fitness system for community fitness festival tournaments.**Community challenges impacting employment which directly relate to the community's ability to obtain continued medical care: FRHS continues to work with Carbon Motors in an effort to increase employment in Connersville and surrounding communities. **Other areas of participation beyond the previously stated goals include: The FRHS Foundation is a cause that FRHS staff supports annually through a variety of functions such as the Golf outing, Gala fundraiser and the Hometown Competitiveness program. Another local hospital foundation also had an "Art to Heart fundraiser for cardiac issues and FRHS contributed monetarily towards that event. The Franklin Co. Foundation Humanitarian award banquet was supported as well. Staffed a booth at the Rush Co Garden Festival. Participation in the other area Relay for Life, Plan for Life and Stand for Life events. Contributed to the local Chamber Of Commerce Whitewater Walk in addition to other C of C events including the Chamber Golf Classic, Chamber Annual Banquet Dinner for the Citizen of the Year and for their booth rental at the John Conner Festival. Two teams were sponsored for the Golf Tournament. Donations to local community club events such as Salvation Army. 28 units of blood were donated for the Blood Drive sponsored by FRHS and another drive at the Health Fair. Worked at the local animal shelter and aided in fund raising activities. Assisting elderly shut-ins regarding their medications. Several Team members spent two days assisting Rush Memorial Hospital when that neighboring hospital's basement flooded. Participated and contributed to the Canoe Fest in Brookville (Franklin Co). Staff was involved in the Link Spelling Bee to promote literacy at the Whitewater Technical Career Center. Sponsorship for the K Miller Circus thru the Connersville Optimists Club. | OtherInformation |
| Affiliated Health Care System | Part VI, Line 7: NOT APPLICABLE. ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. | AffiliatedHealthCareSystem |
| Reports Filed With States | IN | ReportsFiledWithStates |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 0 | RecordsMaintained |
Recipient Table RecipientTable (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | Amount Of Cash GrantAmountOfCashGrant | Amount Of Non Cash AssistanceAmountOfNonCashAssistance | Method Of ValuationMethodOfValuation | Description Of Non Cash AssistanceDescriptionOfNonCashAssistance | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|---|---|
| Franklin County High School | |||||||||
| 1941 Virginia Ave | Connersville | IN | 47331 | 350900741 | 36876 | 2210 | cost | food and supplies | Contributions for donated food and supplies at cost for football fundraising events, sponsorship donations, and pay salary & benefits for Athletic Director. |
| Connersville High School | |||||||||
| 1941 Virginia Ave | Connersville | IN | 47331 | 350900741 | 61909 | 2052 | cost | food and supplies | Contributions for donated food and supplies at cost for football, Marching Band and After-Prom events, sponsorship donations, and pay salary & benefits for Athletic Director. |
| Fayette County Ministerial Association | |||||||||
| 1941 Virginia Ave | Connersville | IN | 47331 | 350900741 | 14300 | Contributions to pay salary & benefits for Reverend. | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 3 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 3 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | Nursing scholarships | TypeOfGrant |
| Number Of Recipients | 4 | NumberOfRecipients |
| Amount Of Cash Grant | 5000 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: All grants to entities in the U.S. are provided to 501(c)(3) public charities for general support. The organization does not monitor the use of these funds by these public charities. In addition the organization makes scholarships and student loans available to eligible persons to further healthcare in the community. The organization does monitor the use of the scholarships and students loans. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Written Policy Re T And E Expenses | 0 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| 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 | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (11 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Dr Steven Johnson | |||||||||||||
| 300078 | 0 | 0 | 0 | 12000 | 0 | 11500 | 0 | 0 | 0 | 323578 | 0 | 0 | 0 |
| Jag Patel MD | |||||||||||||
| 280090 | 0 | 0 | 0 | 6000 | 0 | 11500 | 0 | 0 | 0 | 297590 | 0 | 0 | 0 |
| David Brandon | |||||||||||||
| 245003 | 0 | 45410 | 0 | 94697 | 0 | 11500 | 0 | 11203 | 0 | 407813 | 0 | 0 | 0 |
| Randall White | |||||||||||||
| 183532 | 0 | 0 | 0 | 15455 | 0 | 8892 | 0 | 9424 | 0 | 217303 | 0 | 0 | 0 |
| John Jeffries | |||||||||||||
| 137657 | 0 | 0 | 0 | 22862 | 0 | 7284 | 0 | 8774 | 0 | 176577 | 0 | 0 | 0 |
| Beth Wampler | |||||||||||||
| 140351 | 0 | 0 | 0 | 21561 | 0 | 7287 | 0 | 9575 | 0 | 178774 | 0 | 0 | 0 |
| John Landry | |||||||||||||
| 300099 | 0 | 15000 | 0 | 0 | 0 | 11500 | 0 | 0 | 0 | 326599 | 0 | 0 | 0 |
| Abdul Khan | |||||||||||||
| 308913 | 0 | 0 | 0 | 0 | 0 | 11500 | 0 | 0 | 0 | 320413 | 0 | 0 | 0 |
| Petronio Ilagan | |||||||||||||
| 272604 | 0 | 0 | 0 | 5864 | 0 | 11500 | 0 | 0 | 0 | 289968 | 0 | 0 | 0 |
| Michael Rowe | |||||||||||||
| 275077 | 0 | 0 | 0 | 0 | 0 | 11500 | 0 | 0 | 0 | 286577 | 0 | 0 | 0 |
| Thomas Skeen | |||||||||||||
| 202984 | 0 | 0 | 0 | 0 | 0 | 10149 | 0 | 0 | 0 | 213133 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| Part I, Line 1a | Tax indemnification and gross-up payments were made during the year and were approved by the board. |
| Part I, Line 4a: | Former CEO received severance payments during the year. |
| Part I, Line 7 | Performance Incentive pay is a goal-based non-fixed payment that is directly tied to the performance of the individual in achieving personal and organizational goals. The program is governed by the board of trustees and delegated to the executive committee of the board to be reviewed and approved. Payouts are based on each individual's performance against pre-defined goals and objectives aligned with the overall mission, vision, and strategic goals of the organization and the profitability of FRHS for the fiscal year. If the hospital meets or exceeds budget with respect to excess revenue over expenses excluding any interest income, each employee will receive on week's pay based upon an average number of regular scheduled hours worked per week. The board has the authority to approve payments at its discretion with regards to courageous actions by employees at anytime in accordance with the oganization's whistle blowers policy. |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Dr Jag Patel | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | Board member and Employee | Relationship |
| Amount Of Transaction | 32500 | AmountOfTransaction |
| Description Of Transaction | Dr. Patel owns a building which he rents to the hospital for physician offices. | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| Form 990, Part VI, Section B, line 11 | The process of reviewing the Form 990 entails a detailed review of the Form 990 by the organization's CFO and Controller. The governing body reviews and approves the Form 990 including requested schedules, as ultimately filed with the IRS, and are provided to each voting member of the organization's governing body prior to filing. | |
| Form 990, Part VI, Section B, line 12c | Annual information about the conflict of interest and disclosure are provided to Members of the Board of Trustees, Chief Executive Officer, Administrative staff, All department managers, Individuals with influence over purchasing, and Individuals with contracts to FRHS. Annual questionnaires are to be completed by each individual and returned to the CEO's office which are reviewed by the Chair of the Board of Trustees. In addition, any indiviudal associated with Fayette Regional Health System is to declare situations of actual or potential conflicts of interest as they arise, in writing, and in sufficient detail. | |
| Form 990, Part VI, Section B, line 15 | The process for determining compensation for the CEO is governed by the Board of Trustees and delegated to the Executive Committee of the board to review and approve annually. In addition, all employment contracts and amendments for the CEO will be reviewed and approved by the Executive Committee of the Board and co-signed by the Chair of the Board of Trustees and the Secretary of the Board. The process for determining compensation for other officers/key employees is reviewed annually by the Executive Committee and CEO. The Secretary of the board of Trustees is responsible for recording in the minutes the deliberation and decisions. | |
| Form 990, Part VI, Section C, line 19 | The organization makes the governing documents, conflict of interest policy, or financial statements available upon request. | |
| Part XI, line 2c | The audit committee assumes responsibility for oversight of the audit of the financial statements and selection of the independent accountant; and no processes have changed from prior year. | Oversight of the Audit |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fayette Memorial Hospital Foundation | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1941 Virginia Avenue | AddressLine1 |
| City | Connersville | City |
| State | IN | State |
| ZIP Code | 47331 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311010071 | EIN |
| Primary Activities | To benefit Fayette Regional Hospital System | PrimaryActivities |
| Legal Domicile State | IN | LegalDomicileState |
| Exempt Code Section | 501(c)(3) | ExemptCodeSection |
| Public Charity Status | Line 11a, I | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fayette Regional Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| Fayette Memorial Hospital Foundation | |
| C | 911650 |
| Fayette Memorial Hospital Foundation | |
| K | 163950 |