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Nonprofiteer
← FAIRFIELD MEMORIAL HOSPITAL ASSOCIATION

Form 990 for tax year 2023

Filed by FAIRFIELD MEMORIAL HOSPITAL ASSOCIATION.

Totals

Total revenue
$48,295,823
Total expenses
$53,607,139
Contributions and grants received
$822,570
Grants paid
$130,396
Program service revenue
$45,160,074
Investment income
$70,992
Other revenue
$2,242,187
Total assets, end of year
$55,359,234
Total liabilities, end of year
$32,593,217
Net assets or fund balances, end of year
$22,766,017
Program services expenses (Part IX)
$40,166,813
Management and general expenses
$13,440,326
Fundraising expenses
$0
Program service expenses (Part III)
$40,166,813

Program services were 74.9% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 1d · Related organizations

    $467,995

  • 1e · Government grants (contributions)

    $31,851

  • 1f · All other contributions, gifts and grants

    $322,724

  • 2a · Program service revenue: NET PATIENT REVENUE

    total $40,087,443 · related or exempt $40,087,443

  • 2b · Program service revenue: CLINIC REVENUE

    total $4,676,704 · related or exempt $4,676,704

  • 2c · Program service revenue: HOME HEALTH REVENUE

    total $383,220 · related or exempt $383,220

  • 2d · Program service revenue: MEDICAL RECORDS FEE

    total $12,707 · related or exempt $12,707

  • 3 · Investment income

    total $70,992 · excluded $70,992

  • 6a · Gross rents

    real property $367,547

  • 6b · Less rental expenses

    real property $81,440

  • 6c · Rental income or loss

    real property $286,107

  • 6d · Net rental income or loss

    total $286,107 · related or exempt $286,107

  • 11a · Other revenue: DEACONESS MANAGEMENT FEE

    total $1,530,000 · related or exempt $1,530,000

  • 11b · Other revenue: CAFETERIA & CATERING

    total $280,981 · related or exempt $268,046 · excluded $12,935

  • 11c · Other revenue: HRSA/MOLINA TAKEBACKS

    total $65,698 · related or exempt $65,698

  • 11d · All other revenue

    total $79,401 · related or exempt $79,401

  • 11e · Other revenue, total

    $1,956,080

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $27,540 · program services $27,540

  • 2 · Grants to domestic individuals

    total $102,856 · program services $102,856

  • 5 · Compensation of officers, directors and key employees

    total $826,433 · program services $618,564 · management and general $207,869

  • 6 · Compensation of disqualified persons

    total $228,838 · program services $171,279 · management and general $57,559

  • 7 · Other salaries and wages

    total $22,239,398 · program services $16,645,618 · management and general $5,593,780

  • 8 · Pension plan contributions

    total $136,080 · program services $101,852 · management and general $34,228

  • 9 · Other employee benefits

    total $3,983,749 · program services $2,981,733 · management and general $1,002,016

  • 10 · Payroll taxes

    total $1,625,476 · program services $1,216,627 · management and general $408,849

  • 11b · Fees: legal

    total $114,645 · management and general $114,645

  • 11c · Fees: accounting

    total $185,916 · management and general $185,916

  • 11g · Fees: other

    total $7,036,472 · program services $5,749,062 · management and general $1,287,410

  • 12 · Advertising and promotion

    total $155,654 · program services $45,549 · management and general $110,105

  • 13 · Office expenses

    total $993,750 · program services $823,594 · management and general $170,156

  • 16 · Occupancy

    total $1,116,036 · program services $606,248 · management and general $509,788

  • 17 · Travel

    total $96,080 · program services $28,116 · management and general $67,964

  • 20 · Interest

    total $874,538 · program services $616,872 · management and general $257,666

  • 22 · Depreciation, depletion and amortization

    total $2,943,259 · program services $2,943,259

  • 23 · Insurance

    total $659,046 · management and general $659,046

  • 24a · Other expenses: MEDICAL SUPPLIES AND DR

    total $7,385,800 · program services $6,479,555 · management and general $906,245

  • 24b · Other expenses: MEDICAID ASSESSMENT TAX

    total $1,171,168 · management and general $1,171,168

  • 24c · Other expenses: REPAIRS AND MAINTENANCE

    total $1,020,972 · program services $554,608 · management and general $466,364

  • 24d · Other expenses: FOOD

    total $358,918 · program services $358,918

  • 24e · All other expenses

    total $324,515 · program services $94,963 · management and general $229,552

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $866,452 · end of year $259,111

  • 2 · Savings and temporary cash investments

    beginning of year $1,036,229 · end of year $1,685,342

  • 4 · Accounts receivable

    beginning of year $12,482,110 · end of year $10,867,020

  • 7 · Other notes and loans receivable

    beginning of year $1,315,062 · end of year $337

  • 8 · Inventories for sale or use

    beginning of year $1,214,850 · end of year $1,307,600

  • 9 · Prepaid expenses and deferred charges

    beginning of year $578,038 · end of year $801,830

  • 10a · Land, buildings and equipment: cost or other basis

    $76,163,678

  • 10b · Land, buildings and equipment: accumulated depreciation

    $35,727,445

  • 10c · Land, buildings and equipment, net

    beginning of year $43,150,053 · end of year $40,436,233

  • 11 · Investments: publicly traded securities

    beginning of year $1,761 · end of year $1,761

  • 15 · Other assets

    beginning of year $36,717 · end of year $0

  • 17 · Accounts payable and accrued expenses

    beginning of year $7,038,852 · end of year $5,858,258

  • 19 · Deferred revenue

    beginning of year $1,098,906 · end of year $0

  • 23 · Secured mortgages and notes payable

    beginning of year $25,326,978 · end of year $25,599,592

  • 24 · Unsecured notes and loans payable

    beginning of year $0 · end of year $177,721

  • 25 · Other liabilities

    beginning of year $0 · end of year $957,646

  • 27 · Net assets without donor restrictions

    beginning of year $27,013,990 · end of year $22,563,471

  • 28 · Net assets with donor restrictions

    beginning of year $202,546 · end of year $202,546

Mission and programs · 2023

Mission

THE MISSION OF FAIRFIELD MEMORIAL HOSPITAL IS TO MAINTAIN AND IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE.

  • AS A NOT-FOR-PROFIT COMMUNITY HOSPITAL, FAIRFIELD MEMORIAL IS A CHARITABLE ORGANIZATION THAT EXISTS TO ADVANCE THE HEALTH OF THE RESIDENTS OF WAYNE COUNTY AND SURROUNDING COMMUNITIES. FAIRFIELD MEMORIAL HOSPITAL OPERATES A RURAL HEALTHCARE FACILITY WITH 25 ACUTE CARE BEDS AND 30 SKILLED CARE BEDS. IN AUGUST 2008, THE HOSPITAL OPENED AN OUTPATIENT PHYSICIAN CLINIC. FAIRFIELD MEMORIAL HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE TO ALL PERSONS WITHOUT REGARD TO AND DOES NOT DISCRIMINATE ON THE BASIS OF RACE, COLOR, RELIGION (CREED), GENDER, GENDER SEX EXPRESSION, AGE, NATIONAL ORIGIN (ANCESTRY), PHYSICAL OR MENTAL DISABILITY, MARITAL STATUS, GENDER IDENTITY, SEXUAL ORIENTATION, SOCIAL ECONOMIC STATUS, ETHNICITY, CULTURE, LANGUAGE, MILITARY STATUS, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF FAIRFIELD MEMORIAL HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. THEREFORE, IN KEEPING WITH THIS CORPORATION'S COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITIES WE SERVE. THE COMMUNITY, FREE CARE AND/OR SUBSIDIZED CARE, CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST, AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR INDIVIDUALS INABILITY TO PAY COEXISTS. THE COMMUNITY BENEFITS CAN BE MEASURED IN MANY WAYS INCLUDING: DIRECT PATIENT CARE, SCREENINGS, EDUCATION, FUNDRAISING, AND COMMUNITY SERVICE EFFORTS OF OUR COLLEAGUES. THE HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS, PROVIDING SERVICES TO BOTH MEDICARE AND MEDICAID PATIENTS. CHARITY CARE IS ALSO PROVIDED THROUGH THE HOSPITAL'S INTERNAL FINANCIAL ASSISTANCE POLICY.

    Expenses $40,166,813 · Grants $130,396 · Revenue $47,389,326

As filed on the 2023 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Patrick Molt MD

    PRESIDENT/CMO

    Total calculated
    $40,670
    From this org
    $40,670
    From related orgs
    $0
    Other
    $0
    Hours/week
    20

  • Joey Hungerford

    VICE PRESIDENT

    Total calculated
    $0
    Hours/week
    1.75

  • Anita Pond

    SECRETARY/TREASURER

    Total calculated
    $0
    Hours/week
    1.75

  • Michael Copeland

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1.75

  • Donna Masterson

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1.75

  • D Jamie Pollard

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1.75

  • Matthew Seng

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1.75

  • Doug Wilson

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1.75

  • Josh Scott

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1.75

  • Jared Florence

    DIRECTOR (BEG 04/24)

    Total calculated
    $0
    Hours/week
    1.75

  • Craig Self

    DIRECTOR (BEG 04/24)

    Total calculated
    $0
    Hours/week
    1.75

  • Katherine Bunting

    CEO

    Total calculated
    $326,891
    From this org
    $312,644
    From related orgs
    $0
    Other
    $14,247
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $283,425
    Bonus
    $94
    Other
    $29,125
    Deferred
    $6,067
    Nontaxable benefits
    $8,180
    Filer's total
    $326,891

  • Dana Taylor

    INTERIM CEO (BEG 10/23)/COO

    Total calculated
    $150,058
    From this org
    $140,762
    From related orgs
    $0
    Other
    $9,296
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $140,668
    Bonus
    $94
    Other
    $0
    Deferred
    $2,906
    Nontaxable benefits
    $6,390
    Filer's total
    $150,058

  • Rachel Ewing

    CNO

    Total calculated
    $121,723
    From this org
    $110,412
    From related orgs
    $0
    Other
    $11,311
    Hours/week
    50

  • Amy Marsh Gray

    CFO (END 07/23)

    Total calculated
    $90,879
    From this org
    $86,830
    From related orgs
    $0
    Other
    $4,049
    Hours/week
    40

  • Kristin Boldt

    INTERIM CFO (BEG 09/23)

    Total calculated
    $141,065
    From this org
    $137,386
    From related orgs
    $0
    Other
    $3,679
    Hours/week
    50

  • Kelly Christie

    INTERIM CFO (08/21/23-09/19/23)

    Total calculated
    $19,527
    From this org
    $19,527
    From related orgs
    $0
    Other
    $0
    Hours/week
    40

  • Kory Blank

    ORTHOPEDIC SURGEON

    Total calculated
    $848,469
    From this org
    $828,529
    From related orgs
    $0
    Other
    $19,940
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $755,696
    Bonus
    $0
    Other
    $72,833
    Deferred
    $7,106
    Nontaxable benefits
    $12,834
    Filer's total
    $848,469

  • Arunima Saxena

    PHYSICIAN

    Total calculated
    $384,925
    From this org
    $372,657
    From related orgs
    $0
    Other
    $12,268
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $348,831
    Bonus
    $0
    Other
    $23,826
    Deferred
    $0
    Nontaxable benefits
    $12,268
    Filer's total
    $384,925

  • Lauren Williams

    PHYSICIAN

    Total calculated
    $451,866
    From this org
    $445,476
    From related orgs
    $0
    Other
    $6,390
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $405,350
    Bonus
    $0
    Other
    $40,126
    Deferred
    $0
    Nontaxable benefits
    $6,390
    Filer's total
    $451,866

  • Christopher Ballard

    PHYSICIAN

    Total calculated
    $383,643
    From this org
    $363,743
    From related orgs
    $0
    Other
    $19,900
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $346,371
    Bonus
    $0
    Other
    $17,372
    Deferred
    $7,066
    Nontaxable benefits
    $12,834
    Filer's total
    $383,643

  • Louis Remynse

    UROLOGIST

    Total calculated
    $728,410
    From this org
    $715,576
    From related orgs
    $0
    Other
    $12,834
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $715,576
    Bonus
    $0
    Other
    $0
    Deferred
    $0
    Nontaxable benefits
    $12,834
    Filer's total
    $728,410

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 3 · Compensation committee
  • 3 · Compensation survey or study
  • 3 · Approval by the board or compensation committee

Answered no

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Provenance

Return type
form_990
Tax year
2023
Filed
12 May 2025
IRS schema version
2023v6.0
Source object
202531349349306038

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