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Nonprofiteer
← HENRY COUNTY HOSPITAL INC

Form 990 for tax year 2022

Filed by HENRY COUNTY HOSPITAL INC.

Totals

Total revenue
$36,645,635
Total expenses
$35,183,615
Contributions and grants received
$277,040
Grants paid
$106,975
Program service revenue
$34,297,610
Investment income
-$4,040
Other revenue
$2,075,025
Total assets, end of year
$23,991,931
Total liabilities, end of year
$7,976,306
Net assets or fund balances, end of year
$16,015,625
Program services expenses (Part IX)
$28,050,790
Management and general expenses
$7,132,825
Fundraising expenses
$0
Program service expenses (Part III)
$28,050,790

Program services were 79.7% 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

    $244,085

  • 1f · All other contributions, gifts and grants

    $32,955

  • 1g · Noncash contributions included above

    $250,185

  • 2a · Program service revenue: NET PATIENT REVENUE

    total $34,297,610 · related or exempt $34,297,610

  • 6a · Gross rents

    real property $100,096

  • 6b · Less rental expenses

    real property $0

  • 6c · Rental income or loss

    real property $100,096

  • 6d · Net rental income or loss

    total $100,096 · excluded $100,096

  • 7b · Less cost or other basis and sales expenses

    securities $4,040

  • 7c · Gain or loss

    securities -$4,040

  • 7d · Net gain or loss

    total -$4,040 · excluded -$4,040

  • 11a · Other revenue: JOINT VENTURES

    total $437,934 · related or exempt $437,934

  • 11b · Other revenue: 340B REVENUE

    total $326,007 · related or exempt $326,007

  • 11c · Other revenue: CAFETERIA

    total $144,766 · excluded $144,766

  • 11d · All other revenue

    total $1,066,222 · related or exempt $1,051,982 · unrelated business $14,240

  • 11e · Other revenue, total

    $1,974,929

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $106,975 · program services $106,975

  • 5 · Compensation of officers, directors and key employees

    total $823,075 · program services $660,699 · management and general $162,376

  • 7 · Other salaries and wages

    total $13,699,710 · program services $10,997,038 · management and general $2,702,672

  • 8 · Pension plan contributions

    total $363,063 · program services $291,438 · management and general $71,625

  • 9 · Other employee benefits

    total $1,803,633 · program services $1,447,813 · management and general $355,820

  • 10 · Payroll taxes

    total $1,108,281 · program services $889,640 · management and general $218,641

  • 11b · Fees: legal

    total $46,481 · management and general $46,481

  • 11c · Fees: accounting

    total $76,552 · management and general $76,552

  • 11g · Fees: other

    total $7,488,566 · program services $6,011,226 · management and general $1,477,340

  • 12 · Advertising and promotion

    total $227,257 · program services $182,424 · management and general $44,833

  • 13 · Office expenses

    total $477,741 · program services $383,492 · management and general $94,249

  • 16 · Occupancy

    total $1,913,823 · program services $1,536,265 · management and general $377,558

  • 17 · Travel

    total $14,580 · program services $11,704 · management and general $2,876

  • 19 · Conferences, conventions and meetings

    total $20,045 · program services $16,091 · management and general $3,954

  • 20 · Interest

    total $142,219 · management and general $142,219

  • 22 · Depreciation, depletion and amortization

    total $939,232 · program services $753,941 · management and general $185,291

  • 23 · Insurance

    total $375,400 · program services $301,341 · management and general $74,059

  • 24a · Other expenses: DRUGS AND MEDICAL SUPPL

    total $4,315,712 · program services $3,464,311 · management and general $851,401

  • 24b · Other expenses: FRANCHISE FEE

    total $842,069 · program services $675,946 · management and general $166,123

  • 24c · Other expenses: NUTRITION/WELLNESS

    total $209,123 · program services $167,867 · management and general $41,256

  • 24d · Other expenses: DUES AND SUBSCRIPTIONS

    total $65,713 · program services $52,749 · management and general $12,964

  • 24e · All other expenses

    total $124,365 · program services $99,830 · management and general $24,535

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $2,050 · end of year $1,850

  • 2 · Savings and temporary cash investments

    beginning of year $6,055,583 · end of year $7,769,444

  • 4 · Accounts receivable

    beginning of year $5,771,571 · end of year $5,904,028

  • 8 · Inventories for sale or use

    beginning of year $841,387 · end of year $747,085

  • 9 · Prepaid expenses and deferred charges

    beginning of year $427,227 · end of year $446,415

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

    $26,881,522

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

    $21,159,768

  • 10c · Land, buildings and equipment, net

    beginning of year $6,047,251 · end of year $5,721,754

  • 12 · Investments: other securities

    beginning of year $1,376,946 · end of year $1,740,016

  • 15 · Other assets

    beginning of year $2,306,709 · end of year $1,661,339

  • 17 · Accounts payable and accrued expenses

    beginning of year $2,976,166 · end of year $2,394,269

  • 20 · Tax-exempt bond liabilities

    beginning of year $5,042,612 · end of year $4,400,261

  • 23 · Secured mortgages and notes payable

    beginning of year $640,500 · end of year $655,000

  • 25 · Other liabilities

    beginning of year $0 · end of year $526,776

  • 27 · Net assets without donor restrictions

    beginning of year $12,925,703 · end of year $14,694,123

  • 28 · Net assets with donor restrictions

    beginning of year $1,243,743 · end of year $1,321,502

Mission and programs · 2022

Mission

PLEASE SEE SCHEDULE O FOR THE ORGANIZATION'S MISSION STATEMENT.

Activities or mission (Part I)

PLEASE SEE SCHEDULE O FOR THE ORGANIZATION'S MISSION.

  • 1. LABORATORY--PROVIDING SERVICES FOR IP AND OP, EXTENDED CARE FACILITIES, PHYSICIAN OFFICES AND AREA BUSINESSES. THE LABORATORY PROVIDED OVER 119,222 BILLED TESTS IN 2023.

    Expenses $2,915,724 · Revenue $4,950,137

  • 2. SURGERY: PROVIDING PRE-, INTRA-, AND POST PROCEDURE CARE FOR SURGICAL INPATIENTS AND OUTPATIENTS. INCLUDES GENERAL, ORTHOPEDIC, CATARACT, VEIN, UROLOGY, OBSTETRIC, GYNECOLOGICAL, PAIN, OPHTHALMIC AND ENDOSCOPIC PROCEDURES. SURGICAL CARE SERVICES PERFORMED OVER 1,717 PROCEDURES IN 2023.

    Expenses $2,194,274 · Revenue $5,476,687

  • 3. EMERGENCY: CARE SERVICES ARE PROVIDED CONTINUALLY TO PATIENTS PRESENTING WITH INJURIES AND ILLNESSES. TOTAL PATIENTS TREATED IN THE EMERGENCY DEPARTMENT TOTALED OVER 6,764 FOR 2023.

    Expenses $2,328,482 · Revenue $2,352,469

  • 4: OTHER SERVICES: PROVIDED BY HENRY COUNTY HOSPITAL ARE: MEDICAL IMAGING, INCLUDING X-RAY, CT SCANS, MRI, ULTRASOUND, AND STRESS TESTING; PHARMACY SERVICES; REHAB SERVICES, INCLUDING PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH THERAPY; ONCOLOGY SERVICES; INPATIENT AND INTENSIVE CARE SERVICES; BIRTHING CARE SERVICES; CARDIAC REHAB, EKG, AND RESPIRATORY THERAPY; AND OUTPATIENT DRUG AND ALCOHOL TREATMENT. HENRY COUNTY HOSPITAL PROVIDED OVER 87,438 BILLED DOSES TO PATIENTS THROUGH PHARMACY SERVICES, OVER 399 INPATIENT ADMISSIONS WITH OVER 1,302 DAYS OF CARE, 76 SWING BED PATIENTS WITH OVER 732 DAYS OF CARE, 96 BIRTHS, AND OVER 63,901 OUTPATIENT VISITS IN 2023.

    Expenses $20,612,310 · Grants $106,975 · Revenue $23,291,085

As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • MARVIN BARLOW

    CHAIRMAN

    Total calculated
    $0
    Hours/week
    4

  • BRENT GERKEN

    VICE-CHAIR

    Total calculated
    $0
    Hours/week
    2

  • JIM BURKHART

    SECRETARY

    Total calculated
    $0
    Hours/week
    2

  • DR MIKE CARPENTER

    TREASURER

    Total calculated
    $0
    Hours/week
    2

  • DR ERAST HAFTKOWYCZ

    BOARD MEMBER & OBGYN

    Total calculated
    $300,856
    From this org
    $281,870
    From related orgs
    $0
    Other
    $18,986
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $281,870
    Bonus
    $0
    Other
    $0
    Deferred
    $8,294
    Nontaxable benefits
    $10,692
    Filer's total
    $300,856

  • THOMAS MACK

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    2

  • MELISSA PEPER FIRESTONE

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    2

  • RICKY FRUTH

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    2

  • JOY ERMIE

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    2

  • JOHN WILHELM

    VICE-CHAIR PARTIAL TERM

    Total calculated
    $0
    Hours/week
    2

  • DR JOHN EWONUS

    BOARD MEMBER PARTIAL TERM

    Total calculated
    $0
    Hours/week
    2

  • KRISTI BARND

    CEO

    Total calculated
    $227,882
    From this org
    $211,102
    From related orgs
    $0
    Other
    $16,780
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $211,102
    Bonus
    $0
    Other
    $0
    Deferred
    $5,672
    Nontaxable benefits
    $11,108
    Filer's total
    $227,882

  • TIFFANY KENNERK

    CNO

    Total calculated
    $150,476
    From this org
    $135,601
    From related orgs
    $0
    Other
    $14,875
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $135,601
    Bonus
    $0
    Other
    $0
    Deferred
    $3,858
    Nontaxable benefits
    $11,017
    Filer's total
    $150,476

  • BENJAMIN FISER

    CIO

    Total calculated
    $81,305
    From this org
    $75,943
    From related orgs
    $0
    Other
    $5,362
    Hours/week
    40

  • JAMES NOWACZYK

    CNO

    Total calculated
    $172,521
    From this org
    $156,361
    From related orgs
    $0
    Other
    $16,160
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $156,361
    Bonus
    $0
    Other
    $0
    Deferred
    $1,397
    Nontaxable benefits
    $14,763
    Filer's total
    $172,521

  • DR MORRIS SEAL

    PHYSICIAN

    Total calculated
    $184,964
    From this org
    $167,354
    From related orgs
    $0
    Other
    $17,610
    Hours/week
    20

    Schedule J breakdown matched by us

    Base
    $167,354
    Bonus
    $0
    Other
    $0
    Deferred
    $6,481
    Nontaxable benefits
    $11,129
    Filer's total
    $184,964

  • DR ANDREW GOMBASH

    PHYSICIAN

    Total calculated
    $248,121
    From this org
    $230,666
    From related orgs
    $0
    Other
    $17,455
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $230,666
    Bonus
    $0
    Other
    $0
    Deferred
    $7,030
    Nontaxable benefits
    $10,425
    Filer's total
    $248,121

  • DR JOSEPH KRUEGER

    PHYSICIAN

    Total calculated
    $281,407
    From this org
    $263,493
    From related orgs
    $0
    Other
    $17,914
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $263,493
    Bonus
    $0
    Other
    $0
    Deferred
    $7,489
    Nontaxable benefits
    $10,425
    Filer's total
    $281,407

  • MICHELE JAKUTOWICZ

    PHARMACIST

    Total calculated
    $168,254
    From this org
    $142,311
    From related orgs
    $0
    Other
    $25,943
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $142,311
    Bonus
    $0
    Other
    $0
    Deferred
    $4,435
    Nontaxable benefits
    $21,508
    Filer's total
    $168,254

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

  • 2 · Substantiation required before reimbursing expenses
  • 3 · Compensation committee
  • 3 · Form 990 of other organizations
  • 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

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.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

  • HENRY COUNTY PAIN MANAGEMENT LLC

    RELATED · MEDICAL PAIN MANAGEMENT · OH · 51% owned · share of income $218,948 · share of assets $187,688 · general or managing partner

    Directly controlled by HENRY COUNTY HOSPITAL

Provenance

Return type
form_990
Tax year
2022
Filed
10 September 2024
IRS schema version
2022v5.0
Source object
202442549349300009

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