2024-11-13T03:49:49-00:00 2023-12-31 990 2023-01-01 341571750 Harrison Community Hospital HARR 7409426240 951 East Market Street Cadiz OH 43907 Alex Inclan Director of Accounting 3048453211 2024-11-12 false true X 2023 2024-10-15 13:58:12Z David Phillips 951 East Market Street Cadiz OH 43907 20570743 false X https://wvumedicine.org/harrison-community-hospital/ X 1969 OH To provide the highest level of quality healthcare to all people of its service area regardless of age, sex, religion, national origin and ability to pay. 12 9 144 1 3051429 702890 18076767 19500882 1945 25705 769537 329291 18848249 20558768 1500 0 7490623 8958326 0 0 11748135 11196308 19238758 20156134 -390509 402634 11140839 9745226 13603598 12796949 -2462759 -3051723 X It is the mission of Harrison Community Hospital to provide the highest level of quality healthcare to all people of its service area, regardless of age, sex, religion, national origin and ability to pay. This mission, under the guidance of a community-based board of trustees, is implemented using the philosophy of reaching out to provide services false false 6392824 7320623 Our emergency department serves patients from across the region in their most critical moments. The Harrison Community Hospital emergency department is staffed 24 hours a day, seven days a week, 365 days a year. Our goal is to deliver a fast, accurate diagnosis and efficient treatment and/or transport for all patients. Regardless of insurance status, no patient will ever be turned away for treatment. Harrison Community Hospital had 5,811 emergency room visits during 2023. 2138005 1855940 Harrison Community Hospital internal medicine provides comprehensive primary care for adults and seniors, with a focus on diseases affecting the heart, blood, kidneys, and joints, as well as the digestive, respiratory, and vascular systems. In 2023, Harrison Community Hospital had 2,190 internal medicine visits. 2045321 1640368 Harrison Community Hospital cares for patients of all ages including infants, children, adults, and seniors. In 2023, Harrison Community Hospital had 6,696 family medicine visits. 6116610 5803140 16692760 true true false true false false false false false false true false false false true true false true false false false false false false true false true true false false true false false false false false false false false false false false false false true false false false true X 0 0 146 true true true false false false false false false false false false false false X 12 9 false false false false false false false true true false false true true true true true true true true false OH X Alex Inclan 3048453211 800 Wheeling Ave Glen Dale WV 26038 Douglass Harrison Director, CEO Wheeling Hospital 001.00 041.00 X 0 646335 119472 James Comerci MD Physician 008.00 033.00 X 101117 391163 31164 Shaun Roe DO Director 001.00 040.00 X 0 289109 42901 David Phillips Director, CEO 020.00 020.00 X 129317 129317 61927 Derek Golna Physician 040.00 X 256574 0 41359 Kristy Dobson Nurse Practitioner 040.00 X 129683 0 5937 David Hacker VP Operations BRNS-HCH 020.00 020.00 X 62010 62010 6147 Porsche Beetham Physician 040.00 X 121468 0 1867 Amanda Zelek Lead Pharmacist 040.00 X 102126 0 7022 Nicole Ourant Manager Nursing 040.00 X 101440 0 4471 William Frank Director 001.00 001.00 X 0 0 0 Kent Gallagher Director 001.00 001.00 X 0 0 0 Angela Hannahs Director 001.00 001.00 X 0 0 0 Tom Johnson Director 001.00 001.00 X 0 0 0 Ken Phillips Director 001.00 001.00 X 0 0 0 Garen Rhome Director 001.00 001.00 X 0 0 0 Michael Sliva Director 001.00 001.00 X 0 0 0 Sandi Thompson Director 001.00 001.00 X 0 0 0 Jonathan Kirkland Director 001.00 001.00 X 0 0 0 1003735 1517934 322267 6 false true false PCS & Build LLC 1301 E 9th St Ste 2100 Cleveland OH 441141850 Contract Labor/Repairs 247751 1 662890 40000 702890 Patient Service Revenue 623990 16063453 16063453 Custer RX/Capture RX Revenue 446110 3011935 3002343 9592 Ambulance / EMS Revenue 621910 233363 233363 Provider Relief Funds Reserve 900099 162389 162389 Patient Care Quality Incentives 900099 29742 29742 19500882 10581 10581 19797 19797 19797 19797 19000 3876 15124 15124 15124 11213 8099 3114 3114 Cafeteria Income 900099 122797 122797 Catering Revenue 722320 49086 49086 Rebate Revenue 900099 3373 3373 131124 131124 306380 20558768 16620071 3051429 184378 X 1500 1500 0 0 0 332882 172601 160281 0 6378639 5772044 606595 203891 198118 5773 1463858 1338150 125708 579056 523989 55067 0 0 -8363 -8363 2186 2186 0 3105949 2884056 221893 64751 1703 63048 719965 371373 348592 26345 21527 4818 0 292176 228998 63178 53720 34784 18936 0 0 457405 358499 98906 993627 16876 976751 448135 351233 96902 -26224 -52518 26294 Medical Supplies 3346264 3346264 Provision for Doubtful Accounts 1001761 1001761 Taxes, Licenses Fees 555552 8851 546701 Recruiting 106998 102500 4498 56061 8265 47796 20156134 16692760 3463374 0 4734308 2473224 283930 2206340 2581367 730542 222659 6318 281677 5744218 1891835 3458331 3852383 49986 5000 11140839 9745226 1746197 1220762 583473 583473 10757676 10180149 516252 812565 13603598 12796949 X -2849527 -3294878 386768 243155 -2462759 -3051723 11140839 9745226 X 402634 -991598 X X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 2186 2186 false II-B 1 Harrison Community Hospital is a member of the Ohio Hospital Association OHA and the American Hospital Association AHA and pays annual dues. Lobbying expenses represent the portion of the dues paid to national and state hospital associations that are specifically allocable to lobbying. Harrison Community Hospital does not participate in or intervene in including publishing or distributing of statements any political campaign on behalf of or in opposition to any candidate for public office. 67500 67500 2207445 313382 1894063 2548693 1539355 1009338 920580 39098 881482 3852383 Financial derivatives and other financial products Closely-held equity interests Federal income taxes Local/City PR taxes -1251 Finance Leases Payable 84532 Self Insurance Liability Intercompany Payable 342638 Due to Affiliate Property Taxes Payable 10138 Capitalized Leases Payable 376508 812565 X 19553893 -1001761 -1001761 20555654 3114 3114 20558768 19154373 19154373 1001761 1001761 20156134 X 2 Most of the entities that comprise the System are tax-exempt organizations and not subject to federal or state income taxes in accordance with Section 501c3 of the Internal Revenue Code. On such basis, they will not incur any liability for income taxes, except for possible unrelated business income. AHS, BCHS, PHIC, HPN, and TMHS are organizations subject to federal and/or state income taxes. The System does not have any material uncertain tax positions as of December 31, 2023 and 2022. XI 2d This line consists of allowance for doubtful accounts of 1,001,761 which is reported as an offset to revenue on the financial statements. XI 4b This line consists of auxiliary fundraising proceeds of 3,114 that is reported as revenue on the Form 990 XII 4b This line consists of allowance for doubtful accounts of 1,001,761 which is reported as an offset to revenue on the financial statements. Auxiliary Funds 11213 11213 8099 11213 11213 8099 8099 3114 true true X true X false true true true false true true 159509 159509 4837021 2900089 1936932 0.10110 4996530 3059598 1936932 0.10110 22656 131 22525 0.00120 1816 1816 0.00010 24472 131 24341 0.00130 5021002 3059729 1961273 0.10240 1 990 990 1 990 990 true 494169 74125 1955040 3134941 -1179901 X true true 1 1 Harrison Community Hospital 951 East Market Street Cadiz OH 43907 https//wvumedicine.org/harrison-community-hospital/ X X X X A A 1 false false true X X X X X X X X 23 true true false true X https//wvumedicine.org/wp-content/uploads/2023/11/Barnesville-Hospital-and-Harrison-Community-Hospit X true 24 true https//wvumedicine.org/wp-content/uploads/2024/05/barnesvillehospitalandharrisoncommunityhospitalcom false true X 0000000200.000000000000 X X X X X true true X X X true X https//wvumedicine.org/bill-pay/financial-assistance/ X https//wvumedicine.org/wp-content/uploads/2020/03/Financial-Assistance-Application-Form-3-17-2020.pd X https//wvumedicine.org/bill-pay/financial-assistance/ X X X X X X true X false X X X X true X false true Group Harrison Community Hospital Line Part V, Section B, Line 6a The 2023 Community Health Needs Assessment was conducted with Barnesville Hospital Association. Group Harrison Community Hospital Line Part V, Section B, Line 5 The following comprised Barnesville Hospital and Harrison Community Hospitals CHNA leadership team and provided comprehensive input throughout the process of developing the CHNA. These individuals informed the development of the public input survey and were instrumental in the dissemination of data collection within the community. The leadership team included individuals from the following organizations Barnesville Hospital Association, Harrison Community Hospital, Belmont County Health Department, Belmont County Commissioner, Barnesville Schools, Mental Health and Recovery Board, Monroe County Health Department, Harrison County Health Department, Harrison County Commissioner, and Harrison Hills School District. Group Harrison Community Hospital Line Part V, Section B, Line 11 The existing secondary data, new survey data, community meeting input, and lessons learned from the last CHNA cycle all factored into hospital leaderships prioritization discussion. The hospitals team considered the degree to which each hospital can affect health outcomes for each topic and projects or programs already underway for each within the hospital, as well as the level of importance placed on each by the community relative to the reach of the hospitals impact. A list of top health concerns was organized into four that will be the focus moving forward with implementation planning - Substance Use and Abuse, Obesity and Co-Morbid Disease, Physical Activity and Nutrition, and Mental Health. In order to address the substance use and abuse need, the hospitals plan to sponsor drug free programs. Each year, the hospitals will sponsor an activity for each of the local schools drug free programs. To address the obesity and co-morbid disease health need, the hospitals will set up informational tables in the main lobbies of both hospitals for the entire month of November for National Diabetes Month awareness. The hospitals will record and produce videos of providers sharing tips on managing diabetes and the warning signs of diabetes. To address the physical activity and nutrition health need, each year the hospitals will sponsor at least two 5k race/walks in the Barnesville Hospital and Harrison Community Hospital service areas. The hospitals will also conduct one nutrition class at each facility monthly. Lastly, the hospitals will sponsor a mental health speaker each calendar school year for two of the local schools in order to address the mental health need. Group Harrison Community Hospital Line Part V, Section B, Line 13b Harrison Community Hospital offers discounted care only to individuals who qualify for free care. Harrison Community Hospital offers a Prompt-Pay Discount Program - patients who have no third party coverage uninsured or uninsurable may be eligible for a 50 self-pay discount while patients who have a guarantor balance may be eligible for a 20 discount. To be eligible for either prompt pay discount, the patient/guarantor must meet certain requirements. Group Harrison Community Hospital Line Part V, Section B, Line 24 All patients are charged an amount equal to gross charges regardless of payment method. Once FAP eligibility is confirmed, charge amounts are moved to Charity Care and no longer charged to the patient. Part I Line 3c Harrison Community Hospital HCH uses 200 Federal Poverty Guidelines FPG to determine free care eligibility. However, HCH does not offer discounted care to individuals who fail the 200 FPG test. Part I Line 6a HCH community benefit numbers are reported in total with other hospitals within the West Virginia United Health System. The most recent amounts can be found on WVU Medicines website here https//wvumedicine.org/about/leadership-and-more/community-benefit/. Part I Line 7 Net community benefit expense for 2023 is 1,961,273 and is 10.24 of total net expenses. To calculate net expense, bad debt of 1,001,761 was deducted from total expenses of 20,156,134 as shown in Part IX line 25 of the core Form 990, for a net expense of 19,154,373. Worksheet 2 from the IRS Schedule H instructions was used to derive the Cost-to-Charge ratio, which was used to calculate Charity Care, Unreimbursed Medicaid and other means-tested government programs at cost. Part I Line 7 Worksheet 2 from the IRS Schedule H instructions was used to derive the Cost-to-Charge ratio, which was used to calculate Charity Care, Unreimbursed Medicaid and other means-tested government programs at cost. Part II Individuals with Harrison Community Hospital participated in various Harrison Regional Chamber of Commerce meetings and events in 2023. Part III Line 2 Bad Debt Expense at cost was calculated by multiplying bad debt expense of 1,001,761 by our cost to charge ratio of 49.33 for a total of 494,169. Part III Line 3 Estimated bad debt attributable to patients eligible for charity care on Line 3 was calculated by pulling all outstanding patient balances of 5,000 or greater from our patient accounting system. That report totaled 35,888, which was then multiplied by the cost-to-charge ratio of 49.33 for a total of 17,704. Part III Line 3 We feel that at a minimum, the estimated bad debt attributable to patients eligible for charity care of 17,704 should be considered community benefit due to the fact that anyone with outstanding balances of 5,000 or greater in our demographic usually qualifies as catastrophic if the patient completes the application process. In our Charity Care Policy, we define catastrophic care as any illness or injury that will likely require continuous or frequent treatment for more than one year and would have qualified for charity care if paperwork was completed. Part III Line 4 Patient accounts receivables are primarily paid by federal and state governmental authorities under the Medicare and Medicaid programs, managed health plans, commercial insurance companies, workers compensation programs, employers and patients. Patient accounts receivable are reported at net realizable value. For accounts receivable associated with services provided to patients who have third-party coverage, the System estimates net realizable value based on the estimated contractual reimbursement percentage, which in turn is based on current contract provisions and historical paid claims by payor. For self-pay accounts, including uninsured and patient responsibility accounts, the net realizable value is determined using historical collection experience, adjusted for estimated conversions of patient responsibility portions, expected recoveries and changes in trends to estimate implicit price concessions. The System does not believe there are any significant concentrations of revenues from any particular payor that would subject the System to any significant credit risks in the collection of patient accounts receivable. Management continually reviews the estimated net realizable value of accounts receivable by monitoring cash collections, economic conditions and trends, changes in payor mix, changes in federal or state healthcare coverage and other matters. Changes in general economic conditions, patient accounting service center operations, payor mix, payor claim processing could affect collections of accounts receivable, cash flows and results of operations. Part III Line 4 The System performs periodic assessments to determine if an allowance for expected credit losses is necessary. The System considers its incurred loss experience and adjusts for known and expected events and other circumstances. In estimating its expected credit losses, the System may consider changes in the length of time its receivables have been outstanding, changes in credit ratings for payors, requests from payors to alter payment terms due to financial difficulty, and notices of payor bankruptcies or payors entering receivership. Because the Systems accounts receivable is typically paid for by highly solvent, creditworthy payors, such as Medicare, Medicaid, other governmental programs, and highly regulated commercial insurers on behalf of the patient, the Systems credit losses are immaterial to the consolidated financial statements. Part III Line 4 The mix of accounts receivable at December 31, 2023 and 2022, from patients and third-party payors is as follows For the year-end December 31, 2023 Medicare - 25, Medicaid - 13, Blue Cross - 21, Commercial, managed care and other - 39, Patients - 2, totaling 100. For the year-end December 31, 2022 Medicare - 27, Medicaid - 16, Blue Cross - 19, Commercial, managed care and other - 35, Patients - 3, totaling 100. Part III Line 8 The amount reported in Part III Line 6 3,134,941 was calculated using the total Medicare allowable cost from the Medicare cost report, less Medicare reimbursement of direct GME. Part III Line 8 Harrison Community Hospitals shortfall, 1,179,901 of Medicare program reimbursement should be considered a community benefit because we are relieving a government burden by providing care in excess of our costs to these patients. Part III Line 9b Harrison Community Hospital does have a debt collection policy. When a patient has been approved for financial assistance under our charity care policy, they will not be sent to bad debt. Additionally, if a patient is being evaluated for charity, the patient will not be sent to bad debt agency pending charity guarantor status until the pending status has been finalized approved/denied. All other patients with outstanding balances will be processed through billing and collections pursuant to our Financial Policy. Part VI Line 2 The CHNA process began with a thorough review of the previous cycles needs assessment report and included a review of publicly available secondary data related to counties within Barnesville Hospital and Harrison Community Hospitals service area. This data included U.S. Census data and County Health Rankings data. Using these reports as a springboard, the leadership team started the initial discussion around critical health needs, changes in the community demographics over the previous few years, and lessons learned from the last CHNA cycles health topic prioritization and development of implementation activities. Primary data collection was comprised of surveying community members to gather perceptions of health issues, quality of life, and other related topics. Survey data was analyzed and presented to the hospitals leadership teams at a data presentation that included stakeholders. This event was focused on reviewing the survey data, discussing community assets that impact population health in the hospitals service area, as well as discussing the needs of those not well-represented in the survey data. Part VI Line 2 Ongoing community health fairs, CPR classes, diabetes education and healthy lifestyle seminars are the primary method of gauging community health needs throughout the year. Many of these programs are coordinated with Wheeling Hospital, Inc. The communities usually contact the hospital facility and ask for assistance. The breakfast for kids program was started by the Hospital knowing that there are kids needing a Christmas. Use of Hospital cardio exercise equipment by the community, as a fitness resource, was also enacted due to requests/inquiries from the community. Part VI Line 3 Harrison Community Hospital HCH employs financial counselors to meet with patients and discuss eligibility to qualify for charity care. HCH provides brochures discussing charity care and the qualifications for receiving charity care. These brochures are available at each registration area in the facility. HCH provides financial assistance to patients who do not qualify for any state or federal programs. Part VI Line 3 Our charity care eligibility guidelines are also listed on our website at www.wvumedicine.org under the Billing and Insurance - Online Bill Pay section of the Patient and Visitor page. HCH also has contracted a third party organization to be on-site to help patients, that qualify for charity care, Medicaid, or other types of financial assistance, complete the required applications and provide the correct documentation to receive these benefits. Part VI Line 4 Harrison Community Hospital predominantly services rural Harrison County, Ohio with an approximate population of 14,159. The racial makeup of Harrison County, OH according to the estimated July 1, 2023 census data was 95.2 white, 2.0 African American, 0.3 Asian, 0.3 Native American, with the remainder from other races or a combination of two or more races. The median household income for 2023 was approximated at 54,056 while the median US household income was 75,149. The percentage of households below the poverty level in 2023 was approximately 13.9 compared to 11.1 nationally. Part VI Line 5 We continue to provide quality services to the rural and needy community regardless of major reductions in reimbursement. The organization remains committed to the community even when resources are limited and/or less than cost to provide coverage. We continue to make efforts to attract physicians and medical services for those that cannot connect to programs in other service areas. Part VI Line 6 Harrison Community Hospital is a part of the WV United Health System WVUHS. WVUHS is a not-for-profit corporation formed to serve as part of an integrated health science and healthcare delivery system. WVUHS serves as the parent corporation to an affiliated group of healthcare providing entities. The strategic plan of the System states intent to build a regional health care delivery system in its service areas, while offering a variety of options for providers who want to participate. The System maintains a demonstrated commitment to assist rural communities in preserving and improving the health care available to the patients it serves. Part VI Line 6 System management is focused on recruitment of staff and employees to meet the growing needs of the aging population in the Systems service areas. Other hospitals in the System include West Virginia University Hospitals, Inc. in Morgantown, WV, United Hospital Center in Bridgeport, WV, Camden-Clark Memorial Hospital in Parkersburg, WV, City Hospital, Inc. in Martinsburg, WV, Jefferson Memorial Hospital in Ranson, WV, Potomac Valley Hospital in Keyser, WV, St. Josephs Hospital of Buckhannon, Inc. in Buckhannon, WV, West Virginia Healthcare Cooperative, doing business as, Summersville Regional Medical Center in Summersville, WV, Braxton County Memorial Hospital in Gassaway, WV, Community Health Association, doing business as, Jackson General Hospital in Ripley, WV, Reynolds Memorial Hospital in Glen Dale, WV, Barnesville Hospital Association in Barnesville, OH, Uniontown Hospital in Uniontown, PA, Wheeling Hospital, Inc. in Wheeling, WV, Harrison Community Hospital, Inc. in Cadiz, OH, GRMC, Inc. in Oakland, MD, Princeton Community Hospital Association, Inc. in Princeton, WV, Thomas Health System, Inc. in South Charleston, WV, and Grant Memorial Hospital, Inc. in Petersburg, WV. Part VI Line 6 In addition to the above mentioned hospitals, the System includes physician practices of United Physicians Care, Inc. and Camden-Clark Physician Corp that operate in conjunction with the System hospitals along with United Summit Center, Inc., a behavioral health center located in Clarksburg, WV. The System also includes, WVUH-East, Inc., and Camden-Clark Health Services, Inc., which operate as management companies for their respective hospitals. University Healthcare Foundation, Inc. in Martinsburg, WV, United Health Foundation, Inc., in Bridgeport, WV, Camden-Clark Foundation, Inc., in Parkersburg, WV, St. Josephs Foundation of Buckhannon, Inc., in Buckhannon, WV, Reynolds Memorial Foundation, Inc., in Glen Dale, WV, Harrison Community Hospital Foundation, in Cadiz, OH and Wheeling Hospital Foundation, in Wheeling, WV, which perform various fundraising activities for their respective hospitals. In 2020, the System formed WVUHS Home Care, LLC to provide Home Health and Hospice services to our service areas, supporting System hospitals by providing continuous care to our patients. Wheeling Hospital Ambulatory Surgical Center, LLC a surgical center located in Bridgeport, OH was acquired in 2021. X X false true false false false false false false false Derek Golna Physician 256195 379 12046 29313 297933 James Comerci MD Physician 92370 357327 7376 28532 1371 5304 1772 6853 4630 17909 107519 415925 Douglass Harrison Director, CEO Wheeling Hospital 485560 146113 14662 93289 26183 765807 David Phillips Director, CEO 103940 103940 23072 23072 2305 2305 15530 15530 15434 15433 160281 160280 Shaun Roe DO Director 279901 8790 418 11925 30976 332010 Part I Line 4b The following individuals received deferred compensation contributions in 2023 - Douglass Harrison in the amount of 93,289 from related party and David Phillips in the amount of 10,710 from Harrison Community Hospital and 10,710 from related party. These amounts are properly recorded in deferred compensation on the Form 990 Schedule J. Form 990, Part III, Line 4d Program Service Expenses 6,116,610, Grants and allocations 0, Revenue 5,803,140 Harrison Community Hospital serviced 280 inpatients and 13,020 outpatient visits. Form 990, Part VI, Section B, Line 11B The West Virginia United Health Systems tax team prepares the Form 990 with assistance from the hospital accounting team. The 990 is then reviewed by the Director of Accounting. The 990 is then presented to the Finance Committee. A copy of the 990 is provided to the Board of Directors along with the recommendation from a representative from the Finance Committee prior to filing. Form 990, Part VI, Section B, Line 12C All members of the board of directors and officers receive a copy of the conflict of interest policy annually. Recipients are annually asked to acknowledge they have read the policy, identify any areas of conflict and return the signed disclosure form to Harrison Community Hospital. Responses are reviewed and identified conflicts are referred to the board of directors for discussion and approval. Key employees and other employees are required to complete a conflict of interest questionnaire at hiring and when a chance occurs that may be a conflict of interest. Form 990, Part VI, Section B, Line 15 Officers and key employees compensation is reviewed by the Harrison Community Hospital board, the board trustees review national, regional and local compensation surveys, additionally, years of service are also taken into account. Form 990, Part VI, Section C, Line 19 Governing documents, conflict of interest policy and financial statements are available upon request. Form 990, Part XI, Line 9 Other changes in net assets consist of the following 429,580 of related organization capitalization, 3,114 of auxiliary fundraising net income that is reported on Form 990 as revenue, 287,740 to merge Foundation to HCH, 143,613 change in restricted net assets, 9,335 JOA contribution to SOM, 693,695 intercompany write off, and 1 rounding. Form 990, Part XII, Line 2C Effective April 1, 2021, Harrison Community Hospital became a member of the West Virginia United Health System. As a member of the System, Harrison was included in the consolidated audit prepared by the System independent auditors. The auditors and System accounting team work closely with each entity in preparing for and completing the audit. Form 990, Part III, Line 1 as near to the populace as possible. Form 990, Part V, Line 1a In 2023, West Virginia United Health System WVUHS, EIN 55-0754713, transitioned to a centralized accounts payable process in which WVUHS made the majority of vendor payments and then issued the required 1099s. WVUHS is reimbursed by the entities for their portion of payments made, vendor payments that meet the Top 5 Independent Contractor reporting requirements are reported in Part VII, Section B of the reporting entity. Form 990, Part IX, Line 11g Line 11g consists of the following expenses Consulting Professional Fees of 19,362 of which 3,704 is considered program service expense and 15,658 is considered management and general expense and Contract Labor of 3,086,587 of which 2,880,352 is considered program service expense and 206,235 is considered management and general expense. 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