CLIFTON-FINE HEALTH CARE CORPORATION: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- CLIFTON-FINE HEALTH CARE CORPORATION (EIN 90-0909506)
- Tax period
- 2022-01-01 to 2022-12-31
- Filed
- 2023-11-14
- IRS object ID
- 202343189349310609
- Schema version
- 2022v5.0
- 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 J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-11-14T13:48:25-06:00 | ReturnTs |
| Tax Period End | 2022-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 161226221 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FUSTCHARLES LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 S WARREN STREET | AddressLine1Txt |
| City | SYRACUSE | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13202 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 900909506 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTON-FINE HEALTH CARE CORPORATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CLIF | BusinessNameControlTxt |
| Phone | 3158483351 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1014 OSWEGATCHIE TRAIL | AddressLine1Txt |
| City | STAR LAKE | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13690 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DIERDRA SORRELL | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 3158483351 | PhoneNum |
| Signature | 2023-11-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | DIERDRA | PersonFirstNm |
| Person Last | SORRELL | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | PATRICK CAPELLA | PreparerPersonNm |
| PTIN | P01359200 | PTIN |
| Phone | 3154463600 | PhoneNum |
| Preparation | 2023-11-13 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DIERDRA SORRELL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1014 OSWEGATCHIE TRAIL | AddressLine1Txt |
| City | STAR LAKE | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13690 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $9,819,352 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CLIFTONFINEHOPSITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2012 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | SEE SCHEDULE OTHE PURPOSE FOR WHICH THE CORPORATION WAS ORGANIZED IS TO OWN AND OPERATE THE HEALTH CARE FACILITY KNOWN AS "CLIFTON-FINE HOSPITAL". CLIFTON-FINE HEALTH CARE CORPORATION IS A CRITICAL ACCESS HOSPITAL WHICH PROVIDES HEALTH CARE SERVICES FOR THE BENEFIT OF THE RESIDENTS OF THE STATE OF NEW YORK AND THE TOWNS OF CLIFTON AND FINE, INCLUDING PERSONS IN NEED OF HEALTH CARE SERVICES WITHOUT THE ABILITY TO PAY AS REQUIRED BY LAW. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 110 | TotalEmployeeCnt |
| Total Volunteers | 16 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,576,879 | PYContributionsGrantsAmt |
| CY Contributions Grants | $395,310 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $9,743,571 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $9,135,764 | CYProgramServiceRevenueAmt |
| PY Investment Income | $4,014 | PYInvestmentIncomeAmt |
| CY Investment Income | $52,787 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,237,426 | PYOtherRevenueAmt |
| CY Other Revenue | $235,491 | CYOtherRevenueAmt |
| PY Total Revenue | $12,561,890 | PYTotalRevenueAmt |
| CY Total Revenue | $9,819,352 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $5,262,254 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $5,990,991 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,699,553 | PYOtherExpensesAmt |
| CY Other Expenses | $5,400,621 | CYOtherExpensesAmt |
| PY Total Expenses | $9,961,807 | PYTotalExpensesAmt |
| CY Total Expenses | $11,391,612 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,600,083 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,572,260 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $13,740,997 | TotalAssetsBOYAmt |
| Total Assets EOY | $9,465,538 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,771,890 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,209,562 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $7,969,107 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $6,255,976 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | SEE SCHEDULE OTHE PURPOSE FOR WHICH THE CORPORATION WAS ORGANIZED IS TO OWN AND OPERATE THE HEALTH CARE FACILITY KNOWN AS "CLIFTON-FINE HOSPITAL". CLIFTON-FINE HEALTH CARE CORPORATION IS A CRITICAL ACCESS HOSPITAL WHICH PROVIDES HEALTH CARE SERVICES FOR THE BENEFIT OF THE RESIDENTS OF THE STATE OF NEW YORK AND THE TOWNS OF CLIFTON AND FINE, INCLUDING PERSONS IN NEED OF HEALTH CARE SERVICES WITHOUT THE ABILITY TO PAY AS REQUIRED BY LAW. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $9,470,855 | ExpenseAmt |
| Revenue | $9,371,255 | RevenueAmt |
| Desc | A CRITICAL ACCESS HOSPITAL PROVIDING HEALTH CARE SERVICES FOR THE BENEFIT OF THE RESIDENTS OF THE STATE OF NEW YORK AND THE TOWNS OF CLIFTON AND FINE. | Desc |
| Total Program Service Expenses | $9,470,855 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 6 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 110 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NY | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIERDRA SORRELL CEO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3158484260 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1014 OSWEGATCHIE TRAIL RD | AddressLine1Txt |
| City | STAR LAKE | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13690 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| THOMAS SAUTER | ||||||||
| CHAIRPERSON | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| LEEANN SHORT | ||||||||
| VICE-CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| DAVID DAUT | ||||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| THOMAS CARMAN | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $880,166 | $57,874 | 43.50 | ||
| ALLEN DITCH | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| SADIE HALL | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| CRIS NARGI | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| CHUCK HOOVEN | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JOHN WHEELER | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| HALSEY BAGG | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MAJONICA DRAKE | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JOHN BURNS | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DIERDRA SORRELL | ||||||||
| CEO/EX-OFFICIO | 39.00 | Yes (X) | Yes (X) | $0 | $184,995 | $31,789 | 1.00 | |
| MAXINE BRIGGS | ||||||||
| CFO/TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $453,847 | $46,030 | 39.00 | |
| DAVID I MICHAELSON | ||||||||
| DOCTOR | 40.00 | $233,945 | $0 | $12,259 | Yes (X) | |||
| JACQUELINE C SNYDER | ||||||||
| PHYSICIAN ASSISTANT | 40.00 | $165,246 | $0 | $8,005 | Yes (X) | |||
| MATTHEW ZEGIL | ||||||||
| NURSE PRACTITIONER | 40.00 | $195,655 | $0 | $13,337 | Yes (X) | |||
| BRITTANI BICKEL | ||||||||
| PHYSICIAN ASSISTANT | 40.00 | $154,098 | $0 | $4,136 | Yes (X) | |||
| BYRON EVANS | ||||||||
| PHYSICIAN ASSISTANT | 40.00 | $124,800 | $0 | $1,810 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $873,744 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,519,008 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $175,240 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| APOGEE MEDICAL MANAGEMENT | |||||
| 15059 N SCOTTSDALE ROAD SUITE 600 | SCOTTSDALE | AZ | 85254 | MEDICAL SERVICES | $845,455 |
| SAMARITAN MEDICAL CENTER | |||||
| 830 WASHINGTON STREET | WATERTOWN | NY | 13601 | MEDICAL SERVICES | $663,557 |
| WESTWAYS STAFFING SERVICES INC | |||||
| 790 THE CITY DR S STE 180 | ORANGE | CA | 92868 | STAFFING SERVICES | $334,877 |
| MEDEFIS CONSOLIDATED | |||||
| 2121 N 117TH AVE STE 200 | OMAHA | NE | 68164 | BILLING SERVICES | $246,300 |
| ESP PERSONNEL | |||||
| 72030 METROPLEX DR | THOUSAND PALMS | CA | 92276 | STAFFING SERVICES | $210,611 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $65,561 | RelatedOrganizationsAmt |
| Government Grants | $261,685 | GovernmentGrantsAmt |
| All Other Contributions | $68,064 | AllOtherContributionsAmt |
| Total Contributions | $395,310 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $9,135,764 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $9,135,764 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $9,135,764 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $52,787 | TotalRevenueColumnAmt |
| Exclusion | $52,787 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| OTHER OPERATING REV | 900099 | $137,439 | $137,439 |
| 340B REVENUE | 900099 | $98,052 | $98,052 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $235,491 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,819,352 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $9,371,255 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $52,787 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,966,626 | TotalAmt |
| Program Services | $4,507,641 | ProgramServicesAmt |
| Management And General | $458,985 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $84,559 | TotalAmt |
| Program Services | $76,745 | ProgramServicesAmt |
| Management And General | $7,814 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $584,433 | TotalAmt |
| Program Services | $530,423 | ProgramServicesAmt |
| Management And General | $54,010 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $355,373 | TotalAmt |
| Program Services | $335,460 | ProgramServicesAmt |
| Management And General | $19,913 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,082 | TotalAmt |
| Management And General | $9,082 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $161,845 | TotalAmt |
| Management And General | $161,845 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,035 | TotalAmt |
| Management And General | $6,035 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,792,209 | TotalAmt |
| Program Services | $2,101,838 | ProgramServicesAmt |
| Management And General | $690,371 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,287 | TotalAmt |
| Management And General | $23,287 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $99,236 | TotalAmt |
| Program Services | $82,108 | ProgramServicesAmt |
| Management And General | $17,128 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $173,715 | TotalAmt |
| Program Services | $143,733 | ProgramServicesAmt |
| Management And General | $29,982 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $250,944 | TotalAmt |
| Program Services | $207,632 | ProgramServicesAmt |
| Management And General | $43,312 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,887 | TotalAmt |
| Program Services | $15,627 | ProgramServicesAmt |
| Management And General | $3,260 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,234 | TotalAmt |
| Program Services | $5,019 | ProgramServicesAmt |
| Management And General | $58,215 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $325,592 | TotalAmt |
| Program Services | $302,850 | ProgramServicesAmt |
| Management And General | $22,742 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $127,252 | TotalAmt |
| Management And General | $127,252 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,212,847 | $1,090,292 | $122,555 |
| BAD DEBT | $57,146 | $57,146 | |
| LICENSES AND DUES | $45,323 | $37,500 | $7,823 |
| NYS CASH RECEIPTS ASSES | $33,987 | $33,987 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,391,612 | TotalAmt |
| Program Services | $9,470,855 | ProgramServicesAmt |
| Management And General | $1,920,757 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,999,089 | BOYAmt |
| EOY | $2,054,734 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $713,912 | BOYAmt |
| EOY | $2,581,322 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $407,483 | BOYAmt |
| EOY | $482,113 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,322,771 | BOYAmt |
| EOY | $1,119,967 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $228,606 | BOYAmt |
| EOY | $225,775 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $328,495 | BOYAmt |
| EOY | $175,130 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $9,760,481 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $7,799,187 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,005,316 | BOYAmt |
| EOY | $1,961,294 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,735,325 | BOYAmt |
| EOY | $865,203 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,740,997 | BOYAmt |
| EOY | $9,465,538 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,489,918 | BOYAmt |
| EOY | $1,149,836 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $890,652 | BOYAmt |
| EOY | $801,711 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,391,320 | BOYAmt |
| EOY | $1,258,015 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,771,890 | BOYAmt |
| EOY | $3,209,562 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,801,221 | BOYAmt |
| EOY | $5,149,581 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,167,886 | BOYAmt |
| EOY | $1,106,395 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,969,107 | BOYAmt |
| EOY | $6,255,976 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,740,997 | BOYAmt |
| EOY | $9,465,538 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$1,572,260 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$140,871 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $6,035 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $6,035 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL PAID 6,035 IN DUES TO THE HEALTHCARE ASSOCIATION OF NEW YORK STATE (HANYS). | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,167,886 | BeginningYearBalanceAmt |
| Contributions | $329,749 | ContributionsAmt |
| Other Expenditures | $391,240 | OtherExpendituresAmt |
| End Year Balance | $1,106,395 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $636,137 | BeginningYearBalanceAmt |
| Contributions | $1,576,879 | ContributionsAmt |
| Other Expenditures | $1,045,130 | OtherExpendituresAmt |
| End Year Balance | $1,167,886 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $624,282 | BeginningYearBalanceAmt |
| Contributions | $3,564,738 | ContributionsAmt |
| Other Expenditures | $3,552,883 | OtherExpendituresAmt |
| End Year Balance | $636,137 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $680,172 | BeginningYearBalanceAmt |
| Contributions | $296,932 | ContributionsAmt |
| Other Expenditures | $352,822 | OtherExpendituresAmt |
| End Year Balance | $624,282 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $675,048 | BeginningYearBalanceAmt |
| Contributions | $277,887 | ContributionsAmt |
| Other Expenditures | $272,763 | OtherExpendituresAmt |
| End Year Balance | $680,172 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.02504 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.97496 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,222 | OtherCostOrOtherBasisAmt |
| Book Value | $2,222 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,668,566 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,679,460 | DepreciationAmt |
| Book Value | $989,106 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $733,097 | OtherCostOrOtherBasisAmt |
| Depreciation | $176,018 | DepreciationAmt |
| Book Value | $557,079 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,356,596 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,943,709 | DepreciationAmt |
| Book Value | $412,887 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,961,294 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| INSURANCE BENEFIT RECEIVABLE | $265,203 |
| DUE FROM AFFILIATES | $600,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $865,203 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| CONTRACT LIABILITY - MEDICARE | $265,203 |
| ESTIMATED THIRD PARTY PAYOR SETTLEMENTS, NET | $992,812 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,258,015 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS OF DECEMBER 31, 2022 AND 2021, THE HOSPITAL DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES ARE 2019 THROUGH 2022. THE HOSPITAL DOES NOT ANTICIPATE THAT THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $133,846 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $116,979 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $16,867 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,700,916 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,830,386 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,298,309 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,141,093 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $157,216 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01460 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,133,071 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,088,458 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $174,083 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01620 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,133,071 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,088,458 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $174,083 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01620 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $625,077 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $4,812 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $4,058,853 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $4,367,083 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$308,230 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | 0 | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTON-FINE HEALTH CARE CORPORATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1014 OSWEGATCHIE TRAIL | AddressLine1Txt |
| City | STAR LAKE | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13690 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTON-FINE HEALTH CARE CORPORATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTP://SAMARITANHEALTH.COM/LOCATION/CLIFTON-FINE-HOSPITAL/ | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | WWW.STLAWCO.ORG/DEPARTMENTS/PUBLICHEALTH/ | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTP://WWW.SAMARITANHEALTH.COM/LOCATION/CLIFTON-FINE-HOSPITAL/ | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTP://SAMARITANHEALTH.COM/LOCATION/CLIFTON-FINE-HOSPITAL/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTP://SAMARITANHEALTH.COM/LOCATION/CLIFTON-FINE-HOSPITAL/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTP://SAMARITANHEALTH.COM/LOCATION/CLIFTON-FINE-HOSPITAL/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| CLIFTON-FINE HEALTH CARE CORPORATION | PART V, SECTION B, LINE 5: FORMAL SURVEYS OF LOCAL RESIDENTS, CREATED BY ST. LAWRENCE COUNTY COLLEGES. |
| CLIFTON-FINE HEALTH CARE CORPORATION | PART V, SECTION B, LINE 6A: OTHER HOSPITALS INVOLVED THROUGH THE NORTH COUNTRY INITIATIVE - CLAXTON HEPBURN MEDICAL CENTER, MASSENA MEMORIAL HOSPITAL, GOUVERNEUR HOSPITAL, AND CANTON POTSDAM HOSPITAL |
| CLIFTON-FINE HEALTH CARE CORPORATION | PART V, SECTION B, LINE 6B: THE HOSPITAL'S CHNA WAS DEVELOPED IN PARTNERSHIP WITH THE ST. LAWRENCE HEALTH INITIATIVE, ST. LAWRENCE COUNTY PUBLIC HEALTH, OTHER AREA HOSPITALS, ST. LAWRENCE COUNTY SUICIDE PREVENTION COALITION, ST. LAWRENCE COUNTY COLLEGES AND UNIVERSITITES, AND COMMUNITY-BASED ORGANIZATIONS. |
| CLIFTON-FINE HEALTH CARE CORPORATION | PART V, SECTION B, LINE 11: A THREE YEAR ACTION PLAN WAS DEVELOPED AS PART OF THE CHNA ACCOMPLISHMENTS, THE PLAN INCLUDES: 1.) ADDITION OF MENTAL HEALTH SERVICE INTEGRATED INTO PRIMARY CARE. THIS INCLUDES A LICENSED MENTAL HEALTH COUNSELOR AND A LICENSED CLINICAL SOCIAL WORKER. 2.) COMMUNITY WELLNESS COMMITTEE MADE UP OF HOSPITAL STAFF AND COMMUNITY VOLUNTEERS. ACTIVITIES INCLUDE "WEIGHT WATCHERS" PROGRAM, EXERCISE CLASSES, AND HEALTHY EATING EDUCATIONAL PROGRAMS. |
| CLIFTON-FINE HEALTH CARE CORPORATION | PART V, SECTION B, LINE 13B: BY HOUSEHOLD INCOME AS A PERCENTAGE OF FPL. |
| CLIFTON-FINE HEALTH CARE CORPORATION | PART V, SECTION B, LINE 24: YES IF THAT PATIENT HAD HEALTH INSURANCE AND WE WERE DISCOUNTING A CO-PAY OR DEDUCTIBLE. |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | THE HOSPITAL OFFERS FINANCIAL ASSISTANCE TO EACH PATIENT WITH A HOUSEHOLD INCOME GREATER THAN 200% AND LESS THAN 400% OF THE FEDERAL POVERTY LEVEL ESTABLISHED BY THE FEDERAL GOVERNMENT (THE FPL) IF SUCH INDIVIDUAL HAS NO INSURANCE OR HAS EXHAUSTED HIS OR HER HEALTH INSURANCE BENEFITS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY HOSPITAL CARE AND IS UNABLE TO PAY THE FULL CHARGES FOR THOSE SERVICES. |
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 625,077. |
| PART III, LINE 2: | CFH'S BAD DEBT EXPENSE IS CONFIGURED THROUGH THE ORGANIZATIONS INTERNAL OPERATION SYSTEM, CPSI. |
| PART III, LINE 3: | CLIFTON-FINE HOSPITAL'S BAD DEBT EXPENSE IS CONFIGURED THROUGH THE ORGANIZATIONS INTERNAL OPERATING SYSTEM, CPSI. |
| PART III, LINE 4: | PATIENT ACCOUNTS RECEIVABLES ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABLILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS AND FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL). THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. |
| PART III, LINE 8: | DUE TO THE COMMUNITY'S LARGE MEDICARE POPULATION, THE TOTAL SHORTFALL IS CONSIDERED TO BE PART OF THE COMMUNITY BENEFIT EXPENSE. |
| PART III, LINE 9B: | OUR POLICY STATES THE PERCENTAGE TO WHICH THE PATIENTS ACCOUNT WILL BE REDUCED BY AND IT ALSO STATES ACTIONS THAT WILL BE TAKEN IF THE PATIENT ACCOUNT IS NOT PAID. |
| PART VI, LINE 2: | THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES THROUGH MONTHLY SURVEYS. |
| PART VI, LINE 3: | POSTERS ARE PUT THROUGHOUT THE FACILITY, ESPECIALLY IN THE WAITING AREAS AND IN REGISTRATION, NOTING THE CHARITY CARE ASSISTANCE POLICY. INFORMATION IS ALSO GIVEN TO THOSE THAT DO NOT HAVE INSURANCE IF INQUIRING. |
| PART VI, LINE 4: | FINE COMMUNITY IS LOCATED IN THE RURAL, NORTHWEST PORTION OF NEW YORK STATE'S ADIRONDACK PARK. THE HOSPITAL IS LOCATED IN SOUTHERN ST. LAWRENCE COUNTY AND SERVICES THE TOWNSHIPS OF CLIFTON, FINE AND THE SURROUNDING AREA. WE HAVE APPROXIMATELY 6,700 YEAR-ROUND RESIDENTS. THE POPULATION EXPANDS BY APPROXIMATELY 30% IN THE SUMMER MONTHS. |
| PART VI, LINE 5: | WE ARE PARTICIPATING IN A COMMUNITY NEEDS SURVEY. WE OFFER SEVERAL COMMUNITY WELLNESS PROGRAMS, AND WE HAVE SEVERAL PLANNED OVER THE NEXT COUPLE OF YEARS CENTERING ON WOMEN'S HEALTH, CHILDREN AND WE ARE CURRENTLY OFFERING WELLNESS EXAMS TO THE VETERANS IN OUR COMMUNITY. |
| PART VI, LINE 6: | PASSIVE PARENT MODEL WITH SAMARITAN MEDICAL CENTER, SAMARITAN MEDICAL CENTER HELPS WITH THE IMPLEMENTATION PLAN. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | NY |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| THOMAS CARMAN | ||||||||||||||
| BOARD MEMBER | $0 | $699,733 | $0 | $174,933 | $0 | $5,500 | $0 | $11,200 | $0 | $46,674 | $0 | $938,040 | $0 | $0 |
| MAXINE BRIGGS | ||||||||||||||
| CFO/TREASURER | $0 | $433,347 | $0 | $0 | $0 | $20,500 | $0 | $17,300 | $0 | $28,730 | $0 | $499,877 | $0 | $0 |
| DAVID I MICHAELSON | ||||||||||||||
| DOCTOR | $233,945 | $0 | $0 | $0 | $0 | $0 | $3,392 | $0 | $8,867 | $0 | $246,204 | $0 | $0 | $0 |
| DIERDRA SORRELL | ||||||||||||||
| CEO/EX-OFFICIO | $0 | $184,995 | $0 | $0 | $0 | $0 | $0 | $3,700 | $0 | $28,089 | $0 | $216,784 | $0 | $0 |
| MATTHEW ZEGIL | ||||||||||||||
| NURSE PRACTITIONER | $195,655 | $0 | $0 | $0 | $0 | $0 | $2,837 | $0 | $10,500 | $0 | $208,992 | $0 | $0 | $0 |
| JACQUELINE C SNYDER | ||||||||||||||
| PHYSICIAN ASSISTANT | $165,246 | $0 | $0 | $0 | $0 | $0 | $2,396 | $0 | $5,609 | $0 | $173,251 | $0 | $0 | $0 |
| BRITTANI BICKEL | ||||||||||||||
| PHYSICIAN ASSISTANT | $154,098 | $0 | $0 | $0 | $0 | $0 | $2,234 | $0 | $1,902 | $0 | $158,234 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | SAMARITAN MEDICAL CENTER IS THE SOLE MEMBER OF CLIFTON-FINE HEALTH CARE CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | AS THE SOLE MEMBER, SAMARITAN MEDICAL CENTER CAN APPOINT ONE OR MORE MEMBERS OF THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | SAMARITAN MEDICAL CENTER, AS THE SOLE CORPORATE MEMBER, ALSO HAS THE RIGHT TO APPROVE SIGNIFICANT DECISIONS OF THE ORGANIZATION'S GOVERNING BODY, INCLUDING AMENDMENT OF BYLAWS AND GOVERNING DOCUMENTS AND CHANGE OF MEMBERS OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 WAS REVIEWED IN DETAIL BY MANAGEMENT AND THE FINAL 990 WAS E-MAILED TO THE BOARD PRIOR TO THE NOVEMBER 15, 2023 FILING DATE. |
| FORM 990, PART VI, SECTION B, LINE 12C | CLIFTON-FINE HEALTH CARE CORPORATION REQUIRES ALL BOARD MEMBERS TO DISCLOSE ANNUALLY INTERESTS THAT COULD GIVE RISE TO CONFLICTS. THE CONFLICT OF INTEREST STATEMENTS ARE SUMMARIZED AND REVIEWED BY THE EXECUTIVE COMMITTEE TO IDENTIFY POTENTIAL CONFLICTS OF INTERESTS. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE BOARD OF DIRECTORS UTILIZED COMPENSATION COMPARABILITY DATA AND THE BOARD APPROVES THE COMPENSATION FOR THE CEO. THE CEO DETERMINES THE COMPENSATION OF THE KEY EMPLOYEES OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | CLIFTON-FINE HEALTH CARE CORPORATION WILL MAKE ITS GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | LAB & MEDICAL EXPENSES: PROGRAM SERVICE EXPENSES 2,101,838. MANAGEMENT AND GENERAL EXPENSES 690,371. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,792,209. |
| FORM 990, PART XII, LINE 2C | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| WILDERNESS HEALTHCARE FOUNDATION | |||||||||||
| 1014 OSWEGATCHIE TRAIL | STAR LAKE | NY | 13690 | 223235671 | TO PROVIDE FUNDS TO OR FOR THE BENEFIT OF CLIFTON-FINE HOSPITAL. | NY | 501(C)(3) | LINE 11 | CLIFTON-FINE HEALTH CARE CORPORATION | 0 | |
| SAMARITAN MEDICAL CENTER | |||||||||||
| 830 WASHINGTON STREET | WATERTOWN | NY | 13601 | 150533577 | HOSPITAL | NY | 501(C)(3) | LINE 3 SCH A | 0 | N/A | |
| SAMARITAN KEEP NURSING HOME | |||||||||||
| 133 PRATT STREET | WATERTOWN | NY | 13601 | 160969838 | SKILLED NURSING FACILITY | NY | 501(C)(3) | LINE 3 SCH A | SAMARITAN MEDICAL CENTER | 0 | |
| EDWARD J NOBLE HOSPITAL | |||||||||||
| 104 PADDOCK STREET SUIT 104 | WATERTOWN | NY | 13601 | 237227989 | HOSPITAL | NY | 501(C)(3) | LINE 3 SCH A | SAMARITAN MEDICAL CENTER | 0 | |
| SAMARITAN SENIOR VILLAGE INC | |||||||||||
| 22691 CAMPUS DRIVE | WATERTOWN | NY | 13601 | 454913668 | SENIOR CITIZEN COMMUNITY | NY | 501(C)(3) | LINE 3 SCH A | SAMARITAN MEDICAL CENTER | 0 | |
| SMC FOUNDATION OF NNY INC | |||||||||||
| 830 WASHINGTON STREET | WATERTOWN | NY | 13601 | 161490523 | PROVIDES FUNDS FOR SMC AND AFFILIATES | NY | 501(C)(3) | LINE 7 SCH A | SAMARITAN MEDICAL CENTER | 0 | |
| SAMARITAN HOME HEALTH | |||||||||||
| 165 COLEMAN AVENUE | WATERTOWN | NY | 13601 | 461043637 | CERTIFIED HOME HEALTH AGENCY | NY | 501(C)(3) | LINE 10 SCH A | SAMARITAN MEDICAL CENTER | 0 | |
| SAMARITAN MEDICAL PRACTICE PC | |||||||||||
| 830 WASHINGTON STREET | WATERTOWN | NY | 13601 | 261528342 | PHYSICIAN MEDICAL PRACTICE | NY | 501(C)(3) | SCHED A, PART 1, LN3 | SAMARITAN MEDICAL CENTER | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |