MASSENA HOSPITAL INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- MASSENA HOSPITAL INC (EIN 84-3134268)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-15
- IRS object ID
- 202103199349325155
- Schema version
- 2020v4.0
- 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 | 2021-11-15T16:38:04-06:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 822624857 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAY & GRAY AND ASSOCIATES CPAS PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 MAIN STREET SUITE 101 | AddressLine1Txt |
| City | CANTON | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 136171277 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 843134268 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MASSENA HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MASS | BusinessNameControlTxt |
| Phone | 3157694200 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 HOSPITAL DRIVE | AddressLine1Txt |
| City | MASSENA | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13662 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVID BENDER | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 3152615451 | PhoneNum |
| Signature | 2021-10-25 | SignatureDt |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | DAVID | PersonFirstNm |
| Person Last | BENDER | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JOHN J GRAY JR CPA | PreparerPersonNm |
| PTIN | P00076464 | PTIN |
| Phone | 3153862925 | PhoneNum |
| Preparation | 2021-11-15 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DAVID BENDER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 HOSPITAL DRIVE | AddressLine1Txt |
| City | MASSENA | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13662 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $50,698,342 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2019 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | MASSENA HOSPITAL'S MISSION IS TO PROVIDE QUALITY HEALTHCARE AND THE BEST PATIENT EXPERIENCE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 451 | TotalEmployeeCnt |
| Total Volunteers | 27 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| CY Contributions Grants | $7,000,189 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $37,860,381 | CYProgramServiceRevenueAmt |
| CY Investment Income | $67,543 | CYInvestmentIncomeAmt |
| CY Other Revenue | $5,656,083 | CYOtherRevenueAmt |
| CY Total Revenue | $50,584,196 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| CY Salaries Comp Emp Bnft Paid | $27,227,443 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| CY Other Expenses | $25,961,875 | CYOtherExpensesAmt |
| CY Total Expenses | $53,189,318 | CYTotalExpensesAmt |
| CY Revenues Less Expenses | -$2,605,122 | CYRevenuesLessExpensesAmt |
| Total Assets EOY | $43,221,308 | TotalAssetsEOYAmt |
| Total Liabilities EOY | $18,986,948 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances EOY | $24,234,360 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | MASSENA HOSPITAL'S MISSION IS TO PROVIDE QUALITY HEALTHCARE AND THE BEST PATIENT EXPERIENCE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | Yes (true) | SignificantChangeInd |
| Expense | $26,600,320 | ExpenseAmt |
| Revenue | $69,965,090 | RevenueAmt |
| Desc | ACUTE CARE: MASSENA HOSPITAL IS AN ACUTE CARE, 25-BED HOSPITAL PROVIDING INPATIENT MEDICAL, SURGICAL, DETOX AND PEDIATRIC SERVICES IN ADDITION TO EMERGENCY CARE. ANCILLARY SERVICES INCLUDE A 24/7 LABORATORY, MRI, CT, ULTRASOUND AND MAMMOGRAPHY. TOTAL PATIENT DAYS INCREASED BY APPROXIMATELY 57.36% FROM 2019 TO 2020. OBSERVATION CASES DECREASED BY APPROXIMATELY 8.62% FROM 2019 TO 2020. VOLUME DECREASES WERE A RESULT OF THE COVID-19 IMPACT. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $8,001,318 | ExpenseAmt |
| Revenue | $13,022,151 | RevenueAmt |
| Desc | HOSPITAL BASED CLINICS: IM 2020, HOSPITAL BASED CLINICS VISITS DECREASED APPROXIMATELY 3.36% FROM 55,942 IN 2019 TO 54,061 IN 2020. VOLUME DECREASES WERE A RESULT OF THE COVID-19 IMPACT. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $4,795,474 | ExpenseAmt |
| Revenue | $29,746,782 | RevenueAmt |
| Desc | EMERGENCY ROOM: EMERGENCY ROOM VISITS DECREASED BY 18.90% FROM 2019 TO 2020. VOLUME DECREASES WERE A RESULT OF THE COVID-19 IMPACT. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $3,563,652 | ExpenseAmt |
| Revenue | $7,613,052 | RevenueAmt |
| Desc | IN 2020, OPERATING ROOM CASES DECREASED APPROXIMATELY 29% FROM 1,845 IN 2019 TO 1,310 IN 2020. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $3,563,652 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $7,613,052 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $42,960,764 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 28 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 451 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | Yes (true) | LocalChaptersInd |
| Policies Reference Chapters | Yes (true) | PoliciesReferenceChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NY | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DONNA M MCGREGOR | PersonNm |
| Phone | 3152615451 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 50 LEROY STREET | AddressLine1Txt |
| City | POTSDAM | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13676 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|---|---|
| DALKEITH FACEY MD | |||||||||
| MEDICAL DOCT | 50.00 | 0.00 | Yes (X) | $522,591 | $0 | $48,907 | |||
| KEJAIN TANG MD | |||||||||
| MEDICAL DOCT | 50.00 | 0.00 | Yes (X) | $469,586 | $0 | $48,937 | |||
| BIRINDER SINGH MD | |||||||||
| MEDICAL DOCT | 50.00 | 0.00 | Yes (X) | $472,775 | $0 | $31,649 | |||
| NIMESH DESAI MD | |||||||||
| MEDICAL DOCT | 50.00 | 0.00 | Yes (X) | $416,285 | $0 | $40,789 | |||
| JAYANT JHAVERI MD | |||||||||
| MEDICAL DOCT | 50.00 | 0.00 | Yes (X) | $403,003 | $0 | $47,831 | |||
| DAVID BENDER | |||||||||
| CEO | 50.00 | 0.00 | $0 | $353,769 | $27,382 | Yes (X) | |||
| PATRICK FACTEAU | |||||||||
| CFO | 50.00 | 0.00 | $189,736 | $0 | $24,797 | Yes (X) | |||
| DONNA MCGREGOR | |||||||||
| CFO | 50.00 | 0.00 | $0 | $184,769 | $16,191 | Yes (X) | |||
| MICHAEL COOK | |||||||||
| DIRECTOR | 2.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| REAL FRENCHIE COUPAL | |||||||||
| VICE CHAIR | 4.00 | 5.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| DAWN HEWLETT | |||||||||
| DIRECTOR | 2.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| DAVID LACLAIR | |||||||||
| DIRECTOR | 2.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| LENORE LEVINE | |||||||||
| SECRETARY | 4.00 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| BEDROS BAKIRTZIAN MD | |||||||||
| DIRECTOR | 2.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| MICHAEL MARESCA MD | |||||||||
| DIRECTOR | 2.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| PAUL MORROW | |||||||||
| DIRECTOR | 2.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| LORETTA PEREZ | |||||||||
| BOARD CHAIR | 4.00 | 5.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,473,976 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $538,538 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $286,483 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 36 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt | Address Line1ContractorAddress/ForeignAddress/AddressLine1Txt | CityContractorAddress/ForeignAddress/CityNm | CountryContractorAddress/ForeignAddress/CountryCd | Foreign PostalContractorAddress/ForeignAddress/ForeignPostalCd |
|---|---|---|---|---|---|---|---|---|---|
| DELPHI HOSPITALIST SERVICES LLC | |||||||||
| 1160 CHILI AVE | ROCHESTER | NY | 14624 | PROVIDER STAFFI | $1,411,793 | ||||
| SIEMENS MEDICAL SOLUTIONS USA | |||||||||
| PO BOX 120001-DEPT/0733 | DALLAS | TX | 75312 | CONTRACTED SERV | $649,632 | ||||
| DY STAFFING | |||||||||
| PO BOX 635715 | CINCINNATI | OH | 45263 | PROVIDER STAFFI | $608,957 | ||||
| JEFFREY SHOUB MD | |||||||||
| PROVIDER STAFFI | $350,700 | 4250 RUE FABRE | MONTREAL | CA | H2J 3T6 | ||||
| NIDAL MAKHOUL MD | |||||||||
| 12 EDGEWATER ESTATES | PLATTSBURGH | NY | 12901 | PROVIDER STAFFI | $290,600 | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 11 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $6,619,258 | GovernmentGrantsAmt |
| All Other Contributions | $380,931 | AllOtherContributionsAmt |
| Total Contributions | $7,000,189 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICE REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $37,860,381 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $37,860,381 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $37,860,381 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $32,031 | TotalRevenueColumnAmt |
| Exclusion | $32,031 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $100,988 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $114,146 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$13,158 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$13,158 | TotalRevenueColumnAmt |
| Exclusion | -$13,158 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $35,512 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $35,512 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $35,512 | TotalRevenueColumnAmt |
| Exclusion | $35,512 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|
| 340B RETAIL PROGRAM | $3,470,874 | $3,470,874 |
| DSH DISTRIBUTION | $949,292 | $949,292 |
| DIALYSIS LEASE | $848,788 | $848,788 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $400,287 | TotalRevenueColumnAmt |
| Exclusion | $400,287 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $5,669,241 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $50,584,196 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $37,860,381 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $5,723,626 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,936,428 | TotalAmt |
| Program Services | $17,768,507 | ProgramServicesAmt |
| Management And General | $4,167,921 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $787,109 | TotalAmt |
| Program Services | $637,558 | ProgramServicesAmt |
| Management And General | $149,551 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,995,051 | TotalAmt |
| Program Services | $2,425,991 | ProgramServicesAmt |
| Management And General | $569,060 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,508,855 | TotalAmt |
| Program Services | $1,222,173 | ProgramServicesAmt |
| Management And General | $286,682 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $175,719 | TotalAmt |
| Management And General | $175,719 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,000 | TotalAmt |
| Management And General | $75,000 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,567 | TotalAmt |
| Management And General | $7,567 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $478,273 | TotalAmt |
| Program Services | $478,273 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,199 | TotalAmt |
| Program Services | $51,191 | ProgramServicesAmt |
| Management And General | $12,008 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $433,173 | TotalAmt |
| Program Services | $348,566 | ProgramServicesAmt |
| Management And General | $84,607 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,413 | TotalAmt |
| Program Services | $9,245 | ProgramServicesAmt |
| Management And General | $2,168 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $138,932 | TotalAmt |
| Program Services | $112,535 | ProgramServicesAmt |
| Management And General | $26,397 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,496,246 | TotalAmt |
| Program Services | $1,211,959 | ProgramServicesAmt |
| Management And General | $284,287 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $875,759 | TotalAmt |
| Program Services | $709,365 | ProgramServicesAmt |
| Management And General | $166,394 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PURCHASED/CONTRACTED SERV | $11,706,220 | $9,482,038 | $2,224,182 |
| SUPPLIES | $8,437,639 | $6,834,488 | $1,603,151 |
| OTHER - MISCELLANEOUS | $742,805 | $599,732 | $143,073 |
| CONSULTING & MANAGEMENT F | $476,084 | $385,628 | $90,456 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $843,846 | TotalAmt |
| Program Services | $683,515 | ProgramServicesAmt |
| Management And General | $160,331 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,189,318 | TotalAmt |
| Program Services | $42,960,764 | ProgramServicesAmt |
| Management And General | $10,228,554 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $189,509 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $14,080,386 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $4,346,849 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $558,357 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $294,086 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $64,477,510 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $47,267,530 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $17,209,980 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $6,542,141 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $43,221,308 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $8,396,736 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $98,530 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $10,491,682 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $18,986,948 | 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) |
|---|---|---|
| EOY | $24,234,360 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $24,234,360 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $43,221,308 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$2,605,122 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $26,839,482 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | 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 (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
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 | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $7,567 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $7,567 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1 | FormAndLineReferenceDesc |
| Explanation | HANYS ANNUAL MEMBERSHIP DUES: 4,986 FEDERAL AND STATE ADVOCACY IROQUIOS HEALTHCARE ALLIANCE: 1,907 FEDERAL AND STATE ADVOCACY AMERICAN HOSPITAL ASSOCIATION ANNUAL MEMBERSHIP DUES: 674 FEDERAL AND STATE ADVOCACY | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $495,756 | OtherCostOrOtherBasisAmt |
| Book Value | $495,756 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $32,093,059 | OtherCostOrOtherBasisAmt |
| Depreciation | $18,691,435 | DepreciationAmt |
| Book Value | $13,401,624 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $61,241 | OtherCostOrOtherBasisAmt |
| Depreciation | $23,585 | DepreciationAmt |
| Book Value | $37,656 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $31,450,104 | OtherCostOrOtherBasisAmt |
| Depreciation | $28,552,510 | DepreciationAmt |
| Book Value | $2,897,594 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $377,350 | OtherCostOrOtherBasisAmt |
| Book Value | $377,350 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $17,209,980 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| ASSETS WHOSE USEFUL LIFE IS LIMITED | $4,213,203 |
| GRANT RECEIVABLE- DOH | $2,000,000 |
| OTHER RECEIVABLES | $328,938 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $6,542,141 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| ESTIMATED THIRD-PARTY PAYOR SETTLEME | $5,313,388 |
| DUE TO AFFILIATES | $2,604,347 |
| SLHS BRIDGE FUNDING | $2,573,947 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $10,491,682 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $50,424,140 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $114,145 | OtherRevenueAmt |
| Revenue Not Reported | $114,145 | RevenueNotReportedAmt |
| Revenue Subtotal | $50,309,995 | RevenueSubtotalAmt |
| Other Revenues Not Included | $274,201 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $274,201 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $50,584,196 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $52,983,364 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $52,983,364 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $205,954 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $205,954 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $53,189,318 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 3, PART X | THE SYSTEM AND ITS AFFILIATES ARE NOT FOR PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE)AND ARE EXEMPT FROM FEDERAL INCOME TAX ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE SYSTEM AND AFFILIATES RECOGNIZE THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN FIFTY PERCENT LIKELY OF BEING REALIZED UPON SETTLEMENT. CHANGES IN RECOGNIZATION IN MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGEMENT OCCURS. THE SYSTEM AND AFFILIATES DID NOT RECOGNIZE THE EFFECT OF ANY UNCERTAIN INCOME TAX POSITIONS IN EITHER 2020 OR 2019. |
| SCHEDULE D, PAGE 4, PART XI, LINE 2D | RENTAL EXPENSES 114,145 |
| SCHEDULE D, PAGE 4, PART XI, LINE 4B | GIFTS & BEQUESTS 233,114 OTHER 41,087 |
| SCHEDULE D, PAGE 4, PART XII, LINE 4B | RENTAL EXPENSES 114,145 BOOK / TAX DEPRECIATION DIFFERENCE 91,809 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $36,014 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $36,014 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,391,426 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,107,031 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,284,395 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.15580 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,427,440 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,107,031 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,320,409 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.15640 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $46,069 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $46,069 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $400 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $400 | NetCommunityBenefitExpnsAmt |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $46,469 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $46,469 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,473,909 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,107,031 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,366,878 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.15730 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $35,742 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $35,742 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $35,742 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $35,742 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,132,844 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $75,717 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $8,721,356 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $14,074,543 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$5,353,187 | 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 (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | 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 | MASSENA HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 HOSPITAL DRIVE | AddressLine1Txt |
| City | MASSENA | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 136621056 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.MASSENAHOSPITAL.ORG | WebsiteAddressTxt |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MASSENA HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | Yes (true) | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | 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 |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.MASSENAHOSPITAL.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | false | StrategyPostedWebsiteInd |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.MASSENAHOSPITAL.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.MASSENAHOSPITAL.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.MASSENAHOSPITAL.ORG | 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 Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit Report To Credit Agency | Yes (X) | PermitReportToCreditAgencyInd |
| Permit Legal Judicial Process | Yes (X) | PermitLegalJudicialProcessInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | Yes (true) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, MASSENA HOSPITAL INC. - PART V, LINE 2 | IN JULY 2019, ST. LAWRENCE HEALTH SYSTEM EXECUTED AN ASSET PURCHASE AGREEMENT WITH THE TOWN OF MASSENA AND IT'S HOSPITAL, MASSENA MEMORIAL HOSPITAL (MMH), TO ACQUIRE SUBSTANTIALLY ALL OF THE ASSETS OF MMH AND ASSUME CERTAIN OUTSTANDING LIABILITIES. THE NECESSARY APPROVALS WERE GRANTED AND REQUIRED CONDITIONS MET AND LEGALLY BINDING ON JANUARY 1, 2020. MASSENA HOSPITAL WAS FORMED TO RETAIN THE ACQUIRED ASSETS AND ASSUMED LIABILITIES OF THE FORMER MMH. |
| FACILITY 1, MASSENA HOSPITAL INC. - PART V, LINE 5 | MASSENA HOSPITAL'S (MH'S) MOST RECENT CHNA WAS CONDUCTED BY ITS NEW YORK STATE DSRIP PPS, ADIRONDACK HEALTH INSTITUTE, AS WELL AS ITS LOCAL PARTNERS, THE ST. LAWRENCE COUNTY PUBLIC HEALTH DEPARTMENT AND THE ST. LAWRENCE HEALTH INSTITUTE. MH PARTICIPATES AT THE BOARD LEVEL ON THE ST. LAWRENCE HEALTH INITIATIVE, A NOT-FOR-PROFIT ORGANIZATION COORDINATING HEALTH ASSESSMENT AMONG ALL AREA HEALTH FACILITIES. THIS ORGANIZATION AND OUR DSRIP PPS PROVIDE FORMAL ONGOING COORDINATION OF NEEDS ASSESSMENT AND PROGRAMMING. THE CHNA WAS COMPLETED IN 2019 AND TAKES INTO ACCOUNT INPUT FROM PERSONS REPRESENTING THE COMMUNITY PRIMARILY THROUGH A TELEPHONE AND WEB SURVEY CONDUCTED IN THE SUMMER OF 2019 WITH RESIDENTS OF THE THREE- COUNTY REGION OF ST. LAWRENCE, LEWIS, AND JEFFERSON. MH ALSO SEEKS INPUT FORMALLY THROUGH AN ANNUAL FORUM WITH COMMUNITY LEADERS FROM ALL ACROSS OUR PRIMARY AND SECONDARY SERVICE AREAS, FREQUENT MEETINGS WITH PUBLIC HEALTH OFFICIALS, LOCAL COLLEGE PRESIDENTS, THE LEADERS OF OTHER AREA HEALTH FACILITIES, AND LOCAL GOVERNMENT OFFICIALS. ADDITIONAL INPUT WAS GATHERED FROM HOSPITAL AND HOSPITAL SYSTEM BOARD MEMBERS REPRESENTING PUBLIC HEALTH, DENTISTRY, HOSPICE AND PALLIATIVE CARE, VETERINARY HEALTH, AREA COLLEGES, AND AREA BUSINESSES. |
| FACILITY 1, MASSENA HOSPITAL INC. - PART V, LINE 6A | MASSENA HOSPITAL'S CHNA WAS AUTHORED BY THE HOSPITAL USING DATA GATHERED BY THE ADIRONDACK HEALTH INSTITUTE (REPRESENTING A NINE-COUNTY NORTHERN NY REGION WHICH INCLUDES ST. LAWRENCE COUNTY) AND DATA GATHERED FOR ST. LAWRENCE, LEWIS, AND JEFFERSON COUNTIES ON BEHALF OF THE ST. LAWRENCE HEALTH INSTITUTE/INITIATIVE THROUGH FORT DRUM REGIONAL HEALTH PLANNING ORGANIZATION. |
| FACILITY 1, MASSENA HOSPITAL INC. - PART V, LINE 11 | MASSENA HOSPITAL'S CHNA IDENTIFIED CHRONIC DISEASE PREVENTION AND MANAGEMENT AND MENTAL, EMOTIONAL, AND BEHAVIORAL (MEB) HEALTH AS THE TWO HIGHEST PRIORITY AREAS NEEDING TO BE ADDRESSED. WITHIN THESE AREAS, CHILD AND ADOLESCENT OBESITY, HEART FAILURE, DIABETES, AND COPD WERE IDENTIFIED AS THE MOST PRESSING NEEDS IN CHRONIC DISEASE MANAGEMENT; SUBSTANCE ABUSE AND SUICIDE PREVENTION WERE IDENTIFIED AS TOP NEEDS IN THE MEB HEALTH CATEGORY. THESE PRIORITY AREAS DOVETAIL WITH THE HOSPITAL'S STRATEGIC PLAN, THE PRIORITIES OF THE NEW YORK STATE DSRIP PPS PARTNERS IN A NINE-COUNTY NORTHERN NEW YORK REGION THAT ENCOMPASSES ST. LAWRENCE COUNTY, THE PRIORITIES OF THE NEW YORK STATE HEALTHCARE REDESIGN COMMISSION, THE PRIORITIES OF THE NEW YORK STATE PREVENTION AGENDA, AND THE GOALS OF THE AFFORDABLE CARE ACT TO INCREASE ACCESS, REDUCE COSTS, AND IMPROVE QUALITY. SPECIFIC GOALS AND METRICS HAVE BEEN IDENTIFIED AND THE HOSPITAL'S OUTREACH PROGRAMS ARE DESIGNED TO ADDRESS THESE. AMONG THESE PROGRAMS IS AN EXTENSIVE EDUCATION SERIES FOR THE COMMUNITY ON VARIOUS HEALTH ISSUES; EDUCATION TARGETED TO THOSE WITH SPECIFIC DIAGNOSES; SUPPORT FOR OTHER COMMUNITY ORGANIZATIONS FOR INTEGRATING HEALTHY FOOD CHOICES IN CHILDHOOD AND ADOLESCENT ACTIVITIES; AND SUPPORT FOR LOCAL FOOD BANKS AND A LOCAL NON-PROFIT FOOD SECURITY PROGRAM. MASSENA HOSPITAL, AS A PART OF ST. LAWRENCE HEALTH SYSTEM, CONTINUES TO ENRICH THE REGION IN RECRUITMENT OF PRIMARY CARE PRACTITIONERS AND SPECIALISTS IN TARGETED AREAS, INCLUDING SUBSTANCE USE DISORDER, RHEUMATOLOGY, NEUROLOGY, ENDOCRINOLOGY (FOR ASSISTANCE WITH DIABETES), INFECTIOUS DISEASE, NUTRITION, AND A PULMONOLOGY SPECIALIST WITH A BACKGROUND IN BEHAVIORAL HEALTH TO TAKE THE POSITION OF DIRECTOR OF POPULATION HEALTH. |
| FACILITY 1, MASSENA HOSPITAL INC. - PART V, LINE 15E | THE ORGANIZATION CONSPICUOUSLY POSTS ITS FINANCIAL ASSISTANCE POLICY IN EACH REGISTRATION/RECEPTION AREA. PATIENTS ARE ENCOURAGED TO APPLY FOR ASSISTANCE AND GIVEN CONTACT INFORMATION AT THESE AREAS. IN ADDITION, ANY PATIENT THAT IS UNINSURED AND ADMITTED TO THE HOSPITAL FOR CARE IS PHYSICALLY VISITED BY A FINANCIAL COUNSELOR, AND AN EXPLANATION OF OUR PROGRAM IS MADE ALONG WITH AN APPLICATION. PATIENTS REQUESTING ASSISTANCE IN THE COMPLETION OF THE APPLICATION ARE GIVEN SUCH. ANY INFORMATION REQUIRED FOR APPLICATION FOR THE NYS MEDICAID APPLICATION PROCESS IS COLLECTED BY OUR FINANCIAL CASE MANAGERS AND COMMUNICATED TO THE APPROPRIATE CASE MANAGERS AT OUR COUNTY DEPARTMENT OF SOCIAL SERVICES FOR DETERMINATION OF MEDICAID ELIGIBILITY. |
| FACILITY 1, MASSENA HOSPITAL INC. - PART V, LINE 24 | THE HOSPITAL USES THE HIGHEST VOLUME COMMERCIAL COVERAGE RATE, FROM BLUE CROSS/BLUE SHIELD, WHICH IS ALSO GENERALLY THE LOWEST RATE CHARGED. |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART II | THE AMOUNT REPORTED ON PART II LINE 8 REPRESENTS THE INVESTMENT MADE IN RECRUITING NEW HEALTHCARE PRACTITIONERS TO OUR SERVICE AREA DURING 2020. DUE TO ITS INDIGENT POPULATION AND RURAL NATURE, MUCH OF THE REGION SURROUNDING THE HOSPITAL IS DESIGNATED AS A MANPOWER SHORTAGE AREA. |
| SCHEDULE H, PART III, LINE 2 | THE COSTS ON LINE 2 ARE BASED UPON THE MEDICARE ICR FOR 2020 APPLIED TO THE GROSS CHARGES WRITTEN OFF. |
| SCHEDULE H, PART III, LINE 3 | THE COSTS ON LINE 3 WERE CALCULATED IN ACCORDANCE WITH THE COSTING METHODOLOGY EMPLOYED BY THE NYS DOH BAD DEBT COSTING PROCESS. |
| SCHEDULE H, PART III, LINE 4 | PAGE 16 OF THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS (FN4B-PATIENT SERVICE RECEIVABLES) |
| SCHEDULE H, PART III, LINE 8 | DESCRIBE THE COSTING METHODOLOGY OR SOURCE USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6 (MCR ALLOWABLE COSTS OF CARE RELATED TO PAYMENTS): COSTS REPORTED ON LINE 6 INCLUDE TOTAL INPATIENT COSTS (ROUTINE, ICU, ANCILLARY AND CAPITAL), OBSERVATIONS COSTS, AND OUTPATIENT COSTS FROM MCR COST REPORT, WORKSHEETS D-1: PART II AND PART IV; AND WORKSHEET D: PART V. |
| SCHEDULE H, PART III, LINE 9B | THE ORGANIZATION APPLIES THE SAME COLLECTION PRINCIPLES TO AMOUNTS DUE FROM PATIENTS WHO HAVE QUALIFIED FOR PERCENTAGE DISCOUNTS BUT STILL HAVE A RESPONSIBILITY FOR A PORTION OF THEIR BILL BASED UPON THE SLIDING FEE SCHEDULE. NO SEPARATE DISTINCTION IS MADE FOR THE APPLICATION OF OUR COLLECTION PROCESSES IN THOSE CASES. |
| SCHEDULE H, PART VI, LINE 3 | THE ORGANIZATION CONSPICUOUSLY POSTS ITS FINANCIAL ASSISTANCE POLICY IN EACH REGISTRATION/RECEPTION AREA. PATIENTS ARE ENCOURAGED TO APPLY FOR ASSISTANCE AND GIVEN CONTACT INFORMATION AT THESE AREAS. IN ADDITION, ANY PATIENT THAT IS UNINSURED AND ADMITTED TO THE HOSPITAL FOR CARE IS PHYSICALLY VISITED BY A FINANCIAL COUNSELOR, AND AN EXPLANATION OF OUR PROGRAM IS MADE ALONG WITH AN APPLICATION. PATIENTS REQUESTING ASSISTANCE IN THE COMPLETION OF THE APPLICATION ARE GIVEN SUCH. ANY INFORMATION REQUIRED FOR APPLICATION FOR THE NYS MEDICAID APPLICATION PROCESS IS COLLECTED BY OUR FINANCIAL CASE MANAGERS AND COMMUNICATED TO THE APPROPRIATE CASE MANAGERS AT OUR COUNTY DEPARTMENT OF SOCIAL SERVICES FOR DETERMINATION OF MEDICAID ELIGIBILITY. |
| SCHEDULE H, PART VI, LINE 4 | MASSENA HOSPITAL IS LOCATED IN ST. LAWRENCE COUNTY IN UPSTATE NEW YORK. ST. LAWRENCE COUNTY, THE LARGEST COUNTY IN NEW YORK, IS LOCATED IN THE NORTHERNMOST REACHES OF THE STATE BORDERING ON THE ST. LAWRENCE RIVER AND CANADA. IT IS A RURAL ENVIRONMENT CONSISTING OF 2,685 SQUARE MILES WITH A POPULATION OF APPROXIMATELY 112,000 RESIDENTS. |
| SCHEDULE H, PART VI, LINE 6 | ST. LAWRENCE HEALTH SYSTEM, FORMED DECEMBER 5, 2013, IS OPERATED EXCLUSIVELY FOR THE SOLE CHARITABLE PURPOSE OF BENEFITING AND SUPPORTING CANTON-POTSDAM HOSPITAL AND OTHER CORPORATIONS. AMONG OTHER BENEFITS, THE HEALTH SYSTEM MAY PROVIDE ADVICE AND ASSISTANCE CONCERNING LONG AND SHORT- RANGE PLANNING FOR, AND MONITOR AND PROVIDE ADVICE AND ASSISTANCE TO HELP COORDINATE THE ACTIVITIES OF THE SUPPORTED ORGANIZATION IN ELIMINATING DUPLICATIVE FUNCTIONS; PROVIDE MANAGEMENT CONSULTING ASSISTANCE TO THE SUPPORTED ORGANIZATION TO FURTHER IMPROVE AND ADVANCE HEALTH SERVICES TO THE RESIDENTS OF NEW YORK STATE AND COOPERATE WITH THE SUPPORTING ORGANIZATIONS IN CARRYING OUT THEIR CHARITABLE PURPOSES. |
| SCHEDULE H, PART VI, LINE 7 | NEW YORK |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|
| DALKEITH FACEY MD | ||||||||
| MEDICAL DOCTOR | $522,591 | $12,879 | $36,028 | $571,498 | ||||
| KEJAIN TANG MD | ||||||||
| MEDICAL DOCTOR | $469,586 | $12,908 | $36,029 | $518,523 | ||||
| BIRINDER SINGH MD | ||||||||
| MEDICAL DOCTOR | $472,775 | $11,996 | $19,653 | $504,424 | ||||
| NIMESH DESAI MD | ||||||||
| MEDICAL DOCTOR | $416,285 | $11,866 | $28,923 | $457,074 | ||||
| JAYANT JHAVERI MD | ||||||||
| MEDICAL DOCTOR | $403,003 | $11,803 | $36,028 | $450,834 | ||||
| DAVID BENDER | ||||||||
| CEO | $353,769 | $14,250 | $13,132 | $381,151 | ||||
| PATRICK FACTEAU | ||||||||
| CFO | $189,736 | $7,803 | $16,994 | $214,533 | ||||
| DONNA MCGREGOR | ||||||||
| CFO | $184,769 | $3,273 | $12,918 | $200,960 | ||||
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 3 | THE OBSTETRICS UNIT OF MASSENA HOSPITAL WAS CLOSED ON JULY 13, 2020. |
| FORM 990, PAGE 2, PART III, LINE 4D | IN 2020, OPERATING ROOM CASES DECREASED APPROXIMATELY 29% FROM 1,845 IN 2019 TO 1,310 IN 2020. |
| FORM 990, PAGE 6, PART VI, LINE 6 | ST. LAWRENCE HEALTH SYSTEM, INC. IS A SOLE MEMBER. |
| FORM 990, PAGE 6, PART VI, LINE 7A | ST. LAWRENCE HEALTH SYSTEM, INC. IS A SOLE MEMBER, AND HAS THE ABILITY TO APPOINT MEMBERS OF THE BOARD OF DIRECTORS. |
| FORM 990, PAGE 6, PART VI, LINE 7B | THE MEMBER SHALL HAVE THE FOLLOWING POWERS WITH REGARD TO THE CORPORATION: -APPOINT THE MEMBERS OF THE BOARD OF DIRECTORS. -APPOINT AND REMOVE THE CHIEF EXECUTIVE OFFICER. -APPROVE THE ADOPTION AND AMENDMENT OF BYLAWS. -APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS. -APPROVE STRATEGIC PLANS. -APPROVE AND INITIATE THE FILING OF CERTIFICATE OF NEED APPLICATIONS. -REVIEW AND APPROVE THE ANNUAL AUDIT OF THE CORPORATION AND ANY SUBSIDIARY CORPORATIONS. -APPROVE THE DISSOLUTION OF THE CORPORATION. -APPROVE THE SALE, LEASE, MORTGAGE OR ENCUMBRANCE OF ANY ASSET OTHER THAN ANY SALE, LEASE OR MORTGAGE WHICH IS PART OF AN APPROVED BUDGET. -APPROVE THE SALE OR TRANSFER OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATIONS. -APPROVE ANY MERGER, BUSINESS CONSOLIDATION, ACQUISITION OR JOINT VENTURE. -APPROVE THE PURCHASE OR SALE OF PHYSICIAN PRACTICES OTHER THAN ANY PURCHASE OR SALE WHICH IS PART OF AN APPROVED BUDGET. -APPROVE AND MAY INITIATE THE COMMENCEMENT AND SETTLEMENT OF LITIGATION. -APPROVE ANY FILING OF BANKRUPTCY PETITION. -APPROVE THE INCURRENCE OF ANY DEBT OTHER THAN DEBT WHICH IS INCURRED IN THE ORDINARY COURSE OF BUSINESS AND WHICH IS NOT INCONSISTENT WITH AN APPROVED BUDGET; AND -REQUIRE THE GUARANTEE OF LOANS THROUGH AN OBLIGATED GROUP STRUCTURE THAT WILL SUPPORT ACCESS TO CAPITAL AND INCLUDE DEBT SERVICES. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE FORM 990 IS PREPARED BY THE FINANCE DEPARTMENT STAFF MEMBERS. UPON COMPLETION, THE FORM IS SUBMITTED TO A CPA FIRM FOR REVIEW AND PREPARED FOR FILING. A COPY OF THE DRAFT RETURN IS THEN REVIEWED BY THE SYSTEM CFO AND SYSTEM CONTROLLER. AFTER REVIEW, ANY CHANGES ARE MADE AND A COPY IS PRESENTED TO THE BOARD OF DIRECTORS FOR THEIR REVIEW, COMMENTS AND APPROVAL (PRIOR TO IRS SUBMISSION). |
| FORM 990, PAGE 6, PART VI, LINE 12C | ENFORCEMENT OF CONFLICTS POLICY BOARD MEMBER CONFLICT OF INTEREST DISCLOSURE FORMS ARE COMPLETED AND REVIEWED BY THE BOARD ANNUALLY. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE AUDIT, COMPLIANCE AND COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS UTILIZES THE INPUT OF A NATIONAL CONSULTING FIRM WITH EXPERTISE IN EXECUTIVE COMPENSATION TO REVIEW THE COMPENSATION PACKAGES OFFERED TO TOP MANAGEMENT AS WELL AS OUR COMPLIANCE WITH REGULATORY REQUIREMENTS FOR EXECUTIVE COMPENSATION FOR NOTFOR-PROFIT HOSPITALS. UPON THE FINDINGS OF THE CONSULTANT AND DELIBERATIONS OF THE AUDIT, COMPLIANCE, AND COMPENSATION COMMITTEE, THE COMMITTEE WILL THEN MAKE A RECOMMENDATION TO THE FULL BOARD. THE FULL BOARD WILL THEN VOTE ON THE TOP OFFICIAL'S COMPENSATION PACKAGE. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE COMPENSATION OF OTHER KEY EMPLOYEES IS DETERMINED PRIMARILY BY INFORMATION GATHERED FROM INDEPENDENT SURVEY DATA FROM NATIONAL AND SURROUNDING MARKETS COORDINATED BY THE HUMAN RESOURCE DEPARTMENT. THE CEO AND VICE PRESIDENT OF HUMAN RESOURCES REVIEW THE SURVEY DATA TO DETERMINE SALARY RANGES AND COMPENSATION PACKAGES. THE CEO BRINGS THE INFORMATION AND FINDINGS TO THE AUDIT, COMPLIANCE, AND COMPENSATION COMMITTEE OF THE BOARD FOR THEIR DELIBERATION AND CONSIDERATION. THE AUDIT, COMPLIANCE, AND COMPENSATION COMMITTEE WILL THEN BRING THEIR RECOMMENDATION TO THE FULL BOARD FOR THEIR FINAL APPROVAL. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9 | TRANSFER TO ST. LAWRENCE HEALTH SYSTEM 7,200,000 EFFECT OF AQUISITION 19,639,482 TOTAL 26,839,482 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | Address Line2USAddress/AddressLine2Txt | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| MASSENA HOSPITAL FOUNDATION | |||||||||||
| 1 HOSPITAL DRIVE | PO BOX 625 | MASSENA | NY | 13662 | 222586307 | FOUNDATION | NY | 501C3 | 7 | NA | false |
| ST LAWRENCE HEALTH SYSTEM | |||||||||||
| 50 LEROY STREET | POTSDAM | NY | 13676 | 464259168 | HEALTHCARE | NY | 501C3 | 12A | NA | false | |
| GOUVERNEUR HOSPITAL | |||||||||||
| 77 W BARNEY STREET | GOUVERNEUR | NY | 13642 | 464249555 | HOSPITAL | NY | 501C3 | 3 | SLHS | Yes (true) | |
| CANTON-POTSDAM HOSPITAL | |||||||||||
| 50 LEROY STREET | POTSDAM | NY | 13676 | 161012691 | HOSPITAL | NY | 501C3 | 3 | SLHS | Yes (true) | |
| CANTON-POTSDAM MEDICAL PRACTICE PL | |||||||||||
| 50 LEROY STREET | POTSDAM | NY | 13676 | 460714367 | CLINIC | NY | 501C3 | 3 | SLHS | Yes (true) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CANTON-POTSDAM HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | K | TransactionTypeTxt |
| Involved | $2,094,375 | InvolvedAmt |
| Method Of Amount Determination | FMV | MethodOfAmountDeterminationTxt |