RIVER HOSPITAL INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- RIVER HOSPITAL INC (EIN 81-0600548)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-13
- IRS object ID
- 201733179349306908
- Schema version
- 2016v3.0
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-13T15:28:42-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | 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 | FUST CHARLES CHAMBERS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5784 WIDEWATERS PARKWAY | AddressLine1Txt |
| City | SYRACUSE | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13214 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810600548 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RIVER HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | RIVE | BusinessNameControlTxt |
| Phone | 3154822511 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4 FULLER STREET | AddressLine1Txt |
| City | ALEXANDRIA BAY | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13607 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KELLEY TIERNAN | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3154822511 | PhoneNum |
| Signature | 2017-11-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | THOMAS J GIUFRE | PreparerPersonNm |
| PTIN | P00841958 | PTIN |
| Phone | 3154463600 | PhoneNum |
| Preparation | 2017-11-13 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 24.39.85.114 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-13 | IPDt |
| IP Tm | 12:13:30 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 517AEBE328CBAAA90E396C2FD1060AA56161F780 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | C99E98354DF8E5DB8DC0B72B8E8011BA208B0BCB | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KELLEY TIERNAN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4 FULLER STREET | AddressLine1Txt |
| City | ALEXANDRIA BAY | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13607 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $25,554,092 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.RIVERHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2003 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | IT IS THE MISSION OF RIVER HOSPITAL TO PROVIDE COMPASSIONATE, COST EFFECTIVE AND ACCESSIBLE, PRIMARY HEALTH CARE TO THE YEAR ROUND AND SEASONAL RESIDENTS, AND VISITORS OF THE RIVER COMMUNITIES. THE HOSPITAL PRIDES ITSELF ON HIGH QUALITY OUTPATIENT, INPATIENT AND SPECIALTY SERVICES TO MEET INDIVIDUAL AND COMMUNITY NEEDS THROUGH PARTNERSHIPS WITH OUR PATIENTS AND COMMUNITIES WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 16 | VotingMembersIndependentCnt |
| Total Employee | 272 | TotalEmployeeCnt |
| Total Volunteers | 80 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,896,778 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,800,427 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $16,337,464 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $19,606,701 | CYProgramServiceRevenueAmt |
| PY Investment Income | $212,921 | PYInvestmentIncomeAmt |
| CY Investment Income | $128,153 | CYInvestmentIncomeAmt |
| PY Other Revenue | $808,508 | PYOtherRevenueAmt |
| CY Other Revenue | $1,509,336 | CYOtherRevenueAmt |
| PY Total Revenue | $19,255,671 | PYTotalRevenueAmt |
| CY Total Revenue | $25,044,617 | 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 | $12,666,913 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $13,299,497 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,602,814 | PYOtherExpensesAmt |
| CY Other Expenses | $7,055,663 | CYOtherExpensesAmt |
| PY Total Expenses | $20,269,727 | PYTotalExpensesAmt |
| CY Total Expenses | $20,355,160 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,014,056 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $4,689,457 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $13,172,963 | TotalAssetsBOYAmt |
| Total Assets EOY | $14,641,538 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,969,303 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,577,766 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,203,660 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,063,772 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | IT IS THE MISSION OF RIVER HOSPITAL TO PROVIDE COMPASSIONATE, COST EFFECTIVE AND ACCESSIBLE, PRIMARY HEALTH CARE TO THE YEAR ROUND AND SEASONAL RESIDENTS, AND VISITORS OF THE RIVER COMMUNITIES. THE HOSPITAL PRIDES ITSELF ON HIGH QUALITY OUTPATIENT, INPATIENT AND SPECIALTY SERVICES TO MEET INDIVIDUAL AND COMMUNITY NEEDS THROUGH PARTNERSHIPS WITH OUR PATIENTS AND COMMUNITIES WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $15,305,514 | ExpenseAmt |
| Revenue | $21,116,037 | RevenueAmt |
| Desc | RIVER HOSPITAL, INC. PROVIDED GENERAL INPATIENT, OUTPATIENT, AND EMERGENCY SERVICES TO RESIDENTS IN THE NORTHERN NEW YORK AREA. DURING 2016, THE HOSPITAL PROVIDED 1,765 SWING BED DAYS AND 252 DAYS OF CRITICAL ACCESS CARE TO THE SICK AND INJURED. IN THE OUTPATIENT SERVICE AREA RIVER HOSPITAL PROVIDED 7,802 EMERGENCY ROOM VISITS IN 2016.RIVER HOSPITAL STRIVES TO IDENTIFY AND UPDATE SERVICES BASED UPON THE COMMUNITY NEEDS. WE HAVE IMPLEMENTED ELECTRONIC HEALTH RECORDS AND ARE PARTICIPATING IN THE REGIONAL HEALTH INFORMATION EXCHANGE (RHIO). THE HOSPITAL SERVES A COMMUNITY PAYOR MIX OF 72% GOVERNMENT PAYORS, 27% COMMERCIAL PAYORS AND OTHER AND 1% UNINSURED. | Desc |
| Total Program Service Expenses | $15,305,514 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | 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 |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | 111 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 272 | 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 16 | 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 | 0 | 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 | KELLEY TIERNAN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3153933600 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 214 KING STREET | AddressLine1Txt |
| City | OGDENSBURG | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13669 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| JOSEPH RUSSELL | |||||||
| CHAIRMAN | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ROBERT TOOLE | |||||||
| SECRETARY | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JEANNE SNOW | |||||||
| TREASURER | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| CRAIG GARLOCK | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| NORMAN SNYDER | |||||||
| VICE CHAIRMAN | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| RONALD MILLER | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| RICHARD MACSHERRY | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| RONALD RANDALL | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| JAMES DONEGAN | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| LYNN BROWN | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| RONALD THOMSON | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| CHET TRUSKOWKSI | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| RAYMOND SMITH | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| KEN VANHATTEN | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| SUE RAPANT | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| KATHY MORRIS | |||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| BEN MOORE | |||||||
| CEO | 40.00 | Yes (X) | $240,000 | $0 | $10,827 | ||
| BRADLEY FREY | |||||||
| MEDICAL STAFF PRESIDENT | 40.00 | Yes (X) | $159,338 | $0 | $9,657 | ||
| ALFREDO TORRES | |||||||
| PHYSICIAN | 40.00 | $290,462 | $0 | $29,801 | Yes (X) | ||
| JOHN HUSZONEK | |||||||
| PSYCHIATRIST | 40.00 | $218,116 | $0 | $10,851 | Yes (X) | ||
| ROBERT WERBLIN | |||||||
| ER MEDICAL DIRECTOR | 40.00 | $355,610 | $0 | $12,503 | Yes (X) | ||
| ANDREW OGDEN | |||||||
| MEDICAL DIRECTOR | 40.00 | $215,350 | $0 | $35,225 | Yes (X) | ||
| JOHN ELLIE | |||||||
| PHYSICIAN | 40.00 | $429,632 | $0 | $31,797 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,908,508 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $140,661 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 15 | 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 |
|---|---|---|---|---|---|
| CLAXTON HEPBURN MEDICAL CENTER | |||||
| 214 KING STREET | PEABODY | MA | 13669 | COLLABORATIVE SERVICES | $451,052 |
| SAMARITAN MEDICAL CENTER | |||||
| 104 PADDOCK STREET SUITE 104 | WATERTOWN | NY | 13601 | PHARMACEUTICAL AND IT SERVICES | $389,525 |
| CARDINAL HEALTH 110 INC | |||||
| 6012 MOLLOY ROAD | SYRACUSE | NY | 13211 | PHARMACEUTICAL SERVICES | $266,182 |
| BERNIER CARR & ASSOCIATES PC | |||||
| 327 MULLIN STREET | WATERTOWN | NY | 13601 | ARCHITECTUAL SERVICES | $252,963 |
| CENTOLELLA LYNN DELIA AND TEMES LLC | |||||
| 100 MADISON STREET TOWER 1 STE 190 | SYRACUSE | NY | 13202 | LEGAL/CONSULTING | $231,928 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 16 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,862,460 | GovernmentGrantsAmt |
| All Other Contributions | $1,937,967 | AllOtherContributionsAmt |
| Total Contributions | $3,800,427 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PROGRAM SERVICE REVENUE | 623000 | $15,674,824 | $15,674,824 |
| VAP/DSRIP FUNDS | 623000 | $3,931,877 | $3,931,877 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $19,606,701 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $58,126 | TotalRevenueColumnAmt |
| Exclusion | $58,126 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $27,954 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $69,950 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$41,996 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$41,996 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$41,996 | RelatedOrExemptFuncIncomeAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $507,956 | SecuritiesAmt |
| Other | $1,596 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $439,525 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $68,431 | SecuritiesAmt |
| Other | $1,596 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $70,027 | TotalRevenueColumnAmt |
| Exclusion | $70,027 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| OTHER MISCELLANEOUS OPERATING INC | 623000 | $1,080,912 | $1,080,912 |
| PHYSICAL THERAPY OTHER REVENUE | 623000 | $415,266 | $415,266 |
| ALL OTHER REVENUE | 623000 | $42,863 | $42,863 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,291 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12,291 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,551,332 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,044,617 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $21,116,037 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $128,153 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $419,822 | TotalAmt |
| Program Services | $327,461 | ProgramServicesAmt |
| Management And General | $92,361 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,894,303 | TotalAmt |
| Program Services | $8,497,556 | ProgramServicesAmt |
| Management And General | $2,396,747 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,221,206 | TotalAmt |
| Program Services | $952,541 | ProgramServicesAmt |
| Management And General | $268,665 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $764,166 | TotalAmt |
| Program Services | $630,232 | ProgramServicesAmt |
| Management And General | $133,934 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $182,454 | TotalAmt |
| Management And General | $182,454 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,000 | TotalAmt |
| Management And General | $71,000 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,132,039 | TotalAmt |
| Program Services | $428,941 | ProgramServicesAmt |
| Management And General | $703,098 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $89,538 | TotalAmt |
| Program Services | $2,762 | ProgramServicesAmt |
| Management And General | $86,776 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,483 | TotalAmt |
| Program Services | $61,555 | ProgramServicesAmt |
| Management And General | $16,928 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,542 | TotalAmt |
| Program Services | $39,655 | ProgramServicesAmt |
| Management And General | $23,887 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $163,084 | TotalAmt |
| Program Services | $146,776 | ProgramServicesAmt |
| Management And General | $16,308 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,216,066 | TotalAmt |
| Program Services | $948,531 | ProgramServicesAmt |
| Management And General | $267,535 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $261,498 | TotalAmt |
| Program Services | $203,968 | ProgramServicesAmt |
| Management And General | $57,530 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $1,138,412 | $1,048,721 | $89,691 |
| OUTSIDE SERVICES | $1,059,350 | $617,060 | $442,290 |
| BAD DEBTS | $644,233 | $644,233 | |
| UTILITIES | $246,757 | $202,341 | $44,416 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $709,207 | TotalAmt |
| Program Services | $553,181 | ProgramServicesAmt |
| Management And General | $156,026 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,355,160 | TotalAmt |
| Program Services | $15,305,514 | ProgramServicesAmt |
| Management And General | $5,049,646 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $713,115 | BOYAmt |
| EOY | $1,610,150 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $816,718 | BOYAmt |
| EOY | $1,932,404 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,507,317 | BOYAmt |
| EOY | $1,994,977 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $364,320 | BOYAmt |
| EOY | $437,755 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $98,535 | BOYAmt |
| EOY | $108,470 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $15,629,258 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $10,254,755 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,373,824 | BOYAmt |
| EOY | $5,374,503 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,114,145 | BOYAmt |
| EOY | $2,996,680 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $184,989 | BOYAmt |
| EOY | $186,599 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,172,963 | BOYAmt |
| EOY | $14,641,538 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,784,136 | BOYAmt |
| EOY | $2,659,524 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $192,116 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,531,231 | BOYAmt |
| EOY | $2,490,184 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $653,936 | BOYAmt |
| EOY | $235,942 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,969,303 | BOYAmt |
| EOY | $5,577,766 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,418,138 | BOYAmt |
| EOY | $4,957,268 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,265,670 | BOYAmt |
| EOY | $3,581,996 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $519,852 | BOYAmt |
| EOY | $524,508 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,203,660 | BOYAmt |
| EOY | $9,063,772 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,172,963 | BOYAmt |
| EOY | $14,641,538 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $4,689,457 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $170,655 | 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | 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 D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,785,522 | BeginningYearBalanceAmt |
| Contributions | $1,790,422 | ContributionsAmt |
| Investment Earnings Or Losses | $4,656 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $474,096 | OtherExpendituresAmt |
| End Year Balance | $4,106,504 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,395,083 | BeginningYearBalanceAmt |
| Contributions | $1,166,489 | ContributionsAmt |
| Investment Earnings Or Losses | $183,739 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,959,789 | OtherExpendituresAmt |
| End Year Balance | $2,785,522 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,461,698 | BeginningYearBalanceAmt |
| Contributions | $884,070 | ContributionsAmt |
| Investment Earnings Or Losses | $62,874 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $2,013,559 | OtherExpendituresAmt |
| End Year Balance | $3,395,083 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,023,761 | BeginningYearBalanceAmt |
| Contributions | $3,207,476 | ContributionsAmt |
| Investment Earnings Or Losses | -$3,461 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $2,766,078 | OtherExpendituresAmt |
| End Year Balance | $4,461,698 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,430,770 | BeginningYearBalanceAmt |
| Contributions | $424,661 | ContributionsAmt |
| Investment Earnings Or Losses | -$39,795 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $791,875 | OtherExpendituresAmt |
| End Year Balance | $4,023,761 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.12770 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.87230 | 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 | $11,000 | OtherCostOrOtherBasisAmt |
| Book Value | $11,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,372,049 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,403,862 | DepreciationAmt |
| Book Value | $1,968,187 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,703,734 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,850,893 | DepreciationAmt |
| Book Value | $2,852,841 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $542,475 | OtherCostOrOtherBasisAmt |
| Book Value | $542,475 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,374,503 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INSURANCE RESERVE | Desc |
| Amt | $235,942 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $235,942 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $25,285,222 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $170,655 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $170,655 | RevenueNotReportedAmt |
| Revenue Subtotal | $25,114,567 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$69,950 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$69,950 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $25,044,617 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $20,425,110 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $20,425,110 | ExpensesSubtotalAmt |
| Other Expenses Not Included | -$69,950 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | -$69,950 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $20,355,160 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | PERMANENT ENDOWMENT FUNDS ARE TO BE HELD IN PERPETUITY WITH THE INCOME TO BE USED TO SUPPORT HEALTHCARE SERVICES. TEMPORARY ENDOWMENT FUNDS ARE TO BE USED TO PURCHASE CAPITAL EQUIPMENT FOR HEALTHCARE SERVICES, HOSPITAL OPERATIONS AND SCHOLARSHIPS. |
| PART X, LINE 2: | THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (CODE) AND IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE CODE. AS OF DECEMBER 31, 2016 AND 2015, THE HOSPITAL DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES ARE 2013 THROUGH 2016. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | RENTAL EXPENSES -69,950. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | RENTAL EXPENSES -69,950. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| 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 | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $480,781 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $112,343 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $368,438 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01870 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,046,877 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,312,184 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,734,693 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08800 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,527,658 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,424,527 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,103,131 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10670 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,527,658 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,424,527 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,103,131 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10670 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $644,233 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $141,731 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,798,112 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $4,122,201 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$324,089 | 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 | Yes (1) | 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 | RIVER HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4 FULLER STREET | AddressLine1Txt |
| City | ALEXANDRIA BAY | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13607 | 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 | RIVER HOSPITAL INC | 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 | 16 | 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 | WWW.RIVERHOSPITAL.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.RIVERHOSPITAL.ORG | 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 | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| 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 | WWW.RIVERHOSPITAL.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.RIVERHOSPITAL.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.RIVERHOSPITAL.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 Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit Report To Credit Agency | Yes (X) | PermitReportToCreditAgencyInd |
| Collection Activities | Yes (1) | CollectionActivitiesInd |
| Reporting To Credit Agency | Yes (X) | ReportingToCreditAgencyInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| RIVER HOSPITAL, INC. | PART V, SECTION B, LINE 5: RIVER HOSPITAL TOOK INTO ACCOUNT THE BROAD INTERESTS OF THE COMMUNITY AND THE TRI COUNTY REGION THROUGH COLLABORATIVE EFFORTS OF THE NORTH COUNTRY HEALTH COMPASS PARTNERSHIP, IN THE DEVELOPMENT OF THE 2016 COMMUNITY HEALTH ASSESSMENT AND THE 2016-2018 REGIONAL COMMUNITY HEALTH IMPROVEMENT PLAN. THE NORTH COUNTRY HEALTH COMPASS PARTNERSHIP IS COMPRISED OF REGIONAL REPRESENTATION FROM PUBLIC HEALTH AGENCIES, HOSPITALS AND COMMUNITY-BASED ORGANIZATIONS FROM JEFFERSON, LEWIS AND ST. LAWRENCE COUNTIES, WHO MEET ON A MONTHLY BASIS. THE REGIONAL PRIORITIES WERE SELECTED AFTER CAREFULLY EVALUATING COMMUNITY HEALTH NEEDS, POPULATION HEALTH DATA, REGIONAL ASSETS, AND REGIONAL BARRIERS. PREVENTION AGENDA PRIORITIES AND GOALS WERE RANKED USING AN ONLINE SURVEY TOOL WHICH DISPLAYED HEALTH INDICATORS RELATED TO EACH PRIORITY. RIVER HOSPITAL SELECTED PRIORITIES FOR THE COMMUNITY SERVICE PLAN WHICH ARE IN ALIGNMENT WITH THE PREVENTION AGENDA AND THE EFFORTS OF THE NORTH COUNTRY HEALTH COMPASS PARTNERSHIP AS WELL AS THE INDIVIDUAL HOSPITAL'S EFFORT. |
| RIVER HOSPITAL, INC. | PART V, SECTION B, LINE 6A: CANTON-POTSDAM HOSPITAL, CARTHAGE AREA HOSPITAL, CLAXTON-HEPBURN MEDICAL CENTER, CLIFTON-FINE HOSPITAL, GOUVERNEUR HOSPITAL, LEWIS COUNTY GENERAL HOSPITAL, MASSENA MEMORIAL HOSPITAL, RIVER HOSPITAL AND SAMARITAN MEDICAL CENTER. |
| RIVER HOSPITAL, INC. | PART V, SECTION B, LINE 6B: COMMUNITY PARTNERS IN JEFFERSON, LEWIS, AND ST. LAWRENCE COUNTIES WHO INTERFACE WITH LOW INCOME TARGET POPULATION. |
| RIVER HOSPITAL, INC. | PART V, SECTION B, LINE 11: THE NY STATE 2013-2018 PREVENTION AGENDA WAS THE BASIS TO DEVELOP THIS HEALTH IMPROVEMENT COMMUNITY HEALTH ASSESSMENT AND IMPROVEMENT PLAN. RIVER HOSPITAL AND JEFFERSON COUNTY PUBLIC HEALTH DEPARTMENT SELECTED DISPARITIES IN COLLABORATION WITH PARTNERING HEALTH CARE FACILITIES OF THE NORTH COUNTRY. THE 2016 EVIDENCE BASED INTERVENTIONS SELECTED WERE PREVENT CHRONIC DISEASE WITH EFFORTS TO REDUCE OBESITY, AS WELL AS PROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSE THROUGH THE STRENGTHENING OF THE INFRASTRUCTURE ACROSS SYSTEMS.RIVER HOSPITAL'S 2016-2018 COMMUNITY SERVICE PLAN WILL CONTINUE TO FOCUS INITIATIVES WHICH IMPROVE OUTCOMES WITH CHRONIC DISEASE AND MENTAL HEALTH & SUBSTANCE ABUSE PREVENTION AGENDA PRIORITIES AND THE LOW SOCIOECONOMIC STATUS DISPARITY. RIVER HOSPITAL IS ENGAGING THE COMMUNITY AND PATIENT BASE IN THEIR OWN HEALTH CARE DECISIONS THROUGH PROVIDER-TO-PATIENT EDUCATION METHODS AS A PATIENT CENTERED MEDICAL HOME. IN ADDITION TO PATIENT ENGAGEMENT IN THE HEALTH CARE SETTING, RIVER HOSPITAL SEEKS OPPORTUNITIES TO EDUCATE THE COMMUNITY WHEN THERE ARE OPPORTUNITIES FOR COMMUNITY OUTREACH AND EMPLOYER-BASED HEALTH FAIR TYPE EVENTS. |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | WORKSHEETS 1, 2 & 3 WERE USED TO COMPLETE LINES 7A, 7B AND 7C. |
| 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 $ 644,233. |
| PART III, LINE 2: | THIS ALSO APPLIES TO PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST PAYMENT 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. FOR RECEIVABLES ASSOCIATED WITH 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 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. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS WAS 52% AND 33% OF THE RELATED PATIENT ACCOUNTS RECEIVABLE, NET OF CONTRACTUAL ALLOWANCES AT DECEMBER 31, 2016 AND 2015, RESPECTIVELY.FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE HOSPITAL RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES PROVIDED OR ON THE BASIS OF NEGOTIATED DISCOUNTED RATES. THUS, THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. |
| PART III, LINE 3: | THE METHODOLOGY USED TO CALCULATE THE PORTION OF BAD DEBT ATTRIBUTABLE TO THE PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY WAS TO SUM THE BAD DEBT WRITE OFFS FOR PATIENTS CURRENTLY RECEIVING THE CHARITY CARE DISCOUNTS FROM THE DETAILED BAD DEBT WRITE OFF REPORTS FROM THE BILLING SYSTEM. |
| PART III, LINE 8: | THE SHORTFALL REPORTED ON LINE 7 WAS SETTLED IN 2017 WITHIN THE 2016 MEDICARE COST REPORT SETTLEMENT CALCULATION, THEREFORE, THIS AMOUNT SHOULD NOT BE CONSIDERED TO BE PART OF THE COMMUNITY BENEFIT. |
| PART III, LINE 9B: | UNDER OUR CHARITY CARE PROGRAM, PATIENTS MAY APPLY FOR ASSISTANCE WITHIN 90 DAYS OF DISCHARGE OR DATE OF SERVICE. ONCE THE APPLICATION IS REQUESTED AND RECEIVED BY THE APPLICANT, THE APPLICATION MUST BE RETURNED TO RIVER HOSPITAL WITHIN 30 DAYS FROM THE DATE OF SERVICE. RIVER HOSPITAL DOES NOT PURSUE FURTHER COLLECTION ACTION WHILE THIS APPLICATION IS IN PROCESS PROVIDING THAT THE APPLICATION IS COMPLETED IN A TIMELY FASHION. RIVER HOSPITAL PROCESSES THIS APPLICATION WITHIN 30 DAYS OF RECEIPT. APPLICANTS ARE NOTIFIED IN WRITING OF OUR DECISION. AN INSTALLMENT AGREEMENT IS THEN SENT TO THE APPLICANT, AN INTEREST FREE AGREEMENT, TO BE SIGNED AND RETURNED. |
| PART VI, LINE 2: | RIVER HOSPITAL CONTINUES TO COLLABORATE WITH THE TRI-COUNTY "NORTH COUNTRY HEALTH COMPASS" PARTNERS. THE MISSION OF THE PARTNERSHIP IS TO DEVELOP, IMPLEMENT AND EVALUATE A REGIONAL HEALTH IMPROVEMENT INITIATIVE THROUGH RESEARCH, DATA ANALYSIS, COMMUNITY ENGAGEMENT AND COLLABORATION AMONG PUBLIC HEALTH DEPARTMENTS, HOSPITALS, COMMUNITY BASED ORGANIZATIONS, GENERAL PUBLIC AND HEALTHCARE PROVIDERS. THROUGH THE EFFORTS OF THIS PARTNERSHIP, IT WAS POSSIBLE TO DO A COMMUNITY HEALTH ASSESSMENT (CHA), IN ORDER TO AID IN THE DEVELOPMENT OF THE COMMUNITY HEALTH IMPROVEMENT PLAN AND THE HOSPITAL'S COMMUNITY SERVICE PLAN IN 2016. |
| PART VI, LINE 3: | PATIENTS ARE PROVIDED INFORMATION ABOUT OUR CHARITY CARE PROGRAM AND THE ELIGIBILITY GUIDELINES AT THE TIME OF SERVICE. WE ALSO HAVE THE INFORMATION AVAILABLE ON OUR WEBSITE. |
| PART VI, LINE 4: | RIVER HOSPITAL IS LOCATED WITHIN THE VILLAGE OF ALEXANDRIA BAY, NEW YORK, 'THE HEART OF THE THOUSAND ISLAND REGION', AND INCLUDES AREAS OF BOTH JEFFERSON AND ST. LAWRENCE COUNTIES. RIVER HOSPITAL IS SITUATED DIRECTLY ON THE SHORE OF THE ST. LAWRENCE SEAWAY, A VERY RURAL AREA, YET, ONE OF THE MAJOR COMMERCIAL WATERWAYS, CONNECTING THE GREAT LAKES TO THE WATER WAYS OF THE WORLD. RIVER HOSPITAL'S IMMEDIATE SERVICE AREA REACHES A RADIUS OF APPROXIMATELY 25 MILES. THE FACILITY PROVIDES HEALTH CARE SERVICES TO SEVERAL SURROUNDING COMMUNITIES. WITHIN THE RANGE OF THE RIVER HOSPITAL SERVICE AREA IS THE EXPANSIVE UNITED STATES ARMY'S 10TH MOUNTAIN LIGHT INFANTRY DIVISION AT FORT DRUM AND THE INFLUX OF FAMILY MEMBERS AND ASSOCIATED POPULATION. DIRECTLY TO THE NORTH, ON THE OPPOSITE SHORE OF THE ST. LAWRENCE RIVER IS THE PROVINCE OF ONTARIO, CANADA, CONFINING AVAILABILITY OF UNITED STATES HEALTH CARE SYSTEM TO 180 DEGREE RADIUS. THE LARGEST NEARBY UNITED STATES POPULATION CENTER IS SYRACUSE, NEW YORK, LOCATED 100 MILES TO THE SOUTH.IN ADDITION TO THE FULL TIME RESIDENTS OF THESE COMMUNITIES, RIVER HOSPITAL SERVES A LARGE POPULATION OF SEASONAL RESIDENTS AND VISITORS FROM THE UNITED STATES AND OTHER COUNTRIES OF THE WORLD, DUE IN PART TO THE SEASONAL TOURISM INDUSTRY. THIS ENTIRE REGION IS A MEDICALLY UNDERSERVED AREA (MUA) AND FEDERALLY DESIGNATED HEALTH PROVIDER SHORTAGE AREA (HPSA) WITH POVERTY AND UNEMPLOYMENT RATES THAT SIGNIFICANTLY EXCEED BOTH STATE AND NATIONAL AVERAGES. |
| PART VI, LINE 5: | RIVER HOSPITAL CONTINUES TO BE VERY INVOLVED WITH OTHER PARTNERS TO PROVIDE QUALITY HEALTHCARE SERVICE TO THIS REGION OF NORTHERN NEW YORK STATE, INCLUDING RELATIONSHIPS WITH JEFFERSON COUNTY PUBLIC HEALTH DEPARTMENT, OTHER NORTH COUNTRY HOSPITALS AND AGENCIES/ORGANIZATIONS TO SHARE INFORMATION AND WORK TOGETHER TO EDUCATE THE PUBLIC ON THE AVAILABILITY OF SERVICES IN THIS REGION. RIVER HOSPITAL WORKS CLOSELY WITH FORT DRUM REGIONAL HEALTH PLANNING ORGANIZATION (FDRHPO), WHICH WAS ESTABLISHED TO LINK MILITARY FAMILIES ASSIGNED TO FORT DRUM MILITARY BASE TO QUALITY HEALTHCARE SERVICES AND RESOURCES IN THE REGION, AS THERE IS NO ON-BASE HOSPITAL.RIVER HOSPITAL PARTICIPATED IN HEALTH AND WELLNESS FAIRS WHERE HEALTH INFORMATION WAS DISTRIBUTED ALONG WITH INFORMATION ABOUT THE HOSPITAL. IN AUGUST, THE HOSPITAL PARTNERED WITH UNITED HEALTHCARE TO HOST A BACK TO SCHOOL VACCINATION EVENT. THE HOSPITAL ALSO CONTINUES TO WORK WITH OTHER AGENCIES SUCH AS CANCER SERVICES PROGRAM OF JEFFERSON AND LEWIS COUNTIES, FOR INDIVIDUALS WITHOUT ADEQUATE HEALTH INSURANCE WHO NEEDED MAMMOGRAMS. RIVER HOSPITAL WAS THE HEALTHCARE PROVIDER AT THE HOOD PLANT ANNUAL EMPLOYEE/FAMILY HEALTH FAIR AND OFFERED FLU VACCINES, PHYSICAL THERAPY TECHNIQUES, BLOOD PRESSURE CHECKS, PROPER NUTRITION GUIDELINES AS WELL AS INFORMATION TO IMPROVE/MAINTAIN GOOD HEALTH AND GENERAL RIVER HOSPITAL SERVICES INFORMATION. RIVER HOSPITAL ALSO HOSTED MASH CAMP STUDENTS, SPONSORED BY FORT DRUM REGIONAL HEALTH PLANNING ORGANIZATION, WHEREBY STUDENTS FROM AREA SCHOOLS EXPLORED CAREERS IN HEALTHCARE AT RIVER HOSPITAL. WELLS COLLEGE STUDENTS ALSO VISITED RIVER HOSPITAL TO LEARN MORE ABOUT RURAL HEALTHCARE AND THE COMMUNITIES WE SERVE. LIVE YOUR BEST LIFE WAS HELD IN APRIL, IN PARTNERSHIP WITH CLAXTON-HEPBURN MEDICAL CENTER. THIS FREE, DAY-LONG EVENT INVITED WOMEN WHO HAVE OR HAVE HAD CANCER TO LEARN MORE ABOUT THEIR DISEASE AS WELL AS GAVE THEM TOOLS TO LIVE THEIR BEST LIFE DURING OR AFTER A CANCER DIAGNOSIS. RIVER HOSPITAL CONTINUED TO WORK WITH OTHER REGIONAL HOSPITALS ON A COLLABORATION TO DEVELOP A STRATEGY TO ADDRESS THE DELIVERY OF AFFORDABLE HEALTH CARE SOLUTIONS TO RESIDENTS IN THE TRI-COUNTY AREA. THE REGIONAL NCI HOSPITAL COLLABORATION INCLUDE RIVER HOSPITAL, ALEXANDRIA BAY; CLAXTON HEPBURN MEDICAL CENTER, OGDENSBURG; CLIFTON-FINE HOSPITAL, STAR LAKE; SAMARITAN MEDICAL CENTER, WATERTOWN AND CARTHAGE AREA HOSPITAL, CARTHAGE. RIVER HOSPITAL HAS A PASSIVE PARENT COLLABORATION WITH CLAXTON-HEPBURN MEDICAL CENTER; NORTH STAR HEALTH ALLIANCE. RIVER HOSPITAL ACTIVELY PARTICIPATES WITH THE NEW YORK STATE CRITICAL ACCESS HOSPITALS WHO WORK TOGETHER ON QUALITY IMPROVEMENT PROCESSES AND PATIENT SATISFACTION OUTCOMES. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | NY |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BEN MOORE | ||||||||||||||
| CEO | $200,000 | $0 | $40,000 | $0 | $0 | $0 | $0 | $0 | $10,827 | $0 | $250,827 | $0 | $0 | $0 |
| BRADLEY FREY | ||||||||||||||
| MEDICAL STAFF PRESIDENT | $149,338 | $0 | $10,000 | $0 | $0 | $0 | $0 | $0 | $9,657 | $0 | $168,995 | $0 | $0 | $0 |
| ALFREDO TORRES | ||||||||||||||
| PHYSICIAN | $290,462 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $29,801 | $0 | $320,263 | $0 | $0 | $0 |
| JOHN HUSZONEK | ||||||||||||||
| PSYCHIATRIST | $218,116 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $10,851 | $0 | $228,967 | $0 | $0 | $0 |
| ROBERT WERBLIN | ||||||||||||||
| ER MEDICAL DIRECTOR | $355,610 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $12,503 | $0 | $368,113 | $0 | $0 | $0 |
| ANDREW OGDEN | ||||||||||||||
| MEDICAL DIRECTOR | $201,850 | $0 | $13,500 | $0 | $0 | $0 | $0 | $0 | $35,225 | $0 | $250,575 | $0 | $0 | $0 |
| JOHN ELLIE | ||||||||||||||
| PHYSICIAN | $429,632 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $31,797 | $0 | $461,429 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | NORTH STAR HEALTH ALLIANCE,INC. A NOT-FOR-PROFIT HOLDING COMPANY, IS THE SOLE CORPORATE MEMBER OF THE HOSPITAL. |
| FORM 990, PART VI, SECTION A, LINE 7A | NORTH STAR HEALTH ALLIANCE, INC. ELECTS THE MEMBERS OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION A, LINE 7B | DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO THE APPROVAL OF NORTH STAR HEALTH ALLIANCE, INC. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS MADE AVAILABLE TO THE BOARD MEMBERS PRIOR TO ITS FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH MEMBER OF THE BOARD IS REQUIRED TO COMPLETE AND SIGN A CONFLICT OF INTEREST POLICY ANNUALLY. IF A CONFLICT ARISES IN BETWEEN ANNUAL REVIEW OF THE POLICY, THE BOARD MEMBER IS REQUIRED TO AND RESPONSIBLE FOR REPORTING THE CONFLICT OF INTEREST. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE CEO'S WAGES ARE REVIEWED AND APPROVED BY THE BOARD OF TRUSTEES AND COMPARABLE REGIONAL WAGE DATA PROVIDED BY PAYSCALE AND THE IROQUOIS HEALTHCARE ASSOCIATION SURVEY OF WAGE DATA ARE USED TO DETERMINE COMPETITIVE WAGES. THE CEO IS MONITORED AND EVALUATED BY THE BOARD OF DIRECTORS ON AN ANNUAL BASIS. THE EXECUTIVE DIRECTOR, AND OTHER TOP MANAGEMENT OFFICERS ARE MONITORED AND REVIEWED ON AN ANNUAL BASIS BY THE CEO. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC THROUGH THE COMPANY'S WEBSITE. THE FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC THROUGH THE PUBLIC CHARITY WEBSITE. |
| FORM 990, PART XII, LINE 2C | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTH STAR HEALTH ALLIANCE INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 214 KING STREET | AddressLine1Txt |
| City | OGDENSBURG | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13669 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 161449491 | EIN |
| Primary Activities | PARENT HOLDING COMPANY FOR CLAXTON-HEPBURN MEDICAL CENTER | PrimaryActivitiesTxt |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | 509(A)(3) | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
| 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 |