BROOKS-TLC HOSPITAL SYSTEM INC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- BROOKS-TLC HOSPITAL SYSTEM INC (EIN 16-0743301)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-08-10
- IRS object ID
- 201542229349300109
- Schema version
- 2014v5.0
- 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 | 2015-08-10T07:58:46-05:00 | ReturnTs |
| Tax Period End | 2014-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 160765486 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LUMSDEN & MCCORMICK LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 369 FRANKLIN STREET | AddressLine1Txt |
| City | BUFFALO | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14202 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 160743301 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BROOKS MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BROO | BusinessNameControlTxt |
| Phone | 7163661111 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 529 CENTRAL AVENUE | AddressLine1Txt |
| City | DUNKIRK | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14048 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | J GARY RHODES | PersonNm |
| Person Title | INTERIM CEO | PersonTitleTxt |
| Phone | 7163661111 | PhoneNum |
| Signature | 2015-07-29 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J GRIMALDI | PreparerPersonNm |
| PTIN | P01295846 | PTIN |
| Phone | 7168563300 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-04-25 22:37:26Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | J GARY RHODES | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 529 CENTRAL AVENUE | AddressLine1Txt |
| City | DUNKIRK | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14048 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $47,160,116 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.BROOKSHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1898 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | AN ACUTE CARE HOSPITAL SERVING PRIMARILY RESIDENTS OF NORTHERN CHAUTAUQUA COUNTY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 460 | TotalEmployeeCnt |
| Total Volunteers | 27 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $286,526 | PYContributionsGrantsAmt |
| CY Contributions Grants | $437,128 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $40,499,712 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $40,731,166 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,113,992 | PYInvestmentIncomeAmt |
| CY Investment Income | $90,768 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,710,138 | PYOtherRevenueAmt |
| CY Other Revenue | $718,423 | CYOtherRevenueAmt |
| PY Total Revenue | $43,610,368 | PYTotalRevenueAmt |
| CY Total Revenue | $41,977,485 | 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 | $25,050,563 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $23,389,846 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $20,313,989 | PYOtherExpensesAmt |
| CY Other Expenses | $22,450,692 | CYOtherExpensesAmt |
| PY Total Expenses | $45,364,552 | PYTotalExpensesAmt |
| CY Total Expenses | $45,840,538 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,754,184 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$3,863,053 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $28,222,556 | TotalAssetsBOYAmt |
| Total Assets EOY | $23,409,085 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $11,113,695 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $10,084,854 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $17,108,861 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $13,324,231 | NetAssetsOrFundBalancesEOYAmt |
| Mission | SEE SCHEDULE O FOR FULL MISSION STATEMENT. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $17,587,398 | ExpenseAmt |
| Revenue | $16,151,378 | RevenueAmt |
| Desc | NURSING SERVICES - PROVISION OF DAILY CARE INCLUDING INPATIENT AND OUTPATIENT SERVICES WITHIN THE INSTITUTION | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $18,075,509 | ExpenseAmt |
| Revenue | $24,579,788 | RevenueAmt |
| Desc | OTHER PROFESSIONAL SERVICES - ANCILLARY SERVICES PROVIDED WITHIN THE FACILITY INCLUDING LABORATORY, RADIOLOGY, INHALATION THERAPY, ETC. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $35,662,907 | 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 | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 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 | 51 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 460 | 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | 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 | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NY | StatesWhereCopyOfReturnIsFldCd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JEFFREY MORGAN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7163637212 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 529 CENTRAL AVENUE | AddressLine1Txt |
| City | DUNKIRK | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14048 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| CHRISTOPHER LANSKI | ||||||||
| CHAIRMAN | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| ANDREW BURR | ||||||||
| CHAIRMAN ELECT | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| LOUIS DIPALMA | ||||||||
| TREASURER | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| DR VIRGINIA S HORVATH | ||||||||
| SECRETARY | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| WALTER GOTOWKA | ||||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| RICHARD MILAZZO MD | ||||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| G JAY BISHOP MD | ||||||||
| MEMBER | 2.00 | Yes (X) | $4,800 | $0 | $0 | |||
| FELIXBERTO COSICO JR MD FCCP | ||||||||
| MEMBER | 2.00 | Yes (X) | $2,200 | $0 | $0 | |||
| STEVEN PRZYBYLA | ||||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| JOHN GARY RHODES | ||||||||
| INTERIM CEO | 22.00 | Yes (X) | $0 | $0 | $0 | |||
| JEFFREY MORGAN | ||||||||
| VP FINANCE/CFO | 40.00 | Yes (X) | $248,534 | $0 | $7,170 | |||
| A JACK DAVIS | ||||||||
| VP ADMINISTRATIVE SERVICES | 40.00 | Yes (X) | $145,864 | $0 | $6,968 | |||
| JARROD JOHNSON | ||||||||
| COO | 40.00 | Yes (X) | $171,282 | $0 | $31,276 | |||
| JODI WITHERELL | ||||||||
| VP QUALITY/SAFETY | 40.00 | Yes (X) | $104,206 | $0 | $13,505 | |||
| MARY STAPLES | ||||||||
| VP QA/RISK MANAGEMENT | 40.00 | Yes (X) | $91,525 | $0 | $4,199 | |||
| JONATHAN LAWRENCE | ||||||||
| FORMER CEO | 20.00 | $164,455 | $169,339 | $34,878 | 20.00 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $932,866 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $169,339 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $97,996 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DR JOHN OROSZ | PersonNm |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3425 WEBSTER ROAD | AddressLine1Txt |
| City | FREDONIA | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14063 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | PATHOLOGIST/LAB MED DIRECTOR | ServicesDesc |
| Compensation | $229,992 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $244,921 | GovernmentGrantsAmt |
| All Other Contributions | $192,207 | AllOtherContributionsAmt |
| Total Contributions | $437,128 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE | Desc |
| Business | 621990 | BusinessCd |
| Total Revenue Column | $40,731,166 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $40,731,166 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $40,731,166 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $34,673 | TotalRevenueColumnAmt |
| Exclusion | $34,673 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Personal | $6,714 | PersonalAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Personal | $0 | PersonalAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Personal | $6,714 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,714 | TotalRevenueColumnAmt |
| Exclusion | $6,714 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $5,237,958 | SecuritiesAmt |
| Other | $768 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $5,160,104 | SecuritiesAmt |
| Other | $22,527 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $77,854 | SecuritiesAmt |
| Other | -$21,759 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $56,095 | TotalRevenueColumnAmt |
| Exclusion | $56,095 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| MEALS ON WHEELS | 900099 | $233,737 | $233,737 |
| LAB SERVICES | 900099 | $177,651 | $177,651 |
| CAFETERIA | 722210 | $166,388 | $166,388 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $133,933 | TotalRevenueColumnAmt |
| Exclusion | $133,933 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $711,709 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $41,977,485 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $40,731,166 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $809,191 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $831,529 | TotalAmt |
| Program Services | $7,000 | ProgramServicesAmt |
| Management And General | $824,529 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,479,854 | TotalAmt |
| Program Services | $14,358,946 | ProgramServicesAmt |
| Management And General | $3,120,908 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,303,705 | TotalAmt |
| Program Services | $894,463 | ProgramServicesAmt |
| Management And General | $409,242 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,435,257 | TotalAmt |
| Program Services | $1,680,941 | ProgramServicesAmt |
| Management And General | $754,316 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,339,501 | TotalAmt |
| Program Services | $903,593 | ProgramServicesAmt |
| Management And General | $435,908 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,672,754 | TotalAmt |
| Management And General | $1,672,754 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,441 | TotalAmt |
| Management And General | $22,441 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,910,326 | TotalAmt |
| Program Services | $9,018,443 | ProgramServicesAmt |
| Management And General | $891,883 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $819,112 | TotalAmt |
| Program Services | $233,691 | ProgramServicesAmt |
| Management And General | $585,421 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $635,885 | TotalAmt |
| Program Services | $476,914 | ProgramServicesAmt |
| Management And General | $158,971 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,578 | TotalAmt |
| Management And General | $13,578 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $82,069 | TotalAmt |
| Program Services | $82,069 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,117 | TotalAmt |
| Program Services | $4,117 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,252,759 | TotalAmt |
| Program Services | $1,802,207 | ProgramServicesAmt |
| Management And General | $450,552 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $477,586 | TotalAmt |
| Program Services | $334,215 | ProgramServicesAmt |
| Management And General | $143,371 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SPECIALIST FEES | $1,800,467 | $1,800,467 | |
| PURCHASED SERVICES | $1,634,132 | $1,031,145 | $602,987 |
| PROVISION FOR BAD DEBTS | $1,538,866 | $1,538,866 | |
| CONTRACT LABOR | $1,465,830 | $1,465,830 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $120,770 | TotalAmt |
| Program Services | $30,000 | ProgramServicesAmt |
| Management And General | $90,770 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,840,538 | TotalAmt |
| Program Services | $35,662,907 | ProgramServicesAmt |
| Management And General | $10,177,631 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,116,099 | BOYAmt |
| EOY | $1,398,902 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $898,597 | BOYAmt |
| EOY | $252,707 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,520,831 | BOYAmt |
| EOY | $5,055,189 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,280,579 | BOYAmt |
| EOY | $1,266,201 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $356,150 | BOYAmt |
| EOY | $368,495 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $50,678,424 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $41,876,231 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,986,665 | BOYAmt |
| EOY | $8,802,193 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,552,887 | BOYAmt |
| EOY | $3,094,487 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,645,716 | BOYAmt |
| EOY | $1,402,568 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,865,032 | BOYAmt |
| EOY | $1,768,343 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,222,556 | BOYAmt |
| EOY | $23,409,085 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,144,795 | BOYAmt |
| EOY | $6,353,861 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $158,900 | BOYAmt |
| EOY | $19,372 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,810,000 | BOYAmt |
| EOY | $3,711,621 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,113,695 | BOYAmt |
| EOY | $10,084,854 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,463,145 | BOYAmt |
| EOY | $11,921,663 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $888,507 | BOYAmt |
| EOY | $645,359 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $757,209 | BOYAmt |
| EOY | $757,209 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,108,861 | BOYAmt |
| EOY | $13,324,231 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,222,556 | BOYAmt |
| EOY | $23,409,085 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$3,863,053 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $196,305 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$117,882 | 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
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,645,716 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $59,794 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $302,942 | OtherExpendituresAmt |
| End Year Balance | $1,402,568 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,427,234 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $218,482 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $1,645,716 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,414,171 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $13,063 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $1,427,234 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,412,273 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $1,898 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $1,414,171 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,280,118 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $132,155 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $1,412,273 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.54000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.46000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $401,330 | OtherCostOrOtherBasisAmt |
| Book Value | $401,330 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,476,843 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,583,586 | DepreciationAmt |
| Book Value | $1,893,257 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,128,665 | OtherCostOrOtherBasisAmt |
| Depreciation | $818,638 | DepreciationAmt |
| Book Value | $310,027 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $38,671,586 | OtherCostOrOtherBasisAmt |
| Depreciation | $32,474,007 | DepreciationAmt |
| Book Value | $6,197,579 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,802,193 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | FUNDS HELD IN TRUST | Desc |
| Book Value | $1,402,568 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $1,402,568 | TotalBookValueSecuritiesAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ADVANCES TO RELATED PARTIES | Desc |
| Book Value | $1,768,343 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,768,343 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | $921,891 |
| ACCRUED PENSION LIABILITY | $2,789,730 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,711,621 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $40,460,378 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$1,538,866 | OtherRevenueAmt |
| Revenue Not Reported | -$1,538,866 | RevenueNotReportedAmt |
| Revenue Subtotal | $41,999,244 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$21,759 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$21,759 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $41,977,485 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $44,323,431 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $21,759 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $21,759 | ExpensesNotReportedAmt |
| Expenses Subtotal | $44,301,672 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,538,866 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,538,866 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $45,840,538 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE HOSPITAL IS A 501(C)(3) ORGANIZATION EXEMPT FROM INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE HOSPITAL BELIEVES IT IS NO LONGER SUBJECT TO EXAMINATION BY FEDERAL OR STATE TAXING AUTHORITIES FOR YEARS ENDED PRIOR TO DECEMBER 31, 2011. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS -1,538,866. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | LOSS ON DISPOSAL OF PROPERTY AND EQUIPMENT -21,759. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | LOSS ON DISPOSAL OF PROPERTY AND EQUIPMENT 21,759. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS 1,538,866. |
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 | 0 | ExpensesExceedBudgetInd |
| 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 | $441,390 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $48,177 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $393,213 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00890 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,330,679 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,693,551 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,637,128 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05950 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $147,857 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $98,455 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $49,402 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,919,926 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,840,183 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,079,743 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06950 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $30,520 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $30,520 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,067 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $20,067 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,357,463 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,305,648 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,051,815 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02370 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $967 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $967 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,409,017 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,305,648 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,103,369 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02490 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,328,943 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,145,831 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,183,112 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09440 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $687,877 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $6,944,634 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,564,639 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$620,005 | 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 | BROOKS MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 529 CENTRAL AVENUE | AddressLine1Txt |
| City | DUNKIRK | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14048 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | RENAL DIALYSIS | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BROOKS MEMORIAL HOSPITAL | 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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | 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 |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | HTTP://WWW.CO.CHAUTAUQUA.NY.US/241/PUBLIC-HEALTH | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | 0 | ImplementationStrategyAdoptInd |
| 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 |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| 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 |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| 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 |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | Yes (1) | CollectionActivitiesInd |
| Reporting To Credit Agency | Yes (X) | ReportingToCreditAgencyInd |
| Engaged Legal Judicial Process | Yes (X) | EngagedLegalJudicialProcessInd |
| Other Actions | Yes (X) | OtherActionsInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Medicare Rates | Yes (X) | MedicareRatesInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| BROOKS MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: THE CHNA UTILIZED A THREE PRONGED APPROACH TO GAUGE HEALTH ISSUES, INCLUDING INPUT FROM COMMUNITY MEMBERS, DATA FROM NYSDOH AND OTHER HEALTH RESOURCES, AND INPUT FROM LOCAL CONTENT EXPERTS.COMMUNITY MEMBERS:THE LINK FOR THE SURVEY WAS WIDELY DISTRIBUTED THROUGH FACEBOOK, THE CCDHHS WEBSITE, WAS FEATURED IN A PRESS RELEASE TO LOCAL NEWSPAPERS, AND SENT ELECTRONICALLY TO A NUMBER OF EMPLOYEE AND COMMUNITY-BASED EMAIL DISTRIBUTION LISTS. ALL CCCHPT PARTNERS PARTICIPATED IN ELECTRONIC DISTRIBUTION OF THE SURVEY. THE WEB-BASED FORMAT SUCCESSFULLY REACHED WHITE, MIDDLE CLASS, EMPLOYED, AND INSURED RESIDENTS. PAPER COPIES OF THE SURVEY WERE MADE AVAILABLE THROUGHOUT THE COMMUNITY TO REACH SPECIAL POPULATION GROUPS, WHO WERE LESS LIKELY TO RESPOND TO THE WEB-BASED SURVEY.IN ORDER TO OBTAIN INPUT FROM HARD TO REACH RESIDENTS, THE CCCHPT MADE EFFORTS TO TARGET THE FOLLOWING POPULATION GROUPS:* CHAUTAUQUA COUNTY'S NEW FEDERALLY QUALIFIED HEALTH CENTER - THE CHAUTAUQUA CENTER B33 SERVES A PRIMARILY HISPANIC PATIENT POPULATION. CENTER STAFF ASSISTED PATIENTS IN FILLING OUT THE SURVEYS AND ALSO PROVIDED TRANSLATION SERVICES.* PAPER COPIES OF THE SURVEY WERE PROVIDED TO THE LOCAL AMISH POPULATION AT CANCER SERVICES PROGRAM CLINICS IN SHERMAN AND CLYMER, AND WERE ALSO SHARED BY EMPLOYEES WITH THEIR AMISH FRIENDS.* PAPER COPIES OF THE SURVEY WERE PROVIDED TO INMATES OF THE CHAUTAUQUA COUNTY JAIL TO GAIN INPUT FROM INCARCERATED RESIDENTS. JAIL STAFF ASSISTED IN THIS PROCESS BY ENCOURAGING PARTICIPATION AND PROVIDING ASSISTANCE WHEN NECESSARY.* PAPER COPIES OF THE SURVEY WERE AVAILABLE TO LOW-INCOME RESIDENTS IN CCDHHS TEMPORARY ASSISTANCE OFFICES, THE REPRODUCTIVE HEALTH CLINICS, THE FEDERALLY QUALIFIED HEALTH CENTER, HOSPITAL EMERGENCY ROOMS, AND MENTAL HEALTH CLINICS.COMMUNITY MEMBERS' PERCEPTIONS OF HEALTH ISSUES WERE ALSO GATHERED AT THREE "COMMUNITY CONVERSATIONS" SPONSORED BY THE P2 COLLABORATIVE OF WNY AND THE CHAUTAUQUA COUNTY HEALTH NETWORK. THESE CONVERSATIONS SPANNED CHAUTAUQUA COUNTY'S GEOGRAPHIC AND CULTURAL SEPARATIONS, COVERING THE "NORTH COUNTY" IN DUNKIRK, THE "SOUTH COUNTY" IN JAMESTOWN, AND THE "WEST COUNTY" IN WESTFIELD.EXPERTS CONSULTED:A STAKEHOLDERS MEETING INVOLVED EXPERTS THROUGHOUT THE COUNTY, INCLUDING:BROOKS MEMORIAL HOSPITAL - THERESA SCHRANTZCHAUTAUQUA ALCOHOL AND SUBSTANCE ABUSE COUNCIL - KATHLEEN COLBYCHAUTAUQUA COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES - JULIE APPERSON, ANGELA SWARTZMAN, BREEANNE AGETTCHAUTAUQUA COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES, CANCER SERVICES PROGRAM - DARLENE ROWECHAUTAUQUA COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES, EARLY INTERVENTION PROGRAM - DENISE NICHOLSCHAUTAUQUA COUNTY DEPARTMENT OF MENTAL HYGIENE - BRIANA POST, PAT BRINKMANCHAUTAUQUA COUNTY HEALTH NETWORK - KERRI BROWN, ANN ABDELLA, JANET FORBESCHAUTAUQUA LAKE CHILD CARE CENTER - BETH STARKSCHAUTAUQUA OPPORTUNITIES INC. - TARRA JOHNSON, JEN IRWINDELPHI HEALTH CARE PARTNERS - MELISSA BOCKEASTSIDE YMCA - MAX MARTINJAMESTOWN PSYCHIATRIC - SANDRA DOHLJAMESTOWN TREATMENT COURT, 8TH JUDICIAL DISTRICT - CATHY NEWTONLAKE ERIE REGIONAL HEALTH SYSTEM - SCOTT BUTLER, KIMBERLY MABENP2 OF WNY - MARISSA SLEVARTHE CHAUTAUQUA CENTER - MIKE PEASEWCA HOSPITAL - TONI DEANGELO, LINDA JOHNSON, ANDY O'BRIEN, MARY BOSEKWESTFIELD MEMORIAL HOSPITAL - PATTY BALLMAN, KIM GREINERYMCA OF JAMESTOWN - MEG PICKARD |
| BROOKS MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6A: TLC HEALTH NETWORKWCA HOSPITALWESTFIELD MEMORIAL HOSPITAL |
| BROOKS MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: NEEDS IDENTIFIED:1. PREVENT CHRONIC DISEASE; FOCUS - OBESITY IN ADULTS & CHILDREN.BROOKS MEMORIAL HOSPITAL'S DIETITIAN TAKES REFERRALS FROM PHYSICIANS, PROVIDING A FULL ASSESSMENT AND NUTRITIONAL EDUCATION TO OUTPATIENTS. THE DIETITIAN ALSO ATTENDS LOCAL HEALTH FAIRS AND PROVIDES NUTRITIONAL INFORMATION. THE HOSPITAL'S DIABETIC COUNSELOR FACILITATES A MONTHLY SUPPORT GROUP FOR DIABETICS.2. PROMOTE HEALTH WOMEN, INFANTS & CHILDREN; FOCUS - PRECONCEPTION AND REPRODUCTIVE HEALTH, AND MATERNAL AND INFANT HEALTH.THE BROOKS MEMORIAL HOSPITAL DIRECTOR OF OBSTETRICS CONDUCTS EXPECTANT PARENT CLASSES 4 TIMES A YEAR. SHE IS ALSO A CERTIFIED LACTATION COUNSELOR AND WORKS WITH THE COUNTY TO PROMOTE BREAST FEEDING. THE HOSPITAL HAS WORKED WITH NEW YORK STATE TO ENSURE HEARING SCREENINGS ARE DONE ON NEWBORNS, AND WAS RECOGNIZED FOR THE HIGH COMPLETION PERCENTAGE FOR THESE TESTS.3. PROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSE; FOCUS - STRENGTHEN INFRASTRUCTURE ACROSS SYSTEMS.BROOKS MEMORIAL HOSPITAL HAS WORKED WITH CHAUTAUQUA ALCOHOLISM & SUBSTANCE ABUSE COUNCIL WITH APPLICATION FOR A GRANT TO TREAT SUBSTANCE ABUSE ON MENTAL HEALTH DIAGNOSES SEEN IN THE EMERGENCY ROOM. PATIENTS SEEN IN THE ER RECEIVE REFERRALS FOR FURTHER TREATMENT/COUNSELING. |
| BROOKS MEMORIAL HOSPITAL | PART V, SECTION B, LINE 19D: USE AN EARLY OUT THIRD PARTY TO CONTACT PATIENTS BY TELEPHONE AFTER ACCOUNTS ARE OVER 60 DAYS. ACCOUNTS ARE RETURNED TO THE HOSPITAL FOR DISPOSITION. |
| BROOKS MEMORIAL HOSPITAL | PART V, SECTION B, LINE 22D: THE MAXIMUM AMOUNT A PATIENT WILL BE CHARGED IS DETERMINED BASED ON THE HIGHER OF: MEDICARE RATES, MEDICAID RATES, OR RATES PAID BY THE HIGHEST VOLUME COMMERCIAL PAYOR BASED ON THE TYPE OF SERVICE PROVIDED. |
| BROOKS MEMORIAL HOSPITAL | PART V, SECTION B, LINE 24: PATIENTS WHO DO NOT APPLY FOR FINANCIAL ASSISTANCE OR REQUEST A REDUCTION TO THEIR BILL WILL BE CHARGED THE GROSS CHARGE FOR SERVICES PROVIDED. |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | THE USE OF SIGNIFICANT ASSETS TO BE TAKEN INTO ACCOUNT IN DETERMINING THE AMOUNT A PATIENT WILL PAY FOR MEDICAL SERVICES WILL APPLY ONLY TO THOSE PATIENTS WHOSE INCOME EXCEEDS 150% OF THE FEDERAL POVERTY GUIDELINES. THE NEXT STEP WILL BE TO DETERMINE IF A PATIENT HAS ANY AVAILABLE ASSETS, WHICH CAN BE USED TO SATISFY OUTSTANDING MEDICAL EXPENSES. THOSE TOTAL AVAILABLE ASSETS WILL INCLUDE, BUT NOT BE LIMITED TO, ASSETS IDENTIFIED AS CASH AND THOSE CONVERTIBLE TO CASH AND UNNECESSARY FOR THE PATIENT'S NORMAL LIVING EXPENSES. THE PATIENT'S TOTAL ASSETS TO BE CONSIDERED FOR PAYMENT WILL BE EXPECTED TO BE APPLIED TO THE MEDICAL SERVICES BASED ON THE TABLE THAT FOLLOWS THIS PARAGRAPH. THE REMAINING MEDICAL EXPENSE BALANCE WILL BE DISCOUNTED ACCORDING TO THE PATIENTS ELIGIBILITY DETERMINATION IN SECTION (II). IF THE % OF THE FEDERAL POVERTY INCOME GUIDELINES IS 300% OR LESS THE MAXIMUM AMOUNT OF ASSETS TO BE USED FOR THE PAYMENT OF AN INDIVIDUAL ACCOUNT WILL NOT EXCEED THE "HIGHEST VOLUME PAYOR", AS DEFINED BY NEW YORK STATE NYS PUBLIC HEALTH LAW LAWS OF 2006 CHAPTER 57 SECTION 2807-K SUBDIVISION 9-A, AMOUNT FOR THAT ACCOUNT. ASSETS NOT INCLUDED IN THIS DETERMINATION WILL BE THE: "PATIENT'S" RESIDENCE, ASSETS HELD IN A TAX-DEFERRED OR COMPARABLE RETIREMENT SAVINGS ACCOUNT, COLLEGE SAVINGS ACCOUNTS, OR VEHICLES USED REGULARLY BY A PATIENT OR IMMEDIATE FAMILY MEMBERS. ASSETS NOT UNDER CONSIDERATION AS A SOURCE OF AVAILABLE ASSETS, SUCH AS, THE PRIMARY RESIDENCE ARE SUBJECT TO ANY LEGAL ACTION THAT DOES NOT FORCE THE SALE OR FORECLOSURE OF SUCH PROPERTIES. THE PATIENT'S TOTAL AVAILABLE ASSETS WILL BE REDUCED ACCORDING TO THE NEW YORK STATE ASSET LEVELS TO ARRIVE AT THE TOTAL ASSETS TO BE CONSIDERED.NEW YORK STATE GUIDELINES (THESE LEVELS WILL BE PUBLISHED BY NYS ANNUALLY)HOUSEHOLD SIZE ASSET LEVELS1 $11,6702 $15,7303 $19,7904 $23,8505 $27,9106 $31,9707 $36,0308 $40,0909 $44,15010 $48,210EACH ADDITIONAL PERSON $ 4,060BROOKS MEMORIAL HOSPITALTOTAL ASSETS CONSIDERED EXPECTED % OF ASSETS TO BE USED FOR PAYMENT < $ 1,000 10%$ 1,000 - $ 2,000 15%$ 2,001 - $ 3,000 20%$ 3,000 - $ 5,000 25%$ 5,001 - $ 7,500 30%$ 7,501 - $10,000 40%$10,001 - $25,000 50%$25,001 - NO LIMIT 60%THE MAXIMUM CHARGE AMOUNT AS DESCRIBED ABOVE WILL BE ADJUSTED ACCORDING TO THE FEDERAL POVERTY GUIDELINES INCOME LEVELS AS FOLLOWS:- 0% TO 100% OF THE FPL WILL BE REDUCED TO THE LESSER OF THE "NOMINAL PAYMENT AMOUNT" OR THE MAXIMUM CHARGE AMOUNT.- 101% TO 150% OF THE FPL WILL BE REDUCED ON A SLIDING SCALE NOT TO EXCEED 20% OF THE MAXIMUM CHARGE AMOUNT, BUT NOT LESS THAN THE "NOMINAL PAYMENT AMOUNT" UNLESS THE MAXIMUM CHARGE AMOUNT IS LOWER.- 151% TO 250% OF THE FPL WILL BE REDUCED ON A SLIDING SCALE INCREASING FROM THE 20% TO 100% OF THE MAXIMUM CHARGE AMOUNT, BUT NOT LESS THAN THE "NOMINAL PAYMENT AMOUNT" UNLESS THE MAXIMUM CHARGE AMOUNT IS LOWER.- 251% TO 300% OF THE FPL THE CHARGE WILL BE EQUAL TO THE MAXIMUM CHARGE AMOUNT.- 301% TO UNLIMITED % WILL RESULT IN THE BROOKS MEMORIAL HOSPITAL STANDARD CHARGE AMOUNT FOR THAT SERVICE REDUCED BY 25%, BUT NOT LESS THAN THE MAXIMUM CHARGE AMOUNT FOR THAT TYPE OF SERVICE. |
| PART I, LINE 7: | RCC USED AS CALCULATED IN WORKSHEET 2. |
| PART I, LINE 7G: | RENAL DIALYSIS AND RADIATION THERAPY SERVICES ARE INCLUDED AS SUBSIDIZED HEALTH SERVICES. |
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1,538,866. |
| PART III, LINE 2: | RCC USED AS CALCULATED IN WORKSHEET 2 FOR PART III, LINE 2 TO CALCULATE BAD DEBT COST. PATIENT PAYMENTS AND DISCOUNTS ARE NOT COUNTED TOWARDS BAD DEBT IF POSTED PRIOR TO AN ACCOUNT BEING TRANSFERRED TO BAD DEBT. ONCE IN BAD DEBT, PATIENT PAYMENTS AND DISCOUNTS ARE USED TO REDUCE BAD DEBT. |
| PART III, LINE 3: | THERE WERE NO PATIENTS TURNED OVER TO BAD DEBT WHO QUALIFIED FOR CHARITY CARE. PATIENTS ELIGIBLE FOR CHARITY CARE WHO OWED BALANCES WERE NOT TURNED OVER TO BAD DEBT EVEN THOUGH THEY DID NOT PAY THEIR BALANCES. BAD DEBT SHOULD BE INCLUDED AS A COMMUNITY BENEFIT COSTS AS A HIGH PORTION OF BAD DEBT DERIVES FROM PATIENTS WHO ARE NOT ABLE TO PAY FOR SERVICES AND THE PROVISION OF SUCH SERVICES AT A LOSS CONSTITUTES A FORM OF COMMUNITY BENEFIT. IT IS DIFFICULT FOR A HOSPITAL TO DISTINGUISH THESE PATIENTS WHO FAIL TO RESPOND TO ANY COMMUNICATION AND/OR EFFORT TO DETERMINE ELIGIBILITY FOR CHARITY CARE. |
| PART III, LINE 4: | FOOTNOTE TO AUDITED FINANCIAL STATEMENTS: PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO HAVE FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT 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. |
| PART III, LINE 8: | THE ALLOWABLE MEDICARE COSTS WERE TAKEN DIRECTLY FROM COST REPORT WORKSHEET D. IRS REV. RUL. 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THIS IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT.IN THIS COMMUNITY, MEDICARE IS THE LARGEST PAYER, AND THE HOSPITAL MUST ACCEPT THESE PATIENTS REGARDLESS OF WHETHER THEY MAKE A SURPLUS OR DEFICIT FROM PROVIDING SUCH SERVICES. IF THE MEDICARE PARTICIPATION IS PREMISED ON THIS FACT, THEN PROVIDING MEDICARE SERVICES PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH IS A COMMUNITY BENEFIT.THERE ARE A NUMBER OF LOW-INCOME CONSUMERS RECEIVING MEDICARE.THE ELDERLY ARE OFTEN AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE SERVICES, CMS WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY.MEDICARE PAYMENT ANOMALIES MAY BE PRESENT IN SOME STATES SO EVEN VERY EFFICIENT HOSPITALS ARE UNABLE TO AVOID LOSSES. THUS, LOSSES MAY NOT BE INDICATIVE OF INEFFICIENCY BUT RATHER PROVISION OF A COMMUNITY BENEFIT. |
| PART III, LINE 9B: | A PATIENT WHO IS APPROVED FOR FINANCIAL ASSISTANCE IS ELIGIBLE FOR A PERIOD OF 6 MONTHS FROM THE DATE OF NOTIFICATION. ALL ACCOUNTS FOR THE PATIENT, COVERED BY THE APPLICATION AND DURING THE ELIGIBILITY PERIOD, WILL BE ADJUSTED BASED ON THE LEVEL OF FINANCIAL ASSISTANCE AWARDED. ANY PAYMENTS RECEIVED FROM THE PATIENT ON ACCOUNTS COVERED BY THE APPLICATION OR DURING THE ELIGIBILITY PERIOD WILL BE REFUNDED BASED ON THE LEVEL OF FINANCIAL ASSISTANCE AWARDED. |
| PART VI, LINE 2: | THE HOSPITAL PARTICIPATES WITH OTHER HEALTHCARE PROVIDERS AND INTERESTED PARTIES IN THE CHAUTAUQUA COUNTY COMMUNITY HEALTH PLANNING TEAM (CCCHPT), THE CHAUTAUQUA COUNTY HEALTH NETWORK AND THE CHAUTAUQUA HEALTH ACTION TEAM TO ASSESS THE NEED REGIONALLY. IN 2013 AN EXTENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT WAS PERFORMED. SEE SECTION V, PARTS B AND C FOR ADDITIONAL INFORMATION ON THE CHNA.THE HOSPITAL ALSO UTILIZES PATIENT SATISFACTION SURVEY TOOLS AND LOCAL PUBLIC INFORMATION PERTAINING TO POPULATION CHARACTERISTICS AND HEALTH STATUS. |
| PART VI, LINE 3: | 1. INFORMATION ABOUT THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS PROVIDED UPON ADMISSION, IS POSTED ON THE HOSPITAL WEBSITE, THROUGHOUT THE HOSPITAL, AND PROVIDED THROUGH THE CHAUTAUQUA COUNTY HEALTH NETWORK. STAFF IN THE HOSPITAL HAVE ALSO BEEN IN-SERVICED ABOUT THE FINANCIAL ASSISTANCE PROGRAM SO THAT THEY CAN PROVIDE INFORMATION TO PATIENTS AS WELL.2. BROOKS MEMORIAL HOSPITAL HAS ARRANGED WITH AN AGENCY TO FACILITATE ENROLLING IN THE MEDICAID PROGRAM. THE AGENCY WILL PROVIDE EDUCATION, ASSISTANCE IN COMPLETING THE APPLICATION, AND REPRESENT THE PATIENT AT THE MEDICAID AGENCY. IN ADDITION, THE AGENCY ASSISTS WITH ENROLLMENT THROUGH THE STATE'S INSURANCE EXCHANGE SITE.3. FINANCIAL ASSISTANCE PROGRAM - CONTINUE TO EDUCATE AND PROVIDE FINANCIAL ASSISTANCE OPTIONS FOR THOSE THAT ARE UNINSURED OR UNABLE TO PAY. IN ADDITION TO THE HOSPITAL'S OWN FINANCIAL ASSISTANCE POLICY BROCHURE, BUSINESS OFFICE PERSONNEL WILL CONTINUE TO DISTRIBUTE BROCHURES DEVELOPED BY CCHN TO ASSIST THE UNINSURED OR UNDERINSURED TO FIND AFFORDABLE HEALTHCARE. PATIENT FINANCIAL SERVICES STAFF WILL CONTINUE TO BE EDUCATED REGARDING ALL AVAILABLE ASSISTANCE IN OBTAINING HEALTH INSURANCE. |
| PART VI, LINE 4: | THE HOSPITAL'S PRIMARY SERVICE AREA IS NORTHERN CHAUTAUQUA COUNTY IN NEW YORK AND INCLUDES THE CITY & TOWN OF DUNKIRK, VILLAGES OF FREDONIA, BROCTON, CASSADAGA, FORESTVILLE, AND THE TOWNS OF POMFRET, PORTLAND, STOCKTON, SHERIDAN, AND ARKWRIGHT. THE SECONDARY SERVICE AREA INCLUDES THE TOWNS OF HANOVER, CHERRY CREEK, VILLENOVA AND WESTFIELD. 44% OF THE POPULATION RESIDES IN RURAL AREAS. THE STATE UNIVERSITY OF NEW YORK AT FREDONIA CAMPUS HAS ABOUT 5,000 STUDENTS, INCLUDING SOME INTERNATIONAL STUDENTS.IN THE COUNTY, 16.4% OF THE POPULATION IS 65 AND OLDER, AND WITH THE AVERAGE AGE AT 40.5. 3.6% ARE AFRICAN AMERICAN. THE HISPANIC POPULATION IS 5.9% OF THE TOTAL POPULATION. 7.2% OF THE POPULATION'S PRIMARY LANGUAGE IS NOT ENGLISH. |
| PART VI, LINE 5: | THE BOARD OF TRUSTEES IS A COMMUNITY BOARD, MADE UP ENTIRELY OF CIVIC AND COMMUNITY LEADERS, WHO SERVE VOLUNTARILY. THE BOARD APPOINTS THE CEO, APPROVES BUDGETS, DEVELOPS STRATEGIC PLANS AND PROVIDES OVERSIGHT FOR THE HOSPITAL IN GENERAL. POTENTIAL CONFLICT OF INTEREST BETWEEN BOARD MEMBERS AND THE HOSPITAL ARE REVIEWED ANNUALLY.THE HOSPITAL'S MEDICAL STAFF IS COMPRISED OF QUALIFIED PHYSICIANS FROM WITHIN THE COMMUNITY. THE HOSPITAL CONTRACTS DIRECTLY ONLY FOR EMERGENCY ROOM PHYSICIANS AND A PATHOLOGIST BUT DOES NOT EMPLOY ANY PHYSICIANS.THE HOSPITAL OPERATES A FULL-TIME EMERGENCY ROOM OPEN TO ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. PATIENTS COME TO THE EMERGENCY ROOM BY THEIR OWN TRANSPORTATION OR BY AMBULANCE FROM EITHER A LOCAL FIRE DEPARTMENT OR AN INDEPENDENT AMBULANCE BUSINESS THAT SERVES THE ENTIRE COUNTY. IN ORDER TO ENSURE 24 HOUR PHYSICIAN COVERAGE IN THE ER, THE HOSPITAL PROVIDES A SUBSIDY TO THE ER PHYSICIAN GROUP. NON EMERGENCY CARE IS PROVIDED BASED UPON PHYSICIAN ORDERS TO ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY.SURPLUS FUNDS ARE INVESTED IN MEDICAL EQUIPMENT UPGRADES AND NEW TECHNOLOGIES THROUGH A CAPITAL BUDGET PROCESS. THERE ARE NO "OWNERS" OR STOCKHOLDERS SO NO SURPLUS FUNDS ARE PAID OUT TO OWNERS OR STOCKHOLDERS.THE HOSPITAL WORKS TO ENSURE AN ADEQUATE BLOOD SUPPLY IN THE COMMUNITY AND SURROUNDING AREAS BY HOSTING MONTHLY BLOOD DRIVES IN COOPERATION WITH THE COMMUNITY BLOOD BANK.SOME YEARS AGO THE HOSPITAL IDENTIFIED THE NEED FOR DIALYSIS IN THE COMMUNITY. IN 2009 THE HOSPITAL REPLACED THE EXISTING 10 STATIONS AND ADDED 4 ADDITIONAL STATIONS AS THE TARGETED POPULATION CONTINUES TO GROW. THIS SERVICE OPERATES AT A LOSS, YET THE HOSPITAL CONTINUES TO PROVIDE THIS SERVICE. THE HOSPITAL STRIVES TO IMPROVE THE QUALITY OF PATIENT CARE BY A VARIETY OF ACCREDITATIONS, SURVEYS AND BENCHMARKS INCLUDING:THE HOSPITAL IS ACCREDITED THROUGH DNV, THE AMERICAN COLLEGE OF RADIOLOGY FOR MAMMOGRAPHY, MRI, CT SCAN, NUCLEAR MEDICINE AND ULTRASOUND, AND THE AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION FOR THE CARDIAC REHABILITATION DEPARTMENT. IN 2014, THE HOSPITAL RECEIVED ACCREDITATION FOR THE SLEEP LAB. THE HOSPITAL TAKES A PROACTIVE APPROACH TO THE PREVENTION OF HOSPITAL-ACQUIRED INFECTIONS, INCLUDING:- INSTITUTION WIDE PROGRAM TO PROMOTE EFFECTIVE HAND WASHING- INSTITUTION WIDE PROGRAM TO REDUCE CATHETER RELATED URINARY TRACT INFECTIONS- INSTITUTION WIDE PROGRAM TO REDUCE CENTRAL LINE INFECTIONS- INSTITUTION WIDE PROGRAM TO REDUCE VENTILATOR-ASSOCIATED INFECTIONS. THE HOSPITAL MEETS OR EXCEEDS NATIONAL AND STATE BENCHMARKS FOR THE USE OF ANTIBIOTICS RELATED TO SURGERY.THE HOSPITAL EXCEEDS NATIONAL AND STATE BENCHMARKS FOR THE PREVENTION OF BLOOD CLOTS AFTER SURGERY.THE HOSPITAL UTILIZES BAR CODE MEDICATION ADMINISTRATION TO REDUCE/ELIMINATE MEDICATION ERRORS.THE HOSPITAL USES PATIENT SURVEYS THROUGH BOTH PRESS GANEY AND HCAHPS. AREAS THAT MEASURED BELOW AVERAGE ARE REVIEWED WEEKLY AND BEING ADDRESSED THROUGH:- PRE-OPERATIVE JOINT EDUCATION CLASSES- SURGICAL AMBASSADOR PROGRAM- POST DISCHARGE CALLS TO ASSURE PATIENTS UNDERSTAND THEIR MEDICATION INSTRUCTIONS |
| PART VI, LINE 7, REPORTS FILED WITH STATES | NY |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | 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 (4 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JEFFREY MORGAN | ||||||||||||||
| VP FINANCE/CFO | $224,438 | $0 | $0 | $0 | $24,096 | $0 | $911 | $0 | $6,259 | $0 | $255,704 | $0 | $0 | $0 |
| A JACK DAVIS | ||||||||||||||
| VP ADMINISTRATIVE SERVICES | $144,997 | $0 | $0 | $0 | $867 | $0 | $6,171 | $0 | $797 | $0 | $152,832 | $0 | $0 | $0 |
| JARROD JOHNSON | ||||||||||||||
| COO | $171,021 | $0 | $0 | $0 | $261 | $0 | $8,982 | $0 | $22,294 | $0 | $202,558 | $0 | $0 | $0 |
| JONATHAN LAWRENCE | ||||||||||||||
| FORMER CEO | $161,795 | $166,679 | $0 | $0 | $2,660 | $2,660 | $8,750 | $8,750 | $11,131 | $6,247 | $184,336 | $184,336 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4A | FormAndLineReferenceDesc |
| Explanation | SEVERANCE PAYMENTS TO JONATHAN LAWRENCE TOTALED $333,357 IN 2014. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART III, LINE I | MISSION TO SERVE OUR COMMUNITIES BY PROVIDING ACCESS TO HIGH QUALITY PERSONALIZED HEALTHCARE VISION OUR VISION IS TO BE A MODEL HEALTH CENTER BY CONTINUALLY LEARNING AND PROVIDING EXTRAORDINARY CARE IN ALL ITS DIMENSIONS: CLINICAL EXCELLENCE: WE WILL DELIVER THE BEST CLINICAL CARE IN A CONSISTENT, INTEGRATED WAY. PATIENT ENGAGEMENT: WE WILL PROVIDE A COMPASSIONATE HEALING EXPERIENCE, AND WE WILL ENGAGE PATIENTS IN DECISIONS ABOUT THEIR HEALTH AND CARE. OPERATIONAL EFFECTIVENESS: WE WILL BE WISE AND CAREFUL STEWARDS OF OUR RESOURCES TO ENABLE EXTRAORDINARY CARE. PHYSICIAN ENGAGEMENT: WE WILL CREATE SYSTEMS AND PROCESSES THAT HELP OUR PHYSICIANS BEST SERVE THEIR PATIENTS. COMMUNITY STEWARDSHIP: WE ARE COMMITTED TO SERVING THE DIVERSE NEEDS OF THE REGION, AND TO PROVIDE GENERALLY AVAILABLE MEDICAL SERVICES TO ALL RESIDENTS, REGARDLESS OF ABILITY TO PAY. EMPLOYEE ENGAGEMENT: WE VALUE OUR EMPLOYEES AS OUR MOST IMPORTANT RESOURCE. VALUES - I CARE INTEGRITY OUR ACTIONS ARE GUIDED BY OUR ETHICAL COMMITMENTS - IN PUBLIC INTERACTIONS AND PRIVATE ACTIONS, WE DEDICATE OURSELVES TO SERVICE IN THE BEST INTERESTS OF OUR PATIENTS, THEIR FAMILIES, OUR HOSPITAL AND OUR COMMUNITY. - WE FOLLOW THROUGH ON OUR COMMITMENTS, HOLDING OURSELVES ACCOUNTABLE TO FULFILL OUR PROFESSIONAL OBLIGATIONS. - WHEN WE RECOGNIZE SOMETHING SEEMS WRONG, INAPPROPRIATE OR INCONSISTENT WITH OUR VALUES OR STANDARDS, WE PROACTIVELY SPEAK UP AND TAKE POSITIVE ACTION. - WE ACT WITH OPENNESS, HONESTY, TRANSPARENCY AND TRUSTWORTHINESS IN OUR COMMUNICATION. -AT ALL TIMES WE RESPECT THE DIGNITY, PRIVACY AND CONFIDENTIALITY OF THOSE WE SERVE. COMPASSION WE PROVIDE EXCELLENCE WITH PERSONAL KINDNESS - WITH UNDERSTANDING AND EMPATHY, WE ANTICIPATE THE NEEDS OF OTHERS AND ACT TO APPROPRIATELY AND MEANINGFULLY MEET THESE NEEDS. - BY ACTIVELY LISTENING TO THE PERSPECTIVES, VALUES AND NEEDS OF OTHERS, WE ACT TO BUILD BRIDGES TOWARD WHOLENESS. - OUR INTERACTIONS ARE CHARACTERIZED BY RESPECT, COURTESY, WARMTH AND PROFESSIONAL DIGNITY. - WE MAINTAIN AN ENGAGED, FOCUSED AND PERSONAL PRESENCE WHILE IN SERVICE TO OTHERS, CREATING AND SUSTAINING A THERAPEUTIC MILIEU ACCOUNTABILITY WE TAKE RESPONSIBILITY FOR PERSONAL AND TEAM ACTIONS - WE FULLY ADOPT AND EMBRACE OUR CORE PROFESSIONAL IDENTITY AS THOSE WHOSE TALENTS ARE PLACED IN THE SERVICE OF OTHERS FOR THEIR BENEFIT. - IN ALL OUR INTERACTIONS WE DEMONSTRATE THE HIGHEST PROFESSIONAL STANDARDS OF ETHICS, KNOWLEDGE, SKILL AND COMPETENCE IN DECISION-MAKING AND WORK PERFORMANCE. - IN OUR APPEARANCE, DEMEANOR AND DEPORTMENT WE CONTINUOUSLY SEEK TO CONVEY A PROFESSIONAL IMAGE. - WE APPROACH CHALLENGES IN A MANNER THAT REFLECTS PROFESSIONAL MATURITY, CONFIDENCE AND RESPECT. RESPECT WE ADVOCATE FOR THE DIGNITY OF OTHERS - IN OUR BEHAVIOR TOWARD OTHERS, WE DEMONSTRATE RESPECT FOR THE PERSONAL AUTONOMY, INTRINSIC DIGNITY AND WORTH, AND INDIVIDUAL UNIQUENESS OF EACH PERSON WE SERVE, AND THOSE WITH WHOM WE SERVE. - WE VALUE THE RICH DIVERSITY OF PERSONAL EXPERIENCE, CULTURAL INSIGHT, PROFESSIONAL IDENTITY AND TRAINING IN ACHIEVING COLLABORATIVE GOALS. - WE DEMONSTRATE OUR CONSIDERATION FOR OTHERS BY REGARDING WITH EMPATHY THE FEELINGS AND NEEDS OF OTHERS, AND REGARDING WITH INSIGHT THE EFFECT ON OTHERS OF OUR OWN BEHAVIOR. - WE ACTIVELY SEEK OUT OPPORTUNITIES TO DEMONSTRATE OUR REGARD AND APPRECIATION FOR OTHERS. EXCELLENCE - WE CONTINUOUSLY CHALLENGE THE STATUS QUO IN THE RELENTLESS PURSUIT OF EXCELLENCE. - WE UTILIZE QUANTITATIVE AND QUALITATIVE INFORMATION TO FORM THE BASIS FOR MEASURABLE AND DEMONSTRABLE IMPROVEMENTS IN OUTCOMES. - EACH OF US DEMONSTRATES A PERSONAL COMMITMENT TO THE HIGHEST STANDARDS OF SAFETY, QUALITY AND SERVICE. - INDIVIDUALLY, AND AS HIGH PERFORMING TEAMS, WE CONSCIENTIOUSLY WORK TO BETTER OUR BEST ON A DAILY BASIS. - WE ACTIVELY EMBRACE CHANGE IN THE CONTINUOUS PURSUIT OF INNOVATION AND SUPERIOR CARE. |
| FORM 990, PART VI, SECTION A, LINE 6 | LAKE ERIE REGIONAL HEALTH SYSTEM OF NEW YORK IS THE SOLE CORPORATE MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL OF BOARD MEMBERS. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE 990 IS PREPARED AND REVIEWED BY VARIOUS INDIVIDUALS WITHIN MANAGEMENT AND PROVIDED TO THE GOVERNING BODY PREVIOUS TO ITS FILING WHEN TIME ALLOWS OR AT ITS NEXT MEETING WHEN TIME DOES NOT PERMIT REVIEW PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | DEPARTMENT MANAGERS, ADMINISTRATION, BOARD MEMBERS, AND MATERIAL MANAGEMENT EMPLOYEES SIGN A CONFLICT OF INTEREST STATEMENT ON AN ANNUAL BASIS. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE PRESIDENT/CEO'S COMPENSATION IS REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD. WAGES AND INCREASES ARE COMPARED TO INDUSTRY STANDARDS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC ON THE HOSPITAL WEBSITE (WWW.BROOKSMEMORIAL.ORG) AND CERTAIN DOCUMENTS ARE AVAILABLE AT THE HOSPITAL AND AT PHYSICIANS' OFFICES. |
| FORM 990, PART XI, LINE 9: | NET CHANGE IN FUNDS HELD IN TRUST 59,794. PENSION LIABILITY ADJUSTMENT 1,488,796. CONTRIBUTIONS TO AFFILIATES - ESTIMATED ADVANCES ALLOWANCES -1,666,472. |
| FORM 990, PART XII, LINE 2C: | THE BOARD OF TRUSTEES ASSUME RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| TLC HEALTH NETWORK | ||||||||||
| 12644 SENECA ROAD | IRVING | NY | 140819716 | 160772474 | HOSPITAL | NY | 501(C)(3) | LINE 3 | N/A | 0 |
| LAKE ERIE REGIONAL HEALTH SYSTEM OF NEW YORK | ||||||||||
| 529 CENTRAL AVENUE | DUNKIRK | NY | 14048 | 262778107 | SOLE MEMBER OF HOSPITAL | NY | 501(C)(3) | LINE 11C, III-FI | N/A | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKE ERIE MEDICAL SERVICES PC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 529 CENTRAL AVENUE | AddressLine1Txt |
| City | DUNKIRK | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14048 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 452832259 | EIN |
| Primary Activities | PHYSICIAN GROUP | PrimaryActivitiesTxt |
| Legal Domicile State | NY | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKE ERIE REGIONAL HEALTH SYSTEM OF NEW YORK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| 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 | Yes (1) | 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 | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |