CHENANGO MEMORIAL HOSPITAL INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CHENANGO MEMORIAL HOSPITAL INC (EIN 15-0532180)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-12
- IRS object ID
- 201313169349304801
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-12T14:16:21-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 161226221 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FUST CHARLES CHAMBERS LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5784 WIDEWATERS PARKWAY | AddressLine1 |
| City | SYRACUSE | City |
| State | NY | State |
| ZIP Code | 13214 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 150532180 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHENANGO MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CHEN | NameControl |
| Phone | 6073374111 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 179 NORTH BROAD STREET | AddressLine1 |
| City | NORWICH | City |
| State | NY | State |
| ZIP Code | 13815 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DRAKE LAMEN MD | Name |
| Title | PRESIDENT/CEO | Title |
| Phone | 6073374111 | Phone |
| Date Signed | 2013-11-12 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ANGELA M FRANCO | Name |
| PTIN | P00589741 | PTIN |
| Phone | 3154463600 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DRAKE LAMEN MD | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 179 NORTH BROAD STREET | AddressLine1 |
| City | NORWICH | City |
| State | NY | State |
| ZIP Code | 13815 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 69862113 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.UHS.NET/CMH | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1910 | YearFormation |
| State Legal Domicile | NY | StateLegalDomicile |
| Activity Or Mission Description | CHENANGO MEMORIAL HOSPITAL, INC. (THE HOSPITAL) IS A NOT-FOR-PROFIT CORPORATION ORGANIZED TO OPERATE ACUTE AND SKILLED NURSING FACILITIES IN NORWICH, NEW YORK. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR RESIDENTS OF CHENANGO COUNTY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 15 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 635 | TotalNbrEmployees |
| Total Nbr Volunteers | 102 | TotalNbrVolunteers |
| Total Gross UBI | 51000 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -49591 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1117338 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 905361 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 63938784 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 67702540 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 308094 | InvestmentIncomePriorYear |
| Investment Income Current Year | 334261 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 406955 | OtherRevenuePriorYear |
| Other Revenue Current Year | 918747 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 65771171 | TotalRevenuePriorYear |
| Total Revenue Current Year | 69860909 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 55362 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 54180 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 33932059 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 34655854 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 29950985 | OtherExpensePriorYear |
| Other Expenses Current Year | 32874534 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 63938406 | TotalExpensesPriorYear |
| Total Expenses Current Year | 67584568 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1832765 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2276341 | RevenuesLessExpensesCY |
| Total Assets BOY | 33030740 | TotalAssetsBOY |
| Total Assets EOY | 34995961 | TotalAssetsEOY |
| Total Liabilities BOY | 35146459 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 32005060 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -2115719 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 2990901 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | CHENANGO MEMORIAL HOSPITAL, INC. (THE HOSPITAL) IS A NOT-FOR-PROFIT CORPORATION ORGANIZED TO OPERATE ACUTE AND SKILLED NURSING FACILITIES IN NORWICH, NEW YORK. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR RESIDENTS OF CHENANGO COUNTY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 22050193 | Expense |
| Revenue | 21090815 | Revenue |
| Description | INPATIENT, ACUTE AND LONG TERM SKILLED NURSING SERVICES- CHENANGO MEMORIAL HOSPITAL FULFILLS ITS MISSION BY WORKING TOGETHER WITH THE COMMUNITY, PHYSICIANS AND OTHER HEALTH CARE PROVIDERS TO CONTINUOUSLY IMPROVE THE AVAILABILITY AND QUALITY OF SERVICES AND THE ABILITY TO PROVIDE A COMPREHENSIVE RANGE OF SHORT-TERM INPATIENT ACUTE SERVICES AND LONG-TERM SKILLED NURSING CARE. CHENANGO MEMORIAL HOSPITAL PROVIDES A WIDE RANGE OF MEDICAL-SURGICAL SERVICES, INCLUDING: OPHTHALMOLOGY, EMERGENCY MEDICINE, MATERNITY CARE, PULMONARY MEDICINE, AND PEDIATRICS. TOTAL INPATIENT DAYS FOR THE YEAR ENDED DECEMBER 31, 2012 TOTALED 7,781. DISCHARGES WERE 2,085, AND AVERAGE LENGTH OF STAY WAS 3.73 DAYS. LONG TERM SKILLED NURSING DAYS WERE 26,674. THERE WERE 310 BIRTHS AND 369 INPATIENT SURGERIES PERFORMED AT CHENANGO MEMORIAL HOSPITAL IN 2012. IN 2012, CHENANGO MEMORIAL HOSPITAL GAVE FINANCIAL ASSISTANCE TO 54 INDIVIDUALS FOR WHICH $593,727 OF INPATIENT CARE (AT CHARGES) WAS PROVIDED. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 22477899 | Expense |
| Revenue | 37954641 | Revenue |
| Description | OUTPATIENT AND AMBULATORY SERVICES- CHENANGO MEMORIAL HOSPITAL ALSO PROVIDES A WIDE RANGE OF OUTPATIENT DIAGNOSTIC AND TREATMENT SERVICES, INCLUDING EMERGENCY DEPARTMENT, AMBULATORY SURGERY, FULL-SERVICE LABORATORY, COMPREHENSIVE IMAGING AND OTHER PROCEDURAL OUTPATIENT SERVICES. TOTAL PATIENT VISITS FOR OUTPATIENT SERVICES FOR YEAR-ENDED 2012 TOTALED 158,979. INCLUDED IN THE 158,979 VISITS WERE 14,957 EMERGENCY ROOM VISITS, 1,226 EMERGENCY ROOM TREATED AND ADMITTED AS ACUTE CARE PATIENTS, 2,543 VARIOUS OUTPATIENT SURGICAL CASES, AND 140,253 OTHER OUTPATIENT DEPARTMENT VISITS. IN 2012 CHENANGO MEMORIAL HOSPITAL GAVE FINANCIAL ASSISTANCE TO 542 INDIVIDUALS FOR WHICH $1,218,775 OF OUTPATIENT CARE (AT CHARGES) WAS PROVIDED. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 17326335 | Expense |
| Revenue | 8657084 | Revenue |
| Description | CLINICS- CHENANGO MEMORIAL HOSPITAL PROVIDES A WIDE RANGE OF PRIMARY CARE AND SPECIALTY CARE CLINICS. PRIMARY CARE SERVICES ARE THE FOUNDATION FOR SERVING THE COMMUNITY WITH A COORDINATED SYSTEM OF CARE, WITH SPECIAL ATTENTION TO UNDER-SERVED AREAS. CMH OFFERS SIX FAMILY HEALTH CENTERS LOCATED THROUGHOUT A MULTI-COUNTY SERVICE AREA: 1) NORWICH FAMILY HEALTH CENTER 2) INTERNAL MEDICINE 3) OXFORD FAMILY HEALTH CENTER 4) SHERBURNE FAMILY HEALTH CENTER 5) SIDNEY FAMILY HEALTH CENTER AND 6) WALK-IN CENTER. OTHER OUTPATIENT SERVICES INCLUDE: DENTAL CLINIC, GERIATRICS, WOMEN'S HEALTH CENTER AND GENERAL SURGERY, ENT AND HEART CENTER. TOTAL PATIENT VISITS FOR THE CMH CLINICS AT YEAR-ENDED 2012 TOTALED 80,453. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grants | 54180 | Grants |
| Revenue | 867747 | Revenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Grnt | 54180 | TotalOfOtherProgramServiceGrnt |
| Total Of Other Program Service Rev | 867747 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 61854427 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 78 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 635 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Form8899 Filed | 0 | Form8899Filed |
| Form1098 C Filed | 0 | Form1098CFiled |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 15 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NY | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DRAKE LAMEN MD | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6073374111 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 179 NORTH BROAD ST | AddressLine1 |
| City | NORWICH | City |
| State | NY | State |
| ZIP Code | 13815 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (29 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| DRAKE LAMEN MD | ||||||||
| PRESIDENT/CEO | 55.00 | X | X | 287257 | 0 | 44593 | ||
| HOWARD L ATKINSON | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| THOMAS C EMERSON | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| ROBERT W NASSAR | ||||||||
| CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 | ||
| MATTHEW J SALANGER | ||||||||
| 2ND VICE CHAIRMAN | 1.00 | X | X | 0 | 1284770 | 38034 | ||
| ERIC G LARSEN | ||||||||
| 1ST VICE CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 | ||
| RAJESH DAVE MD | ||||||||
| TRUSTEE | 1.00 | X | 0 | 573938 | 33045 | |||
| JOHN M KWASNIK | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| MARILYN M QUINNEY | ||||||||
| PRESIDENT- AUXILLARY | 1.00 | X | X | 0 | 0 | 0 | ||
| AARON J VALENTINE | ||||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | ||
| KEVIN B DECKER DDS | ||||||||
| PRES OF MEDICAL STAFF | 55.00 | X | X | 190008 | 0 | 40569 | ||
| JOANNE RACE BORFITZ | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| ROBERT G GOMULKA | ||||||||
| TRUSTEE | 1.00 | X | 0 | 460103 | 32888 | |||
| CATHERINE M SCARLETT | ||||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 | ||
| RIC FESTARINI | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| CYNTHIA BRIGLIN-MAVADY MD | ||||||||
| VP OF MEDICAL STAFF | 1.00 | X | X | 0 | 0 | 0 | ||
| MARGARET SWARTWOOD | ||||||||
| CONTROLLER | 55.00 | X | 121843 | 0 | 27035 | |||
| RON CEROW | ||||||||
| ADMINISTRATOR | 55.00 | X | 115413 | 0 | 30928 | |||
| ANNE ENGLISH | ||||||||
| DIRECTOR OF HUMAN RESOURCE | 55.00 | X | 105318 | 0 | 20961 | |||
| DRU CAVANAGH | ||||||||
| VP OF PATIENT CARE SERVICE | 33.00 | X | 88718 | 66621 | 31657 | 22.00 | ||
| WENDY SURDOVAL | ||||||||
| VP OF QUALITY MGMT | 55.00 | X | 104688 | 0 | 25258 | |||
| MICHAEL TREVISANI | ||||||||
| VP MEDICAL AFFAIRS | 55.00 | X | 276173 | 0 | 49238 | |||
| CHRISTINA KISACKY | ||||||||
| VP OF OPERATIONS | 55.00 | X | 144532 | 0 | 35209 | |||
| ROBERT MCCARTHY | ||||||||
| VP OF SYSTEM FINANCIAL OPERATIONS | 27.50 | X | 82970 | 82970 | 20244 | 27.50 | ||
| CHUNJIE YANG MD | ||||||||
| PHYSICIAN | 55.00 | 300019 | 0 | 49076 | X | |||
| EMMANUEL M GUIZANO MD | ||||||||
| PHYSICIAN | 55.00 | 283736 | 0 | 32448 | X | |||
| TIMOTHY COREY MD | ||||||||
| PHYSICIAN | 55.00 | 299998 | 0 | 49778 | X | |||
| FRANK C COLE III MD | ||||||||
| PHYSICIAN | 55.00 | 293180 | 0 | 44033 | X | |||
| JAMES O'BRIEN MD | ||||||||
| PHYSICIAN | 55.00 | 350002 | 0 | 49843 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3043855 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2468402 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 654837 | TotalOtherCompensation |
| Number Individuals GT100 K | 37 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| DELF KING MD PC | |||||
| PO BOX 819 | NORWICH | NY | 13815 | ANESTHESIA SVCS | 1637999 |
| MORRISON MANAGEMENT | |||||
| PO BOX 102289 | ATLANTA | GA | 30368 | THERAPY SVCS | 1560663 |
| CROTHALL | |||||
| BANC OF AMERICA LOCKBOX SVCS | CHICAGO | IL | 60693 | HOUSEKEEPING SVCS | 1074826 |
| VJC MEDICAL | |||||
| PO BOX 568 | FRISCO | TX | 75034 | PHYSICIAN TEMPORARY SERVICES | 681044 |
| SECO PHYSICAL AND OCCUPATIONAL THERAPY | |||||
| PO BOX 1046 | NORWICH | NY | 13815 | THERAPY SVCS | 610041 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 14 | NumberOfContractorsGT100K |
| Membership Dues | 2890 | MembershipDues |
| Fundraising Events | 6647 | FundraisingEvents |
| Government Grants | 284549 | GovernmentGrants |
| All Other Contributions | 611275 | AllOtherContributions |
| Total Contributions | 905361 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| OUTPATIENT AND AMBULATORY SERVICE | 623000 | 37954641 | 37954641 |
| INPATIENT, ACUTE AND LONG TERM SK | 623000 | 21090815 | 21090815 |
| CLINICS | 623000 | 8657084 | 8657084 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 67702540 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 334261 | TotalRevenueColumn |
| Exclusion | $334,261 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 1204 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 6647 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 1204 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| MEANINGFUL USE FUNDS | 623000 | 413511 | 413511 |
| OTHER OPERATING REVENUE | 623000 | 233269 | 233269 |
| CAFETERIA REVENUE | 623000 | 220967 | 220967 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 51000 | TotalRevenueColumn |
| Unrelated Business Revenue | 51000 | UnrelatedBusinessRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 918747 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 69860909 | TotalRevenueColumn |
| Related Or Exempt Function Income | 68570287 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 51000 | UnrelatedBusinessRevenue |
| Exclusion | $334,261 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 54000 | Total |
| Program Services | 54000 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 180 | Total |
| Program Services | 180 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1806020 | Total |
| Program Services | 1806020 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24382724 | Total |
| Program Services | 21964251 | ProgramServices |
| Management And General | 2418473 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2845777 | Total |
| Program Services | 2561199 | ProgramServices |
| Management And General | 284578 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3816132 | Total |
| Program Services | 3434519 | ProgramServices |
| Management And General | 381613 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1805201 | Total |
| Program Services | 1624681 | ProgramServices |
| Management And General | 180520 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 824552 | Total |
| Management And General | 824552 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16618 | Total |
| Management And General | 16618 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 97045 | Total |
| Management And General | 97045 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12676 | Total |
| Management And General | 12676 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4374130 | Total |
| Program Services | 4374130 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8777 | Total |
| Management And General | 8777 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 580913 | Total |
| Program Services | 453750 | ProgramServices |
| Management And General | 127163 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 205541 | Total |
| Program Services | 198591 | ProgramServices |
| Management And General | 6950 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1106451 | Total |
| Program Services | 998743 | ProgramServices |
| Management And General | 107708 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 89537 | Total |
| Program Services | 45955 | ProgramServices |
| Management And General | 43582 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 269881 | Total |
| Program Services | 269881 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2193705 | Total |
| Program Services | 2193705 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 864381 | Total |
| Program Services | 864381 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| SUPPLIES | 13975370 | 13014852 | 960518 |
| BAD DEBTS | 4932514 | 4932514 | |
| NEW YORK STATE CASH REC | 612857 | 612857 | |
| MISCELLANEOUS AUXILLARY | 15517 | 15517 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2694069 | Total |
| Program Services | 2434701 | ProgramServices |
| Management And General | 259368 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 67584568 | Total |
| Program Services | 61854427 | ProgramServices |
| Management And General | 5730141 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2071741 | BOY |
| EOY | 2880354 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6550427 | BOY |
| EOY | 6688137 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9125402 | BOY |
| EOY | 9338480 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 383401 | BOY |
| EOY | 393220 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 513496 | BOY |
| EOY | 554482 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 52567627 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 41179538 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11355636 | BOY |
| EOY | 11388089 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 94312 | BOY |
| EOY | 95697 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2936325 | BOY |
| EOY | 3657502 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33030740 | BOY |
| EOY | 34995961 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6135094 | BOY |
| EOY | 6024456 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4057531 | BOY |
| EOY | 3659706 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24953834 | BOY |
| EOY | 22320898 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 35146459 | BOY |
| EOY | 32005060 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -8953715 | BOY |
| EOY | -4191967 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 386275 | BOY |
| EOY | 741074 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6451721 | BOY |
| EOY | 6441794 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -2115719 | BOY |
| EOY | 2990901 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33030740 | BOY |
| EOY | 34995961 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2276341 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 1385 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 2828894 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Both | X | FinancialStatementBoth |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $12,676 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 12676 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | DUES PAID TO HEALTHCARE ASSOCIATION OF NYS AND IROQUOIS HEALTHCARE | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 6837996 | BeginningOfYearBalance |
| Contributions | 894949 | Contributions |
| Investment Earnings Or Losses | 2755 | InvestmentEarningsOrLosses |
| Other Expenditures | 552832 | OtherExpenditures |
| End Of Year Balance | 7182868 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 6912990 | BeginningOfYearBalance |
| Contributions | 1097217 | Contributions |
| Investment Earnings Or Losses | -24876 | InvestmentEarningsOrLosses |
| Other Expenditures | 1147335 | OtherExpenditures |
| End Of Year Balance | 6837996 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 6555026 | BeginningOfYearBalance |
| Contributions | 885911 | Contributions |
| Investment Earnings Or Losses | 177728 | InvestmentEarningsOrLosses |
| Other Expenditures | 705675 | OtherExpenditures |
| End Of Year Balance | 6912990 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 5781660 | BeginningOfYearBalance |
| Contributions | 1128222 | Contributions |
| Investment Earnings Or Losses | 646828 | InvestmentEarningsOrLosses |
| Other Expenditures | 1001684 | OtherExpenditures |
| End Of Year Balance | 6555026 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 7180804 | BeginningOfYearBalance |
| Contributions | 1315814 | Contributions |
| Investment Earnings Or Losses | -1251758 | InvestmentEarningsOrLosses |
| Other Expenditures | 1463200 | OtherExpenditures |
| End Of Year Balance | 5781660 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 0.89680 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.10320 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 1 | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | 1 | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 167753 | OtherCostOrOtherBasis |
| Book Value | 167753 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 23089070 | OtherCostOrOtherBasis |
| Depreciation | 17030091 | Depreciation |
| Book Value | 6058979 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1349570 | OtherCostOrOtherBasis |
| Depreciation | 1052482 | Depreciation |
| Book Value | 297088 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 25391576 | OtherCostOrOtherBasis |
| Depreciation | 22163630 | Depreciation |
| Book Value | 3227946 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2569658 | OtherCostOrOtherBasis |
| Depreciation | 933335 | Depreciation |
| Book Value | 1636323 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 11388089 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| INTEREST IN CMH FOUNDATION | 2563328 |
| ASSETS LIMITED TO USE- RESTRICTED CASH FOR EQUIPMENT | 687242 |
| OTHER ASSETS | 406932 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 3657502 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (5 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO THIRD-PARTY PAYORS | $4,931,661 |
| DUE TO AFFILIATES | $715,873 |
| LONG TERM PENSION LIABILITY | $14,429,420 |
| CAPITAL LEASE OBLIGATIONS | $561,389 |
| OTHER LIABILITIES | $1,682,555 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 22320898 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 69818661 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 69818661 | RevenueSubtotal |
| Other Revenues Not Included | 42248 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 42248 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 69860909 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 67513924 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 67513924 | ExpensesSubtotal |
| Other Expenses Not Included | 70644 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 70644 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 67584568 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | THE INTENDED USE OF ENDOWMENT FUNDS IS A COMBINATION OF DESIGNATED SPECIAL PURPOSES AND GENERAL USE BY THE HOSPITAL. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X, LINE 2: | THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE HOSPITAL IS SUBJECT TO FEDERAL INCOME TAXES ON UNRELATED BUSINESS INCOME UNDER SECTION 511 OF THE INTERNAL REVENUE CODE. AS OF DECEMBER 31, 2012 AND 2011, THE HOSPITAL DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN FOR EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES ARE 2009 THROUGH 2012. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | AUXILIARY INCOME 42,248. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | AUXILIARY EXPENSES 70,644. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 681655 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 269289 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 412366 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00660 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 11069705 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8557930 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2511775 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04010 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 365090 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 323464 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 41626 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 12116450 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9150683 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2965767 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04740 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 12116450 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9150683 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2965767 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04740 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 8375 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 8375 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 17378 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 17378 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 2987 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 2987 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 5100 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 5100 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 33840 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 33840 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $1,874,355 | BadDebtExpenseAmount |
| Amount Attributable To | 935974 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 14053609 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 17428946 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -3375337 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 0 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHENANGO MEMORIAL HOSPITAL INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 179 NORTH BROAD STREET | AddressLine1 |
| City | NORWICH | City |
| State | NY | State |
| ZIP Code | 13815 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHENANGO MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| Explains Basis | 0 | ExplainsBasis |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 8 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (8 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType | Address Line2Address/AddressLine2 |
|---|---|---|---|---|---|
| CMH FAMILY HEALTH CENTER IN NORWICH | |||||
| 4 NEWTON AVENUE | NORWICH | NY | 13815 | FAMILY HEALTH CENTER | |
| CMH FAMILY HEALTH CENTER IN SHERBURNE | |||||
| 38A CLASSIC STREET | SHERBURNE | NY | 13460 | FAMILY HEALTH CENTER | |
| CMH DENTAL CENTER | |||||
| 32 CONKEY AVENUE | NORWICH | NY | 13815 | DENTAL HEALTH CETNER | |
| CV STRATTON CENTER FOR THERAPIES | |||||
| NORWICH SHOPPING PLAZA- ROUTE 12 | NORWICH | NY | 13815 | CENTER FOR THERAPIES | NORTH |
| CMH FAMILY HEALTH CENTER IN OXFORD | |||||
| 40 NORTH CANAL STREET | OXFORD | NY | 13830 | FAMILY HEALTH CENTER | |
| CMH FAMILY HEALTH CENTER IN SIDNEY | |||||
| 44 PEARL STREET | SIDNEY | NY | 13838 | FAMILY HEALTH CENTER | |
| CMH WALK-IN CENTER | |||||
| 4 NEWTON AVENUE | NORWICH | NY | 13815 | WALK IN CLINIC | |
| CMH ENT CENTER | |||||
| 32 CONKEY AVENUE | NORWICH | NY | 13815 | ENT CENTER | |
Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 3C: PATIENTS WHO HAVE NO INSURANCE, OR HAVE A PATIENT BALANCE ON A SINGLE ACCOUNT GREATER THAN $2,000, HAVE COMPLETED THE APPLICATION PROCESS, INCLUDING APPLYING FOR GOVERNMENT ASSISTANCE (IF DEEMED ELIGIBLE), AND ARE DENIED FOR THE SLIDING FEE FOR EXCESS INCOME, WILL BE AWARDED THE 15% "PARTICIPATION" DISCOUNT. NO FURTHER PAPERWORK IS REQUIRED. UNDER NO CIRCUMSTANCES CAN A PERSON RECEIVE BOTH A SLIDING FEE AND A 15% PARTICIPATION DISCOUNT. | |
| PART I, LINE 7: A COMBINATION OF IRS PROVIDED WORKSHEETS AND THE RATIO OF PATIENT CARE COST TO CHARGES WAS USED. | |
| PART I, L7 COL(F): 100% OF THE ANNUAL BAD DEBT EXPENSE OF $4,932,513 WAS NOT INCLUDED IN THE CALCULATION OF NET BENEFIT EXPENSE. | |
| PART II: THE HOSPITAL'S COMMUNITY BUILDING ACTIVITIES SUPPORT THE HOSPITAL'S MISSION TO DELIVER LOCAL, HIGH QUALITY HEALTHCARE, AND SERVE AS A GATEWAY TO CLINICALLY INTEGRATED SERVICES PROVIDED IN COLLABORATION WITH OTHER LOCAL, REGIONAL, AND NATIONAL CAREGIVERS. SEVERAL MID-LEVEL AND SENIOR-LEVEL MANAGERS SERVE ON COMMUNITY BOARDS THAT INCLUDE: CHENANGO COUNTY HOSPICE AND PALLIATIVE CARE, CHENANGO COUNTY DOH PAC, CHENANGO HEALTH NETWORK, CHENANGO MEMORIAL HOSPITAL FOUNDATION, AND THE CHENANAGO COUNTY EMS BOARD. ADDITIONALLY, THE HOSPITAL HOSTS AN ANNUAL MASH PROGRAM FOR TEENS INTERESTED IN PURSUING A CAREER IN HEALTHCARE AND STUDENTS IN THE NEW VISIONS PROGRAM HELD BY DCMO BOCES. CMH IS A PARTICIPANT IN THE ANNUAL HEALTH SCREENINGS AND WELLNESS EVENT HOSTED BY THE CHENANGO COUNTY ROTARY CLUB AND HOSTS 2 BLOOD DRIVES EACH YEAR FOR THE RED CROSS. LASTLY, THE HOSPITAL PARTICIPATES IN EMERGENCY PREPAREDNESS DRILLS THAT FREQUENTLY INCLUDE LOCAL AND STATE EMERGENCY PERSONNEL. CMH HOLDS DIABETES INFORMATION PROGRAMS IN THE COMMUNITY AND HOSTS SEVERAL SUPPORT GROUPS. | |
| PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT SPECIFICALLY REFERENCE OR DESCRIBE BAD DEBT EXPENSE. THE ORGANIZATION'S COSTING METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED ON PART III, SECTION A. LINES 2 AND 3 IS THE RATIO OF PATIENT CARE COSTS TO CHARGES. | |
| PART III, LINE 8: CMH FEELS THAT ANY SERVICES PROVIDED TO MEDICARE BENEFICIARIES THAT RESULT IN A SHORTFALL TO THE ORGANIZATION BASED ON A LESS THAN ADEQUATE MEDICARE REIMBURSEMENT SHOULD BE TREATED AS A COMMUNITY BENEFIT. CMH TREATS ANY AND ALL COMMUNITY MEMBERS REGARDLESS OF ABILITY TO PAY. CMH'S SERVICE REGION HAS A HIGHER PROPORTION OF ELDERLY THAT THE U.S. AVERAGE. THEREFORE, CMH IS SERVICING AT RISK MEDICARE BENEFICIARIES WITH ALL ITS PROGRAMS AND SERVICES. | |
| PART III, LINE 9B: THE ORGANIZATION'S COLLECTION POLICY PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE ARE AS FOLLOWS:CHARITY CARE IS GIVEN FIRST, THE REMAINING BALANCE, IS THEN SUBJECT TO AN INTEREST FREE PAY PLAN. IF THE PATIENT/ GUARANTOR CHOOSES TO IGNORE ALL FURTHER ATTEMPTS TO MAKE ARRANGEMENTS FOR PAYMENTS, AFTER 180 DAYS THE ACCOUNT IS SENT TO A COLLECTION AGENCY AT THE DISCOUNTED LEVEL. | |
| THE COST OF BAD DEBTS IS COMPUTED BY APPLYING THE OVERALL RATIO OF PATIENT COST TO CHARGES TO THE TOTAL BAD DEBT EXPENSE. | PART III SECTION A #2 |
| THE CHARITY CARE BAD DEBT IS DERIVED BY COMPUTING THE CHARGES SUBJECT TO COLLECTION WHICH IS THE DIFFERENCE BETWEEN THE TOTAL CHARGES AND SELF PAY AMOUNTS. THE OVERALL RATIO OF PATIENT COST TO CHARGES IS APPLIED TO CHARITY CARE BAD DEBT. | PART III SECTION B #3 |
| PART V, SECTION B, LINE 20D: GROSS CHARGES TO ALL PATIENTS WHETHER INSURED OR NOT. | CHENANGO MEMORIAL HOSPITAL |
| PART V, SECTION B, LINE 22: ALL PATIENTS NO MATTER WHAT PAYMENT METHOD ARE CHARGED GROSS CHARGES, THE PATIENTS BALANCE CAN THEN BE REDUCED BY INSURANCE PAYMENTS AND CONTRACTUAL ADJUSTMENTS, AS WELL AS FINANCIAL ASSISTANCE ADJUSTMENTS/DISCOUNTS, SO THAT THE PATIENT ULTIMATELY MAY END UP PAYING MUCH LESS THAN GROSS CHARGES. | CHENANGO MEMORIAL HOSPITAL |
| PART VI, LINE 2: CHENANGO MEMORIAL HOSPITAL USES COMMUNITY SPECIFIC DATA FROM MULTIPLE SOURCES TO UNDERSTAND THE HEALTH CARE NEEDS OF OUR AREA RESIDENTS. DURING 2012, WE CONTINUED TO FOCUS ON IMPROVING COMMUNITY HEALTH CARE BY LISTENING TO INPUT FROM CUSTOMERS AND RESPONDING TO THOSE NEEDS. CHENANGO MEMORIAL HOSPITAL CONTINUALLY INVITES THE PUBLIC TO PARTICIPATE IN ITS SELF-ASSESSMENT PROCESS BY MEANS OF SURVEYS, PRIMARY MARKET STUDIES, FOCUS GROUPS, AND E-MAIL COMMENTS SUBMITTED THROUGH OUR COMPREHENSIVE INTERNET SITE. THROUGHOUT THE YEAR, INPUT FROM STAFF, THE PUBLIC AND BOARD MEMBERS IS UTILIZED IN DETERMINING AND SHAPING THE HOSPITAL'S RESPONSE TO THE COMMUNITY'S HEALTH CARE NEEDS. RECENT STUDIES USED BY OUR ORGANIZATION FOR THE PURPOSE OF ASSESSING OUR MARKET'S HEALTH STATUS INCLUDE:- PRESS GANEY PATIENT SATISFACTION SURVEY SCORES AND COMMENTS (ONGOING)- UHS-SPONSORED PRIMARY MARKET RESEARCH STUDIES, INCLUDING AN ONGOING CONSUMER PERCEPTION SURVEY CONDUCTED BY NRC.- MARKET EXPERT SOFTWARE FROM THE HOSPITAL ASSOCIATION OF NEW YORK STATE (HANYS) WHICH CONTAINS A HEALTH STATUS PROFILER MODULE.- ADMINISTRATIVE AND BOARD STRATEGIC PLANNING COMMITTEES.- FEEDBACK FROM PHYSICIANS- PHYSICIAN AND EMPLOYEE SATISFACTION SURVEYS.- QUALITATIVE SURVEYS AND FOCUS GROUPS TO CAPTURE CONSUMER FEEDBACK- LOCAL AND NATIONAL HEALTH-RELATED NEWS REPORTS.- REPORTS FROM INDUSTRY PUBLICATIONS AND ORGANIZATIONS.CHENANGO MEMORIAL HOSPITAL'S COMMUNITY SERVICE PLANNING IS SHAPED BY ANNUAL STRATEGIC PLANNING WHICH INCLUDES A REVIEW OF ALL AVAILABLE HEALTH/COMMUNITY ASSESSMENT DOCUMENTS, INCLUDING:- COMMUNITY HEALTH ASSESSMENT 2010-2013, CHENANGO COUNTY HEALTH DEPARTMENT- HEALTHY PEOPLE 2020- ANNUAL ENVIRONMENTAL ASSESSMENT PREPARED BY UHS MARKET RESEARCH- UHS, INC. 2012 STRATEGIC PLAN IN 2012, THE CHENANGO MEMORIAL HOSPITAL COMMUNITY SERVICE PLAN CONTINUED TO ADDRESS THE PREVENTION AGENDA OBJECTIVES CHOSEN IN COLLABORATION WITH THE CHENANGO COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY PARTNERS.CMH CONTINUALLY INVITES THE PUBLIC TO PARTICIPANT IN ITS SELF-ASSESSMENT PROCESS BY MEANS OF SURVEYS, PRIMARY MARKET STUDIES, FOCUS GROUPS, AND E-MAIL COMMENTS SUBMITTED THROUGH OUR COMPREHENSIVE INTERNET SITE. THROUGHOUT THE YEAR, INPUT FROM STAFF, THE PUBLIC AND BOARD MEMBERS IS UTILIZED IN DETERMINING AND SHAPING THE HOSPITAL'S RESPONSE TO THE COMMUNITY'S HEALTH CARE NEEDS. THE UHS INC. 2012 STRATEGIC PLAN WAS ALSO INTEGRAL TO ASSESSING COMMUNITY HEALTH NEEDS.CHENANGO MEMORIAL HOSPITAL (CMH) HAS BEEN AN ACTIVE MEMBER OF OUR COUNTY'S RURAL HEALTH NETWORK, CHENANGO HEALTH NETWORK (CHN), SINCE ITS INCEPTION TWENTY YEARS AGO, AND A CMH REPRESENTATIVE SITS ON THE CHN BOARD. THE NETWORK'S MEMBERSHIP INCLUDES BROAD-BASED REPRESENTATIVE OF LOCAL HEALTH AND HUMAN SERVICE PROVIDERS AND BUSINESSES. THE NETWORK'S QUARTERLY BOARD MEETINGS FOCUS ON HEALTH PRIORITY AREAS IN CHENANGO COUNTY, AND THEIR WORK PROVIDED PRELIMINARY INPUT INTO THE COMMUNITY SERVICE PLAN PRIORITIES. IN ADDITION, HOSPITAL STAFF, REPRESENTATIVES OF PUBLIC HEALTH, AND CHENANGO HEALTH NETWORK FORMED A PLANNING GROUP TO GUIDE THE PRIORITY SELECTION FOR THIS PLAN. IN ADDITION, CHENANGO COUNTY COMPLETED A 2 YEAR MAPP. THIS PROCESS ELICITED CONSUMER INPUT FROM OVER 20 FOCUS GROUPS CONDUCTED THROUGHOUT THE COUNTY DURING THE SPRING AND SUMMER OF 2009 AND INCLUDES A WIDE VARIETY OF DEMOGRAPHICS. INPUT FROM THIS PROCESS HAS BEEN FACTORED INTO THE PLANNING PROCESS OF CHENANGO MEMORIAL'S COMMUNITY SERVICE PLAN. | |
| PART VI, LINE 3: OUR ORGANIZATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS OR UNDER OUR CHARITY CARE POLICY AS FOLLOWS:* EVERY CLINIC AND AREA OF PATIENT REGISTRATION HAS A NOTICE POSTED INFORMING THE PATIENT/S/PUBLIC OF THE AVAILABILITY OF FINANCIAL ASSISTANCE* BROCHURES DESCRIBING THE POLICY ARE AVAILABLE AT CLINICS, POINTS OF REGISTRATION, AND ARE MAILED TO SELF PAY PATIENTS ALONG WITH APPLICATIONS* INPATIENTS ARE VISITED BY THE PATIENT FINANCIAL ADVOCATE. THEY ARE MADE AWARE OF GOVERNMENT PROGRAMS AND IF NECESSARY, ARRANGEMENTS ARE MADE WITH THE DEPARTMENT OF SOCIAL SERVICES TO HAVE A WORKER COME IN AND TAKE THE APPLICATION FROM THE PATIENT. THE PATIENT IS GIVEN INFORMATION AND APPLICATION FOR FINANCIAL ASSISTANCE, AND APPLICATION CAN BE TAKEN RIGHT AT PATIENT BEDSIDE* THE WOMAN'S HEALTH CENTER INFORMS ALL SELF PAY PREGNANT WOMEN OF THE "PRESUMPTIVE ELIGIBILITY" PROCESS AND PATIENTS ARE DIRECTED TO PATIENT FINANCIAL SERVICES FOR COMPLETION OF THE APPLICATION AND COMPLETION OF A WIC APPLICATION IF PATIENT SO DESIRES* EVERY CMH EMPLOYEE IS MADE AWARE OF THE CHARITY CARE PROGRAM AT ORIENTATION AND ENCOURAGED TO MAKE PATIENTS AND THE PUBLIC AWARE OF THE PROGRAM. PERSONNEL WHO HAVE PATIENT CONTACT ARE ANNUALLY IN-SERVICED ON CHARITY CARE PROGRAM* EVERY BILL THAT IS SENT OUT IS MARKED "FOR INFORMATION REGARDING OUR "PATIENT FINANCIAL ASSISTANCE" PROGRAM" PLEASE CONTACT 607-337-4295 | |
| PART VI, LINE 4: CHENANGO MEMORIAL HOSPITAL'S SERVICE AREA IS CENTERED IN CHENANGO COUNTY BUT ALSO SERVES PATIENTS FROM OTSEGO, DELAWARE, AND MADISON COUNTIES. PATIENTS FROM CHENANGO COUNTY REPRESENT 68.5% OF THE HOSPITAL'S TOTAL SERVICE AREA WITH THE REMAINING 31.4% COMING FROM THE SURROUNDING COUNTIES. THE HOSPITAL'S PRIMARY SERVICE AREA CONSISTS OF NORTH PITCHER, SOUTH OTSELIC, NEW BERLIN, SHERBURNE, SMYRNA, GUILFORD, MCDONOUGH, MT UPTON, NORWICH, OXFORD, PLYMOUTH, SOUTH NEW BERLIN, AND SOUTH PLYMOUTH. IN THE SECONDARY SERVICE AREA, PATIENTS COME FROM PITCHER, EARLVILLE, AFTON, BAINBRIDGE, GILBERTSVILLE, SIDNEY, AND SMITHVILLE FLATS.PER CAPITAL INCOME, AS REPORTED BY THE US CENSUS BUREAU (2007-2011), IN CHENANAGO COUNTY WAS $22,786 VERSUS $31,796 FOR NEW YORK STATE. MEDIAN HOUSEHOLD INCOME FOR THE SAME PERIOD IN CHENANGO COUNTY WAS $44,662 VERSUS $56,951 FOR THE STATE. 13.9% OF RESIDENTS LIVE BELOW THE POVERTY LINE VS 14.5% STATEWIDE. IN 2012, CHENANGO COUNTY HAD A DISPROPORTIONATE SHARE OF RESIDENTS AGED 65+ AT 17.8% COMPARED TO THE NYS AVERAGE OF 14.1%. ONLY 17.5% OF RESIDENTS HAVE AT LEAST A BACHELOR'S DEGREE VERSUS 32.5% STATEWIDE. | |
| PART VI, LINE 5: THE UHS SYSTEMS MISSION IS TO SERVE THE PEOPLE OF OUR REGION, TO IMPROVE OR MAINTAIN THEIR HEALTH, AND TO PROVIDE THE PATIENT-CENTERED, CONTEMPORARY HEALTH SERVICES IN A CARING, COMPETENT, AND CONVENIENT MANNER. SERVICE WILL BE AFFORDABLE AND WELL ORGANIZED TO MEET THE NEEDS OF OUR PATIENTS AND THEIR FAMILIES. CMH SERVES THE COMMUNITY WITH AN OPEN MEDICAL STAFF AND A DIVERSE COMMUNITY BOARD OF DIRECTORS. ANY SURPLUS FUNDS GENERATED THROUGH OPERATIONS ARE USED SOLELY TO PURCHASE MEDICAL EQUIPMENT AND TECHNOLOGY, UPGRADE FACILITIES AND PROVIDE FOR PROGRAM SERVICE ENHANCEMENTS. | |
| PART VI, LINE 6: CMH IS AN IMPORTANT PART OF A LARGER SYSTEM OF INTEGRATED DELIVERY OF CARE, WHICH PROVIDES ADDITIONAL BENEFITS TO THE COMMUNITY. AS A RESULT OF THE FORMATION OF CMH IN 1910 AND THE SUBSEQUENT TRANSFORMATION OF THE COMBINED ORGANIZATION INTO A HEALTH CARE SYSTEM, OUR REGION TODAY OFFERS MORE COMPLETE AND ADVANCED CARE THAN MANY COMMUNITIES FIVE TIMES OUR SIZE. IN 2012, CHENANGO MEMORIAL HOSPITAL'S SYSTEM ENGAGED IN A STRATEGIC PLANNING PROCESS FOR THE YEARS 2013-2016. CONSISTENT WITH THE MISSION AND VISION, THE PLAN IS FOCUSED ON CONTINUING TO STRENGTHEN THE HEALTH SYSTEM AND ITS SERVICES TO COMMUNITY. THE STRATEGIC PLAN IS ORGANIZED AROUND FOUR GOALS: CLINICAL EXCELLENCE,SERVICE EXCELLENCE, MARKET GROWTH AND FINANCIAL STRENGTH. SPECIFIC DESTINATION METRICS OR MEASURES OF SUCCESS WERE DEVELOPED FOR EACH STRATEGIC GOAL. THE SPECIFIC INITIATIVES SUPPORTING ACHIEVEMENT OF THE GOALS ARE REVIEWED ON A REGULAR BASIS. EACH ENTITY CARRIES OUT INITIATIVES LOCALLY AND REGIONALLY. THE CMH COMMUNITY SERVICE REPORT CAPTURES THE BENEFITS SPECIFIC TO CMH. THE OTHER HOSPITAL MEMBERS OF THE UHS SYSTEM, UHS WILSON MEDICAL CENTER, UHS BINGHAMTON GENERAL HOSPITAL, AND DELAWARE VALLEY HOSPITAL SUBMIT SEPARATE REPORTS.- CLINICAL EXCELLENCE: CMH HAS FOCUSED ITS RESOURCES AND ENERGY AROUND ACHIEVING DISTINCTION AS A HEALTH SYSTEM IN CLINICAL QUALITY, PATIENT SAFETY AND SERVICE. CMH IS FOCUSED ON VIGOROUS ASSESSMENT AND IMPROVEMENT OF THE ORGANIZATION'S PERFORMANCE USING KEY PATIENT QUALITY, SAFETY AND SATISFACTION INDICATORS. THE PLAN PLACES A FOCUS IN PARTICULAR ON EMERGENCY ROOM PERFORMANCE, CLOSER INTEGRATION OF NON-ACUTE SERVICES WITH THE HOSPITALS, DEVELOPMENT AND IMPLEMENTATION OF STATE-OF-THE-ART INFORMATION TECHNOLOGY TO SUPPORT INITIATIVES IN PATIENT QUALITY AND SAFETY AND NEW INITIATIVES IN THE RECRUITMENT AND RETENTION OF A QUALITY PHYSICIAN AND ALLIED HEALTH WORKFORCE.- SERVICE EXCELLENCE: ADDRESS DELIVERING ON THE CMH BRAND PROMISE OF A MEANINGFULLY BETTER PATIENT EXPERIENCE. THE PLAN FOCUSES ON PATIENT-CENTERED CARE AND THE BRAND PROMISE OF RESPECT AND ACCOUNTABILITY. THIS GOAL ALIGNS TECHNOLOGY WITH PERFORMANCE STANDARDS TO IMPROVE ACCESS TO BETTER MEET PATIENT NEEDS.- MARKET GROWTH: THIS GOAL AREA ADDRESSES THE KEY ASPECTS OF ALIGNING TECHNOLOGY, PHYSICIAN RESOURCES AND PROGRAMS AROUND THE CLINICAL NEEDS OF THE SERVICE AREA. THE PLAN FOCUSES ATTENTION ON KEY TERTIARY SERVICES AND THE ASSURANCE OF AN ADEQUATE SUPPLY OF PRIMARY CARE AND SPECIALIST PHYSICIANS FOR THE AREA. AT THE SAME TIME, CMH REMAINS COMMITTED TO MEETING THE COMMUNITY'S BEHAVIORAL HEALTH SERVICES NEEDS.- FINANCIAL STRENGTH: TO ENSURE CMH HAS THE FINANCIAL CAPACITY TO SUPPORT ITS CLINICAL SERVICE AND GROWTH GOALS, THE STRATEGIC PLAN CALLS THE ORGANIZATION TO DEMONSTRATE CONSISTENT PERFORMANCE WITH RESPECT TO BENCHMARKED OPERATING EFFICIENCIES. THIS INCLUDES PARTICIPATING IN 340B INDIGENT CARE PHARMACY PRICING IN ORDER TO SERVE MORE ELIGIBLE PATIENTS AND PROVIDE MORE COMPREHENSIVE SERVICE.CHENANGO MEMORIAL HOSPITAL FILES THE COMMUNITY BENEFIT REPORT WITH NEW YORK STATE. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CMH AUXILIARY TO CMH HOSPITAL | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 179 NORTH BROAD STREET | AddressLine1 |
| City | NORWICH | City |
| State | NY | State |
| ZIP Code | 13815 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 150532180 | EINOfRecipient |
| IRC Section | 501 (C) (3) | IRCSection |
| Amount Of Cash Grant | 54000 | AmountOfCashGrant |
| Amount Of Non Cash Assistance | 0 | AmountOfNonCashAssistance |
| Method Of Valuation | CASH | MethodOfValuation |
| Purpose Of Grant | ESD ULTRASOUND AND MED/SURG BEDS | PurposeOfGrant |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (14 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DRAKE LAMEN MD | ||||||||||||||
| PRESIDENT/CEO | 287257 | 0 | 0 | 0 | 0 | 0 | 30000 | 0 | 14593 | 0 | 331850 | 0 | 0 | 0 |
| MATTHEW J SALANGER | ||||||||||||||
| 2ND VICE CHAIRMAN | 0 | 805904 | 0 | 157106 | 0 | 321760 | 0 | 16750 | 0 | 21284 | 0 | 1322804 | 0 | 0 |
| RAJESH DAVE MD | ||||||||||||||
| TRUSTEE | 0 | 480788 | 0 | 78696 | 0 | 14454 | 0 | 16750 | 0 | 16295 | 0 | 606983 | 0 | 0 |
| KEVIN B DECKER DDS | ||||||||||||||
| PRES OF MEDICAL STAFF | 190008 | 0 | 0 | 0 | 0 | 0 | 22801 | 0 | 17768 | 0 | 230577 | 0 | 0 | 0 |
| ROBERT G GOMULKA | ||||||||||||||
| TRUSTEE | 0 | 388087 | 0 | 64036 | 0 | 7980 | 0 | 16750 | 0 | 16138 | 0 | 492991 | 0 | 0 |
| DRU CAVANAGH | ||||||||||||||
| VP OF PATIENT CARE SERVICE | 88718 | 66621 | 0 | 0 | 0 | 0 | 18641 | 0 | 13016 | 0 | 120375 | 66621 | 0 | 0 |
| MICHAEL TREVISANI | ||||||||||||||
| VP MEDICAL AFFAIRS | 276173 | 0 | 0 | 0 | 0 | 0 | 30000 | 0 | 19238 | 0 | 325411 | 0 | 0 | 0 |
| CHRISTINA KISACKY | ||||||||||||||
| VP OF OPERATIONS | 144532 | 0 | 0 | 0 | 0 | 0 | 17344 | 0 | 17865 | 0 | 179741 | 0 | 0 | 0 |
| ROBERT MCCARTHY | ||||||||||||||
| VP OF SYSTEM FINANCIAL OPERATIONS | 82970 | 82970 | 0 | 0 | 0 | 0 | 5559 | 5559 | 4563 | 4563 | 93092 | 93092 | 0 | 0 |
| CHUNJIE YANG MD | ||||||||||||||
| PHYSICIAN | 300019 | 0 | 0 | 0 | 0 | 0 | 30000 | 0 | 19076 | 0 | 349095 | 0 | 0 | 0 |
| EMMANUEL M GUIZANO MD | ||||||||||||||
| PHYSICIAN | 283736 | 0 | 0 | 0 | 0 | 0 | 30000 | 0 | 2448 | 0 | 316184 | 0 | 0 | 0 |
| TIMOTHY COREY MD | ||||||||||||||
| PHYSICIAN | 299998 | 0 | 0 | 0 | 0 | 0 | 30000 | 0 | 19778 | 0 | 349776 | 0 | 0 | 0 |
| FRANK C COLE III MD | ||||||||||||||
| PHYSICIAN | 293180 | 0 | 0 | 0 | 0 | 0 | 30000 | 0 | 14033 | 0 | 337213 | 0 | 0 | 0 |
| JAMES O'BRIEN MD | ||||||||||||||
| PHYSICIAN | 350002 | 0 | 0 | 0 | 0 | 0 | 30000 | 0 | 19843 | 0 | 399845 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | UNITED HEALTH SERVICES, INC. IS THE SOLE MEMBER OF CHENANGO MEMORIAL HOSPITAL, INC. | |
| FORM 990, PART VI, SECTION A, LINE 7A | THE SOLE MEMBER, UNITED HEALTH SERVICES, INC, SHALL ELECT TRUSTEES AT THE ANNUAL MEETING OF THE ORGANIZATION. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE 990 PREPARATION AND FILING IS THE RESPONSIBILITY OF THE HOSPITALS BOARD OF DIRECTORS WHO DELEGATES THE TIMELY AND ACCURATE COMPLETION OF THE 990 TO MANAGEMENT. THE FINANCE DIVISION PREPARED THE 990 FORMS WHICH WAS REVIEWED BY THE ORGANIZATION'S PUBLIC ACCOUNTANTS, CONTROLLER AND VP OF FINANCE. | |
| FORM 990, PART VI, SECTION B, LINE 12C | DIRECTORS, OFFICERS AND KEY EMPLOYEES SUBMIT CONFLICT OF INTEREST STATEMENTS ANNUALLY WHICH ARE REVIEWED BY THE CEO, BOARD CHAIRMAN AND THE ORGANIZATION'S AUDIT COMMITTEE. | |
| FORM 990, PART VI, SECTION B, LINE 15 | IT IS THE PHILOSOPHY OF THE HOSPITAL THAT THE EXECUTIVE STAFF BE COMPENSATED FAIRLY FOR THEIR WORK. BASE SALARY LEVELS, INCENTIVE/BONUS PROGRAMS AND BENEFIT PLANS SHALL TAKE INTO ACCOUNT THE LOCAL, REGIONAL AND NATIONAL MARKETS TO ALLOW UHS HOSPITALS TO RECRUIT, MOTIVATE, REWARD, RECOGNIZE AND RETAIN HIGHLY TALENTED EXECUTIVES WITH THE SKILL SETS REQUIRED TO FULFILL ITS MISSION. THE EXECUTIVE COMPENSATION PROGRAM MUST FOCUS EXECUTIVES' ATTENTION ON UHS'S STRATEGIC INITIATIVES AND MISSION CRITICAL PERFORMANCE OBJECTIVES THAT WILL LEAD TO THE ORGANIZATION'S AND SYSTEM'S SUCCESS. TO CARRY OUT THIS COMPENSATION PHILOSOPHY, THE UHS HOSPITALS (WHICH INCLUDES CHENANGO MEMORIAL HOSPITAL) BOARD OF DIRECTORS' EXECUTIVE COMPENSATION COMMITTEE REVIEWS ANNUALLY A COMPREHENSIVE REPORT PREPARED BY AN EXTERNAL EXECUTIVE COMPENSATION CONSULTING FIRM, SULLIVAN COTTER ASSOCIATES TO DETERMINE THE APPROPRIATENESS OF THE BASE AND TOTAL COMPENSATION LEVELS FOR THE SENIOR MANAGEMENT STAFF. THIS ANNUAL REPORT FOCUSES ON TWO KEY AREAS; 1) THE COMPETITIVENESS OF THE SENIOR MANAGEMENT STAFF'S BASE AND TOTAL COMPENSATION (INCLUDING BENEFITS) VS. NATIONAL BENCHMARK DATA FOR COMPARABLY SIZED HEALTH CARE SYSTEMS AND HOSPITAL (BASED UPON 'TOTAL REVENUE' METRICS), AND 2) A 'REASONABLENESS ASSESSMENT' CONSISTENT WITH U.S. TREASURY DEPARTMENT REGULATIONS GOVERNING EXECUTIVE COMPENSATION FOR NOT-FOR-PROFIT ORGANIZATIONS. THE DATA FROM THIS REPORT ASSISTS THE EXECUTIVE COMPENSATION COMMITTEE IN DETERMINING THE APPROPRIATENESS OF THE SENIOR MANAGEMENTS' CURRENT BASE AND TOTAL COMPENSATION LEVELS AND THE NEED FOR ANY ADJUSTMENTS FOR THAT CALENDAR YEAR. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION PROVIDES FORM 1023, FORM 990 AND OTHER INFORMATION REQUIRED UNDER INTERNAL REVENUE SERVICE REGULATIONS TO THE PUBLIC, UPON REQUEST. | |
| FORM 990, PART XI, LINE 9: | CUMULATIVE EFFECT OF AUXILIARY INCOME AND EXPENSE 28,401. CHANGE IN INTEREST IN CHENANGO MEMORIAL HOSPITAL FOUNDATION 415,623. PENSION CHANGES OTHER THAN NET PERIODIC BENEFIT COSTS -1,592,496. CHANGE IN VALUE OF FUNDS HELD IN TRUST BY OTHERS -9,927. FORGIVENESS OF DEBT BY AFFILIATE 3,987,293. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (11 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| UNITED HEALTH SERVICES HOSPITALS INC | ||||||||||
| 33-57 HARRISON STREET | JOHNSON CITY | NY | 13790 | 161165049 | HOSPITAL | NY | 501 (C) (3) | 3 | UNITED HEALTH SERVICES INC | 0 |
| IDEAL SENIOR LIVING CENTER INC | ||||||||||
| 508 HIGH AVENUE | ENDICOTT | NY | 13760 | 222902896 | SENIOR LIVING CENTER | NY | 501 (C) (3) | 3 | UNITED HEALTH SERVICES INC | 0 |
| IDEAL SENIOR LIVING CENTER HOUSING CO | ||||||||||
| 508 HIGH AVENUE | ENDICOTT | NY | 13760 | 222902899 | SENIOR HOUSING | NY | 501 (C) (3) | 9 | UNITED HEALTH SERVICES INC | 0 |
| TWIN TIER HOME HEALTH INC | ||||||||||
| 4401 VESTAL PARKWAY EAST | VESTAL | NY | 13850 | 222348211 | HOME HEALTH CARE | NY | 501 (C) (3) | 3 | UNITED HEALTH SERVICES INC | 0 |
| UNITED HEALTH SERVICES INC | ||||||||||
| 20-42 MITCHELL AVENUE | BINGHAMTON | NY | 13903 | 222682421 | PARENT COMPANY | NY | 501 (C) (3) | 9 | BOARD OF DIRECTORS UHS INC | 0 |
| UNITED MEDMANAGEMENT | ||||||||||
| 601 RIVERSIDE DRIVE | JOHNSON CITY | NY | 13790 | 161396133 | PHYSICIAN PRACTICES | NY | 501 (C) (3) | 11B | UNITED HEALTH SERVICES INC | 0 |
| PROFESSIONAL HOME CARE INC | ||||||||||
| 4401 VESTAL PARKWAY EAST | VESTAL | NY | 138503556 | 161261977 | HOME HEALTH CARE | NY | 501 (C) (3) | 3 | UNITED HEALTH SERVICES INC | 0 |
| DELAWARE VALLEY HOSPITAL INC | ||||||||||
| ONE TITUS PLACE | WALTON | NY | 13856 | 150524324 | HOSPITAL | NY | 501 (C) (3) | 3 | UNITED HEALTH SERVICES INC | 0 |
| ECKELBERGER TOWER INC | ||||||||||
| 156 CORLISS AVENUE | JOHNSON CITY | NY | 13790 | 237171440 | MEDICAL STUDENT HOUSING | NY | 501 (C) (3) | 9 | UNITED HEALTH SERVICES INC | 0 |
| CMH FUND | ||||||||||
| 179 NORTH BROAD STREET | NORWICH | NY | 13815 | 222985550 | INACTIVE | NY | 501 (C) (3) | 11B | CHENANGO MEMORIAL HOSPITAL INC | 0 |
| PROJECT HEAR INC | ||||||||||
| 4401 VESTAL PARKWAY EAST | VESTAL | NY | 13850 | 161462675 | HOME EMERGENCY ALARM SYSTEM | NY | 501 (C) (3) | 3 | TWIN TIER HOME HEALTH INC | 0 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Controlled OrgControlledOrg | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|
| PATHWAY HEALTH MANAGEMENT INC | ||||||||||
| 20 MITCHELL AVENUE | BINGHAMTON | NY | 13903 | 161228654 | WINDING DOWN OF MANAGEMENT SERVICES TO SUSQUENHANA MEDICAL ASSOCIATES | NY | UNITED HEALTH SERVICES INC | C | 0 | |
| CHENANGO MADA INC | ||||||||||
| 179 N BROAD STREET | NORWICH | NY | 13915 | 161290726 | INACTIVE | NY | CMH FUND INC | C | 0 | 1.00000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 1 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 1 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |