BROOKS-TLC HOSPITAL SYSTEM INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- BROOKS-TLC HOSPITAL SYSTEM INC (EIN 16-0743301)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-09-15
- IRS object ID
- 201342599349300804
- 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 D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-09-15T08:59:57-05:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 160765486 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LUMSDEN & MCCORMICK LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 369 FRANKLIN STREET | AddressLine1 |
| City | BUFFALO | City |
| State | NY | State |
| ZIP Code | 14202 | 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 | 160743301 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BROOKS MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | BROO | NameControl |
| Phone | 7163661111 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 529 CENTRAL AVENUE | AddressLine1 |
| City | DUNKIRK | City |
| State | NY | State |
| ZIP Code | 14048 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | J GARY RHODES | Name |
| Title | INTERIM CEO | Title |
| Phone | 7163661111 | Phone |
| Date Signed | 2013-09-05 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MICHAEL J GRIMALDI | Name |
| PTIN | P01295846 | PTIN |
| Phone | 7168563300 | 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 | J GARY RHODES | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 529 CENTRAL AVENUE | AddressLine1 |
| City | DUNKIRK | City |
| State | NY | State |
| ZIP Code | 14048 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 44592594 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.LAKEERIEHEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1898 | YearFormation |
| State Legal Domicile | NY | StateLegalDomicile |
| Activity Or Mission Description | AN ACUTE CARE HOSPITAL SERVING PRIMARILY RESIDENTS OF NORTHERN CHAUTAUQUA COUNTY | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 16 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 13 | NbrIndependentVotingMembers |
| Total Nbr Employees | 556 | TotalNbrEmployees |
| Total Nbr Volunteers | 36 | TotalNbrVolunteers |
| Total Gross UBI | -2102 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -2352 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 176790 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 211447 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 41748396 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 41280676 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 314115 | InvestmentIncomePriorYear |
| Investment Income Current Year | 316523 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 664112 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1264094 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 42903413 | TotalRevenuePriorYear |
| Total Revenue Current Year | 43072740 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 23653429 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 25527393 | 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 | 19380384 | OtherExpensePriorYear |
| Other Expenses Current Year | 19879795 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 43033813 | TotalExpensesPriorYear |
| Total Expenses Current Year | 45407188 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -130400 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -2334448 | RevenuesLessExpensesCY |
| Total Assets BOY | 34147820 | TotalAssetsBOY |
| Total Assets EOY | 33294269 | TotalAssetsEOY |
| Total Liabilities BOY | 10664602 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 11084059 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 23483218 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 22210210 | NetAssetsOrFundBalancesEOY |
| Mission Description | SEE SCHEDULE O BELOW FOR FULL MISSION STATEMENT. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 17587786 | Expense |
| Revenue | 16369278 | Revenue |
| Description | NURSING SERVICES - PROVISION OF DAILY CARE INCLUDING INPATIENT AND OUTPATIENT SERVICES WITHIN THE INSTITUTION | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 18075908 | Expense |
| Revenue | 24911398 | Revenue |
| Description | OTHER PROFESSIONAL SERVICES - ANCILLARY SERVICES PROVIDED WITHIN THE FACILITY INCLUDING LABORATORY, RADIOLOGY, INHALATION THERAPY, ETC. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 35663694 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | 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 | 0 | 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 | 1 | 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 | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 56 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 556 | 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 |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 16 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 13 | 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 | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | 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 | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedure |
| 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 | J GARY RHODES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7163661111 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 529 CENTRAL AVENUE | AddressLine1 |
| City | DUNKIRK | City |
| State | NY | State |
| ZIP Code | 14048 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (25 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 |
|---|---|---|---|---|---|---|---|
| CHRISTOPHER LANSKI | |||||||
| CHAIRMAN | 2.00 | X | X | 0 | 0 | 0 | |
| TIMOTHY COOPER | |||||||
| CHAIRMAN ELECT | 2.00 | X | X | 0 | 0 | 0 | |
| BRIAN FENZL | |||||||
| SECRETARY | 2.00 | X | X | 0 | 0 | 0 | |
| LOUIS DIPALMA | |||||||
| TREASURER | 2.00 | X | X | 0 | 0 | 0 | |
| EUGENE BAILEN | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| WALTER GOTOWKA | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| RICHARD MILAZZO MD | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 13622 | ||
| DR VIRGINIA S HORVATH | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| ANDREW BURR | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| THOMAS POSTLE | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| THOMAS SYROCZYNSKI | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| JAMES WILD MD | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 60000 | 30.00 | |
| VIRGINIA COOPER | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| G JAY BISHOP MD | |||||||
| MEMBER | 2.00 | X | 4600 | 0 | 15086 | ||
| KEVIN OUWELEEN MD | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| SUSAN MCNAMARA PHD | |||||||
| MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| JONATHAN I LAWRENCE | |||||||
| PRESIDENT AND CEO | 20.00 | X | 189643 | 189643 | 40180 | 20.00 | |
| RALPH T WEBDALE | |||||||
| CFO/VP FINANCE | 40.00 | X | 132306 | 0 | 20773 | ||
| KENNETH D CRONE | |||||||
| CFO | 20.00 | X | 81544 | 81545 | 21861 | 20.00 | |
| JARROD JOHNSON | |||||||
| COO | 40.00 | X | 182652 | 0 | 21867 | ||
| TERESA LARSON | |||||||
| VP RISK MGMT/CORP COMPLIAN | 40.00 | X | 92635 | 0 | 25791 | ||
| SALLIE PIAZZA | |||||||
| VP NURSING | 40.00 | X | 91539 | 0 | 19330 | ||
| JOAN VANDETTE | |||||||
| VP HUMAN RESOURCES | 40.00 | X | 66441 | 0 | 8849 | ||
| MARY STAPLES | |||||||
| VP QA/RISK MANAGEMENT | 20.00 | X | 4272 | 4272 | 1040 | 20.00 | |
| THOMAS EAST | |||||||
| VP INFORMATION TECHNOLOGY | 20.00 | X | 6055 | 6055 | 3233 | 20.00 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 851687 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 281515 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 251632 | TotalOtherCompensation |
| Number Individuals GT100 K | 3 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (2 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| DR JOHN OROSZ | |||||
| 3425 WEBSTER ROAD | FREDONIA | NY | 14063 | PATHOLOGIST/LAB MED DIRECTOR | 230000 |
| DR RAJIV PARIKH | |||||
| 1134 CENTRAL AVENUE | DUNKIRK | NY | 14048 | INPATIENT PEDIATRICIAN | 110000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 2 | NumberOfContractorsGT100K |
| Government Grants | 164883 | GovernmentGrants |
| All Other Contributions | 46564 | AllOtherContributions |
| Total Contributions | 211447 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICE REVENU | Description |
| Business Code | 621990 | BusinessCode |
| Total Revenue Column | 41280676 | TotalRevenueColumn |
| Related Or Exempt Function Income | 41280676 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 41280676 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 207992 | TotalRevenueColumn |
| Exclusion | $207,992 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 17400 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 17400 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 17400 | TotalRevenueColumn |
| Exclusion | $17,400 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1623456 | Securities |
| Other | 4929 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1501695 | Securities |
| Other | 18159 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 121761 | Securities |
| Other | -13230 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 108531 | TotalRevenueColumn |
| Exclusion | $108,531 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| LAB SERVICES | 900099 | 562614 | $562,614 |
| MEALS ON WHEELS | 900099 | 239513 | $239,513 |
| CAFETERIA | 722210 | 176785 | $176,785 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 267782 | TotalRevenueColumn |
| Unrelated Business Revenue | -2102 | UnrelatedBusinessRevenue |
| Exclusion | $269,884 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1246694 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 43072740 | TotalRevenueColumn |
| Related Or Exempt Function Income | 41280676 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | -2102 | UnrelatedBusinessRevenue |
| Exclusion | $1,582,719 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 976853 | Total |
| Management And General | 976853 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18971727 | Total |
| Program Services | 15962463 | ProgramServices |
| Management And General | 3009264 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1475196 | Total |
| Program Services | 1016965 | ProgramServices |
| Management And General | 458231 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2679047 | Total |
| Program Services | 1838930 | ProgramServices |
| Management And General | 840117 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1424570 | Total |
| Program Services | 946305 | ProgramServices |
| Management And General | 478265 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 67914 | Total |
| Management And General | 67914 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 794058 | Total |
| Management And General | 794058 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50244 | Total |
| Management And General | 50244 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10064264 | Total |
| Program Services | 9090191 | ProgramServices |
| Management And General | 974073 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 731783 | Total |
| Management And General | 731783 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 501311 | Total |
| Program Services | 375983 | ProgramServices |
| Management And General | 125328 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25006 | Total |
| Management And General | 25006 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 117715 | Total |
| Program Services | 91740 | ProgramServices |
| Management And General | 25975 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12773 | Total |
| Program Services | 12773 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2592136 | Total |
| Program Services | 2067814 | ProgramServices |
| Management And General | 524322 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 486733 | Total |
| Program Services | 373599 | ProgramServices |
| Management And General | 113134 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| PROVISION FOR BAD DEBTS | 1638856 | 1638856 | |
| PURCHASED SERVICES | 1217440 | 906492 | 310948 |
| MEDICAL SPECIALIST FEES | 700548 | 700548 | |
| CONTRACT LABOR | 640312 | 603782 | 36530 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 238702 | Total |
| Program Services | 37253 | ProgramServices |
| Management And General | 201449 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 45407188 | Total |
| Program Services | 35663694 | ProgramServices |
| Management And General | 9743494 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2468381 | BOY |
| EOY | 896432 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4901948 | BOY |
| EOY | 4590694 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3919741 | BOY |
| EOY | 4167073 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1262049 | BOY |
| EOY | 1271967 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 505877 | BOY |
| EOY | 366631 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 50291879 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 38432832 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13021732 | BOY |
| EOY | 11859047 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5623591 | BOY |
| EOY | 6675341 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1414171 | BOY |
| EOY | 1427234 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1030330 | BOY |
| EOY | 2039850 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34147820 | BOY |
| EOY | 33294269 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4121588 | BOY |
| EOY | 4321521 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 470131 | BOY |
| EOY | 312684 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6072883 | BOY |
| EOY | 6449854 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10664602 | BOY |
| EOY | 11084059 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22069047 | BOY |
| EOY | 20782976 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 656962 | BOY |
| EOY | 670025 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 757209 | BOY |
| EOY | 757209 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23483218 | BOY |
| EOY | 22210210 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34147820 | BOY |
| EOY | 33294269 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -2334448 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 410743 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 650697 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| 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 Separate | X | FinancialStatementSeparate |
| 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 D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1414171 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 13063 | InvestmentEarningsOrLosses |
| End Of Year Balance | 1427234 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1412273 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 1898 | InvestmentEarningsOrLosses |
| End Of Year Balance | 1414171 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1280118 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 132155 | InvestmentEarningsOrLosses |
| End Of Year Balance | 1412273 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1066646 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 213472 | InvestmentEarningsOrLosses |
| End Of Year Balance | 1280118 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1387081 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -320435 | InvestmentEarningsOrLosses |
| End Of Year Balance | 1066646 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.47000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.53000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 1 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 401330 | OtherCostOrOtherBasis |
| Book Value | 401330 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 10464705 | OtherCostOrOtherBasis |
| Depreciation | 8177449 | Depreciation |
| Book Value | 2287256 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 989532 | OtherCostOrOtherBasis |
| Depreciation | 748083 | Depreciation |
| Book Value | 241449 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 38390541 | OtherCostOrOtherBasis |
| Depreciation | 29507300 | Depreciation |
| Book Value | 8883241 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 45771 | OtherCostOrOtherBasis |
| Book Value | 45771 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 11859047 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | ADVANCES TO RELATED PARTIES | Description |
| Book Value | 2039850 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 2039850 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | $1,765,282 |
| ACCRUED PENSION LIABILITY | $4,684,572 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 6449854 | TotalOfAmounts |
| Tot Revenue Etc Audited Fincl Stmt | 41447114 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -1638856 | OtherRevenues |
| Revenue Not Rptd F990 | -1638856 | RevenueNotRptdF990 |
| Revenue Subtotal | 43085970 | RevenueSubtotal |
| Other Revenues Not Included | -13230 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -13230 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 43072740 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 43781562 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 13230 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 13230 | ExpensesNotRptdF990 |
| Expenses Subtotal | 43768332 | ExpensesSubtotal |
| Other Expenses Not Included | 1638856 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 1638856 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 45407188 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS -1,638,856. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | LOSS ON DISPOSAL OF PROPERTY AND EQUIPMENT -13,230. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | LOSS ON DISPOSAL OF PROPERTY AND EQUIPMENT 13,230. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS 1,638,856. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| 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 | 420221 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 20614 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 399607 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00880 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7578985 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7110041 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 468944 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01030 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7999206 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7130655 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 868551 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01910 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 31490 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 31490 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 26695 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 26695 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2022 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2022 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 60207 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 60207 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00130 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8059413 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7130655 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 928758 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02040 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 849 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 849 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 49180 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 49180 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 50029 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 50029 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $782,765 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 5764127 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 4563738 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 1200389 | 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 | 1 | 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 | BROOKS MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 529 CENTRAL AVENUE | AddressLine1 |
| City | DUNKIRK | City |
| State | NY | State |
| ZIP Code | 14048 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | RENAL DIALYSIS | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BROOKS 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 |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lawsuit | X | PermitLawsuit |
| Collection Activities | 1 | CollectionActivities |
| Other Actions | X | OtherActions |
| 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 |
| Medicare Rate | X | MedicareRate |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (19 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| 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 SIDE ASSET LEVELS1 $ 9,5002 $13,9003 $15,9854 $18,0705 $20,1556 $22,2407 $24,3258 $26,410EACH ADDITIONAL PERSON $ 2,085BROOKS 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 6A: N/A | ||
| PART I, LINE 7: RCC USED AS CALCULATED IN WORKSHEET 2. | ||
| PART I, LINE 7G: PHYSICIAN CLINIC NOT INCLUDED IN SUBSIDIED SERVICES - N/A. | ||
| PART II: BROOKS MEMORIAL HOSPITAL IS IN A MEDICALLY UNDERSERVED AREA. SIGNIFICANT ONGOING EFFORTS AT PHYSICIAN RECRUITMENT CONSTITUTE THE BULK OF THE EXPENSE IN COMMUNITY BUILDING ACTIVITIES FOR WORKFORCE DEVELOPMENT. CURRENT PHYSICIAN SHORTAGES INCLUDE PRIMARY CARE, PEDIATRICS, OBSTETRICS, SURGERY, ORTHOPEDIC, UROLOGY, RADIATION ONCOLOGIST, NEUROLOGIST, MEDICAL ONCOLOGIST AND PULMONOLOGIST.OUR MEDICAL EXPLORERS POST AND HEALTH CAMP CAREERS EXPOSE LOCAL YOUTH TO THE EXCITING POSSIBILITIES AND OPPORTUNITIES AVAILABLE IN HEALTHCARE. THEY FOSTER LONG TERM RELATIONSHIPS BETWEEN THE HOSPITAL AND THESE FUTURE HEALTH CARE PROVIDERS, OFTEN ENCOURAGING THEM TO RETURN TO THEIR HOME COMMUNITIES. | ||
| 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.WHY BAD DEBT SHOULD BE INCLUDED AS A COMMUNITY BENEFIT COST: A HIGH PROPERTION OF BAD DEBT DERIVES FROM PATIENTS WHO ARE NOT ABLE TO PAY FOR SERVICES AND THAT THE PROVISION OF SUCH SERVICES AT A LOSS CONSISTITUTES A FORM OF COMMUNITY BENEFIT. IT IS DIFFICULT FOR A HOSPITAL TO DISTINGUISH THESE PATIENTS WHO FAIL TO RESPOND TO ANY COMMUNICATION AND/OR EFFFORT TO DETERMINE ELIGIBILITY FOR COMMUNITY CARE. | ||
| PART III, LINE 8: THE ALLOWABLE MEDICARE COST WERE TAKEN DIRECTLY FROM COST REPORT WORKSHEET D. | ||
| 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. | ||
| RCC USED AS CALCLUATED IN WORKSHEET 2 FOR PART III, LINE 2 TO CALCULATE BAD DEBT COST. PATIENT PAYMENTS AND DISCOUNTS ARE NOT COUNTED TOWARD BAD DEBT IF POSTED PRIOR TO AN ACCOUNT BEING TRANSFERRED TO BAD DEBT. ONCE IN BAD DEBT, PATIENT PAYMENTS AND DISCOUNTS ARE USED OT REDUCE BAD DEBT. | DETERMINNG COST OF BAD DEBT, ACCOUNTING FOR DISCOUNTS/PAYMENTS RELATED TO B | PART III, LINE 2 |
| 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. | PART III, LINE 3 | |
| PART V, SECTION B, LINE 17E: 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 20D: 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 22: PATIENTS WHO DO NOT APPLY FOR FINANCIAL ASSISTANCE OR REQUEST A REDUCTION TO THEIR BILL WILL BE CHARGED THE GROSS CHARGE FOR SERVICSE PROVIDED. | BROOKS MEMORIAL HOSPITAL | |
| 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. THE HOSPITAL ALSO UTILIZES PATIENT SATISFACTION SURVEY TOOLS AND LOCAL PUBLIC INFORMATION PERTAINING TO POPULATION CHARACTERISTICS AND HEALTH STATUS. AT MONTHLY PUBLIC PRESENTATIONS OF HEALTH TOPICS, PROGRAM EVALUATION FORMS REQUEST INPUT FROM TEH ATTENDEES FOR NEEDED SERVICES AND TOPICS. | ||
| 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 A FACILITATED ENROLLER FROM FIDELIS IN THE HOSPITAL EVERY THURSDAY FROM 1-4 PM, OFFERING ASSISTANCE TO THE PUBLIC.3. 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.4. BROOKS MEMORIAL HOSPITAL CONTINUES TO MAKE REFERRALS TO THE GET COVERED HELPLINE.5. 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. IN THE HOSPITAL'S IMMEDIATE MUNICIPALITY 15.3% OF THE POPULATION IS 65 OR OLDER, 25.9% IS UNDER 20 YEARS OLD. 6.1% IS AFRICAN AMERICAN AND 26.4% IS HISPANIC. | ||
| 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.BROOKS MEMORIAL HOSPITAL IS IN A MEDICALLY UNDERSERVED AREA. SIGNIFICANT ONGOING EFFORTS AT PHYSICIAN RECRUITMENT ARE EXPENDED. CURRENT PHYSICIAN SHORTAGES INCLUDE PRIMARY CARE, PEDIATRICS, OBSTETRICS, SURGERY, ORTHOPEDIC, UROLOGY, RADIATION ONCOLOGIST, NEUROLOGIST, MEDICAL ONCOLOGIST AND PULMONOLOGIST.THE HOSPITAL IS AN ACTIVE MEMBER OF THE COUNTY WIDE DIABETES TASK FORCE. THE GOALS OF THIS ORGANIZAION ARE TO IDENTIFY PROBLEMS, PROPOSE AND IMPLEMENT CHANGES THAT AFFECT THE SYSTEM, PROMOTE GOOD HEALTH, ENCOURAGE PREVENTION, IMPROVE MANAGEMENT AND CREATE AWARENESS.THE HOSPITAL WORKS TO ENSURE AN ADEQUATE BLOOD SUPPLY IN THE COMMUNITY AND SURROUNDING AREAS BY HOSTING MONTHLY BLOOD DRIVES IN COOPERATION IWTH 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 INVEST IN IT.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, THE AMERICAN COLLEGE OF RADIATION ONCOLOGY, AND THE AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION FOR THE CARDIAC REHABILITATION DEPARTMENT. 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 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 IMPLEMENTED BAR CODE MEDICATION ADMINISTRATION TO REDUCE/ELIMINATE MEDICATION ERRORS. THE HOSPITAL USES PATIENT SURVEYS THROUGH BOTH PRESS GANEY AND HCAPHS. AREAS THAT MEASURED BELOW AVERAGE ARE REVIEWED WEEKLY AND BEING ADDRESSED THROUGH:- HOURLY ROUNDING- PRE-OPERATIVE JOINT EDUCATION CLASSES- SURGICAL AMBASSADOR PROGRAM- POST DISCHARGE CALLS TO ASSURE PATIENTS UNDERSTAND THEIR MEDICATION INSTRUCTIONS- CUSTOMER SERVICE TRAINING | ||
| PART VI, LINE 6: ALL OF THE HOSPITALS AND FACILITIES WITHIN LAKE ERIE REGIONAL HEALTH SYSTEM WORK CLOSELY TOGETHER BOTH IN DETERMINING THE HEALTH NEEDS OF THE COMMUNITIES SERVED AND DECIDED HOW BEST TO MEET THOSE NEEDS. OFFICIALS FROM BOTH HOSPITALS HAVE BEEN SELECTED TO WORK TOGETHER ON VARIOUS PROJECTS TO FURTHER THIS CAUSE, INCLUDING RESEARCHING COMMUNITY HEALTH NEEDS, WORKING WITH LOCAL HEALTH ORGANIZATIONS THROUGHOUT THE COUNTY AND BEYOND, DELEVELOPING A FREE COMMUNITY WELLNESS PROGRAM CALLED HEALTHQUEST WNY, PROMOTING HEALTHQUEST WNY AND OTHER HEALTH RELATED EVENTS, DEVELOPING AND PROMOTING HEALTHY LIFESTYLE CLASSES AT EACH OF OUR FACILITIES, REACHING OUT TO IDENTIFIED POPULATIONS OF NEED AND MORE. THIS ALLOWAS THE FACILITIES WITHIN THE SYSTEM TO MORE EVENLY SHARE THE BURDEN OF PROVIDING SUCH INFORMATION AND SERVICES WHILE ALSO ALLOWING US TO EXTEND OUR REACH FURTHER OUT INTO THE COMMUNITY THAN WE WOULD BE ABLE TO DO INDIVIDUALLY AND WITH FEWER UNNECESSARY REDUNDANCIES. | ||
| NY | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | X | WrittenEmploymentContract |
| 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 (4 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JONATHAN I LAWRENCE | ||||||||||||||
| PRESIDENT AND CEO | 162618 | 162618 | 23843 | 23843 | 3182 | 3182 | 8500 | 8500 | 11590 | 11590 | 209733 | 209733 | 0 | 0 |
| RALPH T WEBDALE | ||||||||||||||
| CFO/VP FINANCE | 131492 | 0 | 0 | 0 | 814 | 0 | 5974 | 0 | 14799 | 0 | 153079 | 0 | 0 | 0 |
| KENNETH D CRONE | ||||||||||||||
| CFO | 81544 | 81545 | 0 | 0 | 0 | 0 | 6082 | 6082 | 4848 | 4849 | 92474 | 92476 | 0 | 0 |
| JARROD JOHNSON | ||||||||||||||
| COO | 157564 | 0 | 25000 | 0 | 88 | 0 | 0 | 0 | 21867 | 0 | 204519 | 0 | 0 | 0 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | KEVIN WILD | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | ADMIN. FELLOW AND SON OF BOARD MEMBER | Relationship |
| Amount Of Transaction | 21656 | AmountOfTransaction |
| Description Of Transaction | KEVIN WILD IS AN ADMINISTRATIVE FELLOW AND A SON OF BOARD MEMBER DR. JAMES WILD. | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | 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 PREGIOUS 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.BROOKSHOSPITAL.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 13,063. PENSION LIABILITY ADJUSTMENT 637,634. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| 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. | |
| PART III, LINE I | BROOKS MEMORIAL HOSPITAL IS A PRIMARY ACUTE CARE HOSPITAL DEDICATED TO PROVIDING QUALITY HEALTH CARE SERVICES TO CONTINUOUSLY IMPROVE THE HEALTH OF PEOPLE IN WESTERN NEW YORK. TO ACCOMPLISH THIS MISSION: S.E.R.V.E. WE WILL CONTINUE TO SUPPORT THE COMMUNITY/PATIENT BY PROVIDING A BROAD ARRAY OF SERVICES TO MEET THEIR PRIMARY HEALTH CARE AND WELLNESS NEEDS, WHILE SHARING OUR SPECIAL SERVICE CAPABILITIES TO BENEFIT OUR REGION. WE WILL CONTINUE TO PROVIDE NEEDED EDUCATION ON WELLNESS AND HEALTH TO OUR PATIENTS AND COMMUNITY. WE WILL FOSTER THIS THROUGH THE DEVELOPMENT AND PROFESSIONAL GROWTH OF ALL EMPLOYEES. WE WILL REMAIN DEDICATED TO PROVIDING QUALITY HEALTH CARE THROUGH QUALITY PEOPLE. WE WILL TREAT EACH PERSON (PATIENT, FAMILY, PHYSICIAN, EMPLOYEE, AND VISITOR) WITH REVERENCE AND RESPECT, WITHOUT DISCRIMINATION ON THE BASIS OF RACE, CREED, RELIGION, NATIONALITY, SEX, AGE, FINANCIAL CLASS OR ANY OTHER BASIS. WE WILL ACTIVELY WORK WITH THE PHYSICIANS TO FULFILL OUR COMMON GOAL OF PROVIDING QUALITY PATIENT CARE. WE WILL VALUE ALL MEMBERS OF THE HEALTH CARE SYSTEM. WE WILL CONTINUE TO WORK WITH PATIENTS, FAMILIES, PHYSICIANS, HOSPITAL STAFF AND CLERGY AS A TEAM. WE WILL STRIVE TO CONTINUOUSLY IMPROVE THE QUALITY OF SERVICE TO THE COMMUNITY BY MEETING AND EXCEEDING THE NEEDS OF THE WHOLE PERSON IN A COMPASSIONATE, SAFE, MODERN, AND EFFICIENT MANNER. WE WILL SEEK LONG-TERM, MUTUALLY BENEFICIAL RELATIONSHIPS TO DELIVER QUALITY HEALTH CARE. WE WILL MONITOR, EVALUATE AND UPDATE SERVICES AND SYSTEMS AS NEEDS CHANGE, SO AS TO CONTINUE TO PROVIDE QUALITY HEALTH CARE, WHILE BEING FISCALLY RESPONSIBLE TO ENABLE US TO ACCOMPLISH THIS MISSION. | FULL MISSION STATEMENT |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | 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 | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |