HIGHMARK HEALTH: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- HIGHMARK HEALTH (EIN 16-0743222)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-15
- IRS object ID
- 201213209349306441
- Schema version
- 2011v1.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-15T14:32:06-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | 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 | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 160743222 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WESTFIELD MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | WEST | NameControl |
| Phone | 7163264921 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 189 EAST MAIN STREET | AddressLine1 |
| City | WESTFIELD | City |
| State | NY | State |
| ZIP Code | 14787 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SCOTT A WHALEN | Name |
| Title | PRESIDENT & CEO | Title |
| Phone | 7163264921 | Phone |
| Date Signed | 2012-11-15 | 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 | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | SCOTT A WHALEN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 189 EAST MAIN STREET | AddressLine1 |
| City | WESTFIELD | City |
| State | NY | State |
| ZIP Code | 14787 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 8232238 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.SAINTVINCENTHEALTH.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1944 | YearFormation |
| State Legal Domicile | NY | StateLegalDomicile |
| Activity Or Mission Description | WESTFIELD MEMORIAL HOSPITAL IS COMMITTED TO PROVIDING COMPASSION AND EXCELLENCE IN THE DELIVERY OF CARE THAT APPROPRIATELY ADDRESSES THE HEALTH NEEDS OF OUR COMMUNITIES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 15 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 15 | NbrIndependentVotingMembers |
| Total Nbr Employees | 130 | TotalNbrEmployees |
| Total Nbr Volunteers | 21 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 56018 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 261851 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 7489344 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 7788370 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 23875 | InvestmentIncomePriorYear |
| Investment Income Current Year | 25006 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 138906 | OtherRevenuePriorYear |
| Other Revenue Current Year | 157011 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 7708143 | TotalRevenuePriorYear |
| Total Revenue Current Year | 8232238 | 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 | 4788392 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 4627223 | 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 | 4839288 | OtherExpensePriorYear |
| Other Expenses Current Year | 5263542 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 9627680 | TotalExpensesPriorYear |
| Total Expenses Current Year | 9890765 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -1919537 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1658527 | RevenuesLessExpensesCY |
| Total Assets BOY | 6563211 | TotalAssetsBOY |
| Total Assets EOY | 6414910 | TotalAssetsEOY |
| Total Liabilities BOY | 1423724 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1241524 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 5139487 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 5173386 | NetAssetsOrFundBalancesEOY |
| Mission Description | WESTFIELD MEMORIAL HOSPITAL IS COMMITTED TO PROVIDING COMPASSION AND EXCELLENCE IN THE DELIVERY OF CARE THAT APPROPRIATELY ADDRESSES THE HEALTH NEEDS OF OUR COMMUNITIES. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 7964449 | Expense |
| Revenue | 7934816 | Revenue |
| Description | WESTFIELD MEMORIAL HOSPITAL, INC. IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL THAT PROVIDES INPATIENT CARE SERVICES TO ALL RESIDENTS OF NORTHERN CHAUTAUQUA COUNTY WITHOUT REGARD TO THE PATIENT'S ABILITY TO PAY. | Description |
| Total Program Service Expense | 7964449 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | 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 | 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 | 0 | 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 | 24 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 130 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| 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 |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 15 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 15 | 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 | 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 | 1 | 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 | TINA GOWEN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8144525055 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 189 EAST MAIN STREET | AddressLine1 |
| City | WESTFIELD | City |
| State | NY | State |
| ZIP Code | 14787 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| DAVID HAZELTON | ||||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |||
| HELEN BARAN | ||||||||
| CHAIR | 5.00 | X | 0 | 0 | 0 | X | ||
| SANDRA BROWN | ||||||||
| SECRETARY | 5.00 | X | 0 | 0 | 0 | X | ||
| MARK HAGEN MD | ||||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |||
| MARTHA SMITH | ||||||||
| TREASURER | 5.00 | X | 0 | 0 | 0 | X | ||
| JOHN RAWLINSON | ||||||||
| VICE CHAIR | 5.00 | X | 0 | 0 | 0 | X | ||
| ROBERT CRANE | ||||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |||
| SCOTT A WHALEN PHD | ||||||||
| PRESIDENT/CEO | 5.00 | X | 0 | 508276 | 117596 | X | ||
| JOHN HAMELS PHD | ||||||||
| VICE CHAIR | 5.00 | X | 0 | 0 | 0 | |||
| TOM BERKHOUSE | ||||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |||
| MAUREEN CHADWICK | ||||||||
| DIRECTOR | 5.00 | X | 0 | 155508 | 32592 | |||
| PAMELA FRANK | ||||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |||
| PAUL HOLLEY MD | ||||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |||
| DIANA HOLT | ||||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |||
| SCOTT MASON | ||||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |||
| KAREN BELCHER | ||||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |||
| THOMAS ELLIOTT | ||||||||
| DIRECTOR | 5.00 | X | 0 | 323066 | 18728 | |||
| THOMAS MARSH | ||||||||
| DIRECTOR | 5.00 | X | 0 | 0 | 0 | |||
| HENRY WARD | ||||||||
| CHIEF FINANCIAL OFFICER | 20.00 | 0 | 106005 | 16838 | X | |||
| BARBARA ROTTE | ||||||||
| DIRECTOR | 5.00 | 0 | 0 | 0 | X | |||
| RONALD FILIPPI | ||||||||
| PHYSICIAN ASSISTANT | 40.00 | 205177 | 0 | 24819 | X | |||
| DAVID TRUSEL | ||||||||
| PHYSICIAN ASSISTANT | 40.00 | 116710 | 0 | 14118 | X | |||
| C ANGELA BONTEMPO | ||||||||
| FORMER PRESIDENT/CEO | 0.00 | 0 | 623972 | 3522 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 321887 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1716827 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 228213 | TotalOtherCompensation |
| Number Individuals GT100 K | 2 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (4 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| TRI-STATE ANESTHESIA SERVICES | |||||
| 444 WEST 8TH STREET | ERIE | PA | 16502 | ANESTHESIA SERVICES | 281297 |
| FAMILY HEALTH MEDICAL SERVICES | |||||
| PO BOX 168 95 E CHAUTAQUA ST | MAYVILLE | NY | 14757 | CONTRACTED STAFFING OF ER AND OTHER MEDI | 259493 |
| NASH PHARMACY SERVICES PC | |||||
| 36 CENTRAL AVENUE | FREDONIA | NY | 14063 | PHARMACY SERVICES | 118440 |
| ARAMARK | |||||
| 12483 COLLECTIONS CENTER DRIVE | CHICAGO | IL | 60693 | BIOMEDICAL ENGINEERING & EQUPIMENT MAINT | 108956 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 4 | NumberOfContractorsGT100K |
| Government Grants | 261851 | GovernmentGrants |
| Total Contributions | 261851 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT REVENUE | Description |
| Business Code | 621990 | BusinessCode |
| Total Revenue Column | 7788370 | TotalRevenueColumn |
| Related Or Exempt Function Income | 7788370 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 7788370 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 24966 | TotalRevenueColumn |
| Exclusion | $24,966 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 10565 | 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 | 10565 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 10565 | TotalRevenueColumn |
| Exclusion | $10,565 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 40 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 40 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 40 | TotalRevenueColumn |
| Exclusion | $40 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| MISCELLANEOUS | 900099 | 139025 | 139025 |
| CAFETERIA | 722210 | 7421 | 7421 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 146446 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 8232238 | TotalRevenueColumn |
| Related Or Exempt Function Income | 7934816 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $35,571 | ExclusionAmount |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3878595 | Total |
| Program Services | 2914982 | ProgramServices |
| Management And General | 963613 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 56009 | Total |
| Program Services | 42007 | ProgramServices |
| Management And General | 14002 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 414597 | Total |
| Program Services | 311299 | ProgramServices |
| Management And General | 103298 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 278022 | Total |
| Program Services | 208093 | ProgramServices |
| Management And General | 69929 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 45015 | Total |
| Management And General | 45015 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1147745 | Total |
| Program Services | 1135245 | ProgramServices |
| Management And General | 12500 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1327188 | Total |
| Program Services | 1132081 | ProgramServices |
| Management And General | 195107 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 114572 | Total |
| Program Services | 1350 | ProgramServices |
| Management And General | 113222 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27589 | Total |
| Program Services | 8729 | ProgramServices |
| Management And General | 18860 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 598426 | Total |
| Program Services | 598426 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 181516 | Total |
| Program Services | 181516 | ProgramServices |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| PURCHASED SERVICES | 1439585 | 1048815 | 390770 |
| BAD DEBT EXPENSE | 359939 | 359939 | |
| MISCELLANEOUS | 21967 | 21967 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9890765 | Total |
| Program Services | 7964449 | ProgramServices |
| Management And General | 1926316 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 255037 | BOY |
| EOY | 283680 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 583224 | BOY |
| EOY | 571082 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 242100 | BOY |
| EOY | 263241 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 68113 | BOY |
| EOY | 59676 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 15054454 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 11250499 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3998381 | BOY |
| EOY | 3803955 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 918240 | BOY |
| EOY | 953871 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 51600 | BOY |
| EOY | 51600 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 446516 | BOY |
| EOY | 427805 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6563211 | BOY |
| EOY | 6414910 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1262741 | BOY |
| EOY | 1087824 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 160983 | BOY |
| EOY | 153700 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1423724 | BOY |
| EOY | 1241524 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4639221 | BOY |
| EOY | 4690148 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 403904 | BOY |
| EOY | 386876 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 96362 | BOY |
| EOY | 96362 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5139487 | BOY |
| EOY | 5173386 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6563211 | BOY |
| EOY | 6414910 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -1658527 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 1692426 | 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 |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 53750 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 1683 | InvestmentEarningsOrLosses |
| Other Expenditures | -1683 | OtherExpenditures |
| End Of Year Balance | 53750 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 53750 | BeginningOfYearBalance |
| End Of Year Balance | 53750 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5689443 | OtherCostOrOtherBasis |
| Depreciation | 3886702 | Depreciation |
| Book Value | 1802741 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 9114366 | OtherCostOrOtherBasis |
| Depreciation | 7151865 | Depreciation |
| Book Value | 1962501 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 250645 | OtherCostOrOtherBasis |
| Depreciation | 211932 | Depreciation |
| Book Value | 38713 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 3803955 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | INTEREST IN NET ASSETS OF AFFILIATED FOUNDATION | Description |
| Book Value | 427805 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 427805 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | ESTIMATED THIRD PARTY PAYOR SETTLEMENTS | Description |
| Amount | $153,700 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 153700 | TotalOfAmounts |
| Total Revenue | 8232238 | TotalRevenue |
| Total Expenses | 9890765 | TotalExpenses |
| Excess Or Deficit For Year | -1658527 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 12107 | NetUnrealizedGLOnInvestments |
| Other | $1,680,319 | OtherAmount |
| Total Adjustments | 1692426 | TotalAdjustments |
| Excess Or Deficit Per FS | 33899 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 9924664 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 12107 | NetUnrealizedGainsInvestments |
| Other Revenues | 1680319 | OtherRevenues |
| Revenue Not Rptd F990 | 1692426 | RevenueNotRptdF990 |
| Revenue Subtotal | 8232238 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 8232238 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 9890765 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 9890765 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 9890765 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE HOSPITAL IS A 501(C)(3) ORGANIZATION EXEMPT FROM INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE HOSPITAL BELIEVES IT IS NO LONGER SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES FOR YEARS PRIOR TO 2008. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | NET APPRECIATION OF FUNDS HELD IN TRUST 142,844. NET ASSET CONTRIBUTION 1,537,475. TOTAL TO SCHEDULE D, PART XI, LINE 8: 1,680,319. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | NET APPRECIATION OF FUNDS HELD IN TRUST 142,844. NET ASSET CONTRIBUTION FROM SAINT VINCENT HEALTH SYSTEM 1,537,475. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 350.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent350 | X | Pcent350 |
| 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 | 162437 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 197506 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -35069 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1202186 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 903435 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 298751 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03130 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1364623 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1100941 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 263682 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03130 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 30870 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 30870 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02760 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 30870 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 30870 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02760 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1395493 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1100941 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 294552 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05890 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $176,433 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 1129242 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 1610220 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -480978 | 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 | 0 | WrittenDebtCollectionPolicy |
| 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 | WESTFIELD MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 189 EAST MAIN STREET | AddressLine1 |
| City | WESTFIELD | City |
| State | NY | State |
| ZIP Code | 14787 | 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 | WESTFIELD MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 350.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 0 | UsesFPGDiscounted |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Other Factors | X | OtherFactors |
| Explains Application Method | 0 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| 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 | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)
| ExplanationExplanation | Return ReferenceReturnReference | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 6A: SAINT VINCENT HEALTH SYSTEM, THE SOLE CORPORATE MEMBER WESTFIELD MEMORIAL HOSPITAL, PREPARES THE COMMUNITY BENEFIT REPORT OF WESTFIELD MEMORIAL HOSPITAL. | ||
| PART I, LINE 7: THE COST-TO-CHARGE RATIO WAS CALCULATED USING WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. | ||
| BAD DEBT EXPENSE OF $359,939 HAVE BEEN EXCLUDED FROM TOTAL EXPENSES FOR CALCULATION OF PERCENT OF TOTAL EXPENSE. | PART I, LINE 7, COLULMN F | |
| PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE DUE 30 DAYS AFTER THE DATE OF DISCHARGE. RECEIVABLES PAST DUE MORE THAN 120 DAYS ARE CONSIDERED DELINQUENT. DELINQUENT RECEIVABLES ARE GENERALLY WRITTEN OFF BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE PATIENT AND OTHER THIRD-PARTY PAYORS. | ||
| PART III, LINE 8: THE AMOUNTS REPORTED ON PART III, LINE 7 ARE NOT TREATED AS COMMUNITY BENEFIT. | ||
| FOOTNOTE DESCRIBING BAD DEBT EXPENSE:PATIENT ACCOUNTS RECEIVABLE ARE DUE 30 DAYS AFTER THE DATE OF DISCHARGE. RECEIVABLES PAST DUE MORE THAN 120 DAYS ARE CONSIDERED DELINQUENT. DELINQUENT RECEIVABLES ARE GENERALLY WRITTEN OFF BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE PATIENT AND OTHER THIRD-PARTY PAYORS. | PART III, LINE 4 | |
| MEDICARE ALLOWABLE COSTS ARE CALCULATED USING A COST-TO-CHARGE RATIO. MEDICARE ALLOWABLE COSTS OF CARE CAME FROM MEDICARE COST REPORT FOR CALENDAR YEAR 2011. | PART III, LINE 7 | |
| PART V, SECTION B, LINE 10: COMMUNITY CARE DECISIONS ARE BASED ON YEARLY INCOME, FAMILY SIZE AND OTHER FACTORS, SUCH AS SAVINGS AND INVESTMENTS. THOSE FACTORS WILL BE COMPARED TO GUIDELINES APPROVED BY THE SAINT VINCENT HEALTH CENTER BOARD OF TRUSTEES TO DETERMINE ELIGIBILITY FOR COMMUNITY CARE. | WESTFIELD MEMORIAL HOSPITAL, INC. | |
| PART V, SECTION B, LINE 11H: COMMUNITY CARE DECISIONS ARE BASED ON YEARLY INCOME, FAMILY SIZE AND OTHER FACTORS, SUCH AS SAVINGS AND INVESTMENTS. THOSE FACTORS WILL BE COMPARED TO GUIDELINES APPROVED BY THE SAINT VINCENT HEALTH CENTER BOARD OF TRUSTEES TO DETERMINE ELIGIBILITY FOR COMMUNITY CARE. | WESTFIELD MEMORIAL HOSPITAL, INC. | |
| PART V, SECTION B, LINE 19D: BASED ON SECTION 501(R)(5) THE MAXIMUM AMOUNT CHARGED TO FAP - ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE IS THE SAME AMOUNT BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE. | WESTFIELD MEMORIAL HOSPITAL, INC. | |
| PART VI, LINE 2: WESTFIELD MEMORIAL HOSPITAL DOES NOT CURRENTLY HAVE A FORMALIZED METHOD TO ASSESS THE COMMUNITY FOR ITS HEALTH CARE NEEDS. WE CURRENTLY USE INTERNAL AND EXTERNAL MARKET STUDIES TO ESTABLISH PATTERNS OF UTILIZATION OF SERVICES AND AGE OF POPULATION. IN THE NEXT FEW YEARS, WESTFIELD MEMORIAL HOSPITAL PLANS TO LAUNCH A MORE FORMALIZED PROCESS TO ASSESS OUR COMMUNITY NEEDS. | ||
| PART VI, LINE 3: INFORMING THE PUBLIC THAT CHARITY CARE IS AVAILABLE IS AN IMPORTANT ELEMENT OF OUR CHARITY CARE PROGRAM AND WESTFIELD MEMORIAL HOSPITAL CONTINUOUSLY STRIVES TO IMPROVE ITS COMMUNICATIONS WITH PATIENTS ON THE AVAILABILITY OF CHARITY CARE INFORMATION AND FORMALIZING OUR CHARITY CARE POLICY. A SUMMARY DESCRIPTION OF THE CHARITY CARE POLICY IS AVAILABLE IN PATIENT REGISTRATION AREAS AND FROM FINANCIAL COUNSELORS WHO ARE PRESENT ON-SITE TO ASSIST PATIENTS IN QUALIFYING FOR GOVERNMENTAL ASSISTANCE PROGRAMS AND CHARITY CARE. | ||
| PART VI, LINE 4: WESTFIELD MEMORIAL HOSPITAL SERVES RESIDENTS IN CHAUTAUQUA COUNTY NEW YORK. CHAUTAUQUA COUNTY IS A RURAL AREA OF APPROXIMATELY 1500 SQUARE MILES AND HAS A POPULATION OF 134,904. THE COST OF LIVING INDEX IS LESS THAN AVERAGE AND THE PERCENT OF RESIDENTS LIVING IN POVERTY WAS 13.8%. | ||
| PART VI, LINE 5: ONE OF THE HALLMARKS OF A CHARITABLE ORGANIZATION IS THAT THE ORGANIZATION SERVES A BROAD, INDEFINITE CHARITABLE CAUSE. ONE OF THE KEY INDICATORS THAT AN ORGANIZATION SERVES THE BROADER COMMUNITY IS CONTROL OF THE ORGANIZATION BY INDEPENDENT COMMUNITY LEADERS. WESTFIELD MEMORIAL HOSPITAL S GOVERNING BOARD IS MADE UP OF TWO MEMBERS FROM ITS SPONSOR, THE SAINT VINCENT HEALTH SYSTEM, AND THE BALANCE FROM THE COMMUNITY AT LARGE WHO DIRECT AND GUIDE MANAGEMENT IN CARRYING OUT THE MISSION OF WESTFIELD MEMORIAL HOSPITAL. TRUSTEES ARE SELECTED ON THE BASIS OF THEIR EXPERTISE AND EXPERIENCE IN A VARIETY OF AREAS BENEFICIAL TO WESTFIELD MEMORIAL HOSPITAL AND ARE NOT COMPENSATED FOR THEIR SERVICES. | ||
| PART VI, LINE 6: WESTFIELD MEMORIAL HOSPITAL WAS BUILT ON A FOUNDATION OF CARING FOR ALL PEOPLE AND THAT COMMITMENT HAS REMAINED STRONG THROUGH THE YEARS. IT IS A PART OF THE SAINT VINCENT HEALTH SYSTEM LOCATED IN NEARBY ERIE PENNSYLVANIA. THIS MISSION HAS HELPED TO MAKE SAINT VINCENT HEALTH SYSTEM ONE OF THE LARGEST EMPLOYERS IN ERIE, PENNSYLVANIA AND WESTFIELD, NEW YORK WITH THE ABILITY TO MAKE A SIGNIFICANTLY POSITIVE ECONOMIC IMPACT ON ERIE COUNTY PA AND CHAUTAUQUA COUNTY NEW YORK IN TERMS OF SALARIES PAID TO ASSOCIATES AND DOLLARS SPENT WITHIN THE REGION. THIS ECONOMIC IMPACT IN FISCAL YEAR 2011 AMOUNTS TO MORE THAN $604 MILLION, A 9.7% INCREASE OVER THE PREVIOUS YEAR. IN ADDITION, MORE THAN $25.9 MILLION WAS SPENT CARING FOR THOSE MOST IN NEED THROUGH THE HOSPITAL'S COMMUNITY SERVICE, FREE SERVICES AND MEDICAID PATIENTS. | ||
| A COMMUNITY BENEFIT REPORT IS FILED IN NEW YORK. | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | 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 (5 entries)
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SCOTT A WHALEN PHD | |||||||||||||
| 0 | 492170 | 0 | 0 | 0 | 16106 | 0 | 106645 | 0 | 10951 | 0 | 625872 | 0 | 0 |
| MAUREEN CHADWICK | |||||||||||||
| 0 | 154868 | 0 | 0 | 0 | 640 | 0 | 20710 | 0 | 11882 | 0 | 188100 | 0 | 0 |
| THOMAS ELLIOTT | |||||||||||||
| 0 | 277506 | 0 | 0 | 0 | 45560 | 0 | 12802 | 0 | 5926 | 0 | 341794 | 0 | 23031 |
| RONALD FILIPPI | |||||||||||||
| 205177 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 24819 | 0 | 229996 | 0 | 0 | 0 |
| C ANGELA BONTEMPO | |||||||||||||
| 0 | 603942 | 0 | 0 | 0 | 20030 | 0 | 0 | 0 | 3522 | 0 | 627494 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 4B | SCOTT WHALEN EARNED DEFERRED COMPENSATION OF $106,645 THOMAS ELLIOTT EARNED DEFERRED COMPENSATION OF $12,802 THOMAS ELLIOTT RECEIVED A RETIREMENT PAYMENT OF $15,399 MAUREEN CHADWICK EARNED DEFERRED COMPENSATION OF $20,710 | |
| PART III | ADDITIONAL INFORMATION FOR SCHEDULE J, PART II: SCOTT WHALEN: HEALTH, DENTAL & DISABILITY INSURANCE BENEFITS - $10,951; 2011 DEFERRED COMPENSATION - $106,645; TOTAL 2011 BENEFITS EARNED - $117,596; TOTAL BENEFITS - $117,596. MAUREEN CHADWICK: HEALTH, DENTAL & DISABILITY INSURANCE BENEFITS - $11,822; 2011 DEFERRED COMPENSATION - $20,710; TOTAL 2011 BENEFITS EARNED - $32,592; TOTAL BENEFITS - $32,592. RONALD FILIPPI: HEALTH, DENTAL & DISABILITY INSURANCE BENEFITS - $39,602; TOTAL 2011 BENEFITS EARNED - $39,602; TOTAL BENEFITS - $39,602. THOMAS ELLIOTT: HEALTH, DENTAL & DISABILITY INSURANCE BENEFITS - $5,926; 2011 DEFERRED COMPENSATION - $12,802; TOTAL 2011 BENEFITS EARNED - $18,728; TOTAL PRIOR PERIOD DEFERRED COMPENSATION - $23,031; TOTAL BENEFITS - $41,759. C. ANGELA BONTEMPO: HEALTH, DENTAL & DISABILITY INSURANCE BENEFITS - $3,522; TOTAL 2011 BENEFITS EARNED - $3,522; TOTAL BENEFITS - $3,522. | SUPPLEMENTAL INFORMATION |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | SAINT VINCENT HEALTH SYSTEM IS THE SOLE CORPORATE MEMBER OF WESTFIELD MEMORIAL HOSPITAL. | |
| FORM 990, PART VI, SECTION A, LINE 7A | SAINT VINCENT HEALTH SYSTEM IS THE SOLE CORPORATE MEMBER OF WESTFIELD MEMORIAL HOSPITAL. | |
| FORM 990, PART VI, SECTION A, LINE 7B | SAINT VINCENT HEALTH SYSTEM IS THE SOLE CORPORATE MEMBER OF WESTFIELD MEMORIAL HOSPITAL. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 IS REVIEWED BY FINANCE PERSONNEL AND MANAGEMENT. THE FORM 990 IS THEN PRESENTED TO THE BOARD OF DIRECTORS FOR FINAL REVIEW AND APPROVAL. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE POLICY IS DISTRIBUTED TO THE BOARD OF DIRECTORS AND KEY LEADERSHIP IN ACCORDANCE WITH THE WMH CONFLICT OF INTEREST POLICY. COLLECTED DISCLOSURE FORMS ARE PRE-SCREENED BY THE CORPORATE COMPLIANCE OFFICER AND LEGAL COUNSEL FOR POTENTIAL CONFLICTS AND RECOMMENDATIONS FOR CORRECTIVE ACTION, IF NECESSARY. THE CORPORATE COMPLIANCE OFFICER THEN DISCUSSES THESE DISCLOSURES AND CORRECTIVE ACTIONS WITH THE CHAIRPERSON OF THE WMH BOARD OF DIRECTORS. THE CHAIRPERSON WOULD THEN TAKE ACTION AS NECESSARY. | |
| FORM 990, PART VI, SECTION B, LINE 15 | EXECUTIVE AND TOP MANAGEMENT COMPENSATION IS DETERMINED BY THE SAINT VINCENT HEALTH SYSTEM HUMAN RESOURCES DEPARTMENT AND AN EXECUTIVE COMPENSATION CONSULTING FIRM. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED GAINS ON INVESTMENTS: 12,107. NET APPRECIATION OF FUNDS HELD IN TRUST 142,844. NET ASSET CONTRIBUTION 1,537,475. TOTAL TO FORM 990, PART XI, LINE 5: 1,692,426. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| 990, PART XI, LINE 2C | THE PROCESS IS CONSISTENT WITH PRIOR YEAR. |
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 |
|---|---|---|---|---|---|---|---|---|---|---|
| SAINT VINCENT HEALTH SYSTEM | ||||||||||
| 232 WEST 25TH STREET | ERIE | PA | 16544 | 250965547 | HEALTH CARE | PA | 501(C)(3) | 11 | SISTERS OF SAINT JOSEPH OF NORTHWESTERN PA | 0 |
| SAINT VINCENT FOUNDATION FOR HEALTH AND HUMAN SERVICES | ||||||||||
| 232 WEST 25TH STREET | ERIE | PA | 16544 | 251669168 | HEALTH CARE | PA | 501(C)(3) | 11 | SISTERS OF SAINT JOSEPH OF NORTHWESTERN PA | 0 |
| SAINT VINCENT MEDICAL EDUCATION AND RESEARCH INSTITUTE | ||||||||||
| 238 WEST 22ND STREET | ERIE | PA | 16502 | 251679140 | HEALTH CARE | PA | 501(C)(3) | 9 | SAINT VINCENT HEALTH SYSTEM | 0 |
| NORTHWEST REGIONAL GAMMA KNIFE NETWORK | ||||||||||
| 232 WEST 25TH STREET | ERIE | PA | 16544 | 201007381 | HEALTH CARE | PA | 501(C)(3) | 3 | SAINT VINCENT HEALTH CENTER | 0 |
| SAINT VINCENT SURGERY CENTER OF ERIE | ||||||||||
| 312 WEST 25TH STREET | ERIE | PA | 16502 | 421609387 | HEALTH CARE | PA | 501(C)(3) | 3 | SAINT VINCENT HEALTH CENTER | 0 |
| MILLCREEK PHYSICIAN ASSOCIATES | ||||||||||
| 1910 SASSAFRAS STREET SUITE 100 | ERIE | PA | 16502 | 200509297 | HEALTH CARE | PA | 501(C)(3) | 9 | SAINT VINCENT HEALTH SYSTEM | 0 |
| SAINT VINCENT AFFILIATED PHYSICIANS | ||||||||||
| 1910 SASSAFRAS STREET SUITE 100 | ERIE | PA | 16502 | 203784338 | HEALTH CARE | PA | 501(C)(3) | 9 | SAINT VINCENT HEALTH SYSTEM | 0 |
| SAINT VINCENT HEALTH CENTER | ||||||||||
| 232 WEST 25TH STREET | ERIE | PA | 16544 | 250965547 | HEALTH CARE | PA | 501(C)(3) | 3 | SISTERS OF SAINT JOSEPH OF NORTHWESTERN PA | 0 |
| ERIE REGIONAL DMAT PA-3 | ||||||||||
| 232 WEST 25TH STREET | ERIE | PA | 16544 | 753140132 | HEALTH CARE | PA | 501(C)(3) | 7 | SAINT VINCENT HEALTH CENTER | 0 |
| SISTERS OF SAINT JOSEPH OF NORTHWESTERN PA | ||||||||||
| 5031 W RIDGE ROAD | ERIE | PA | 16506 | 250965595 | HEALTH CARE | PA | 501(C)(3) | 1 | NONE | 0 |
| REGIONAL TELEMEDICINE NETWORK | ||||||||||
| 232 WEST 25TH STREET | ERIE | PA | 16544 | 271117671 | HEALTH CARE | PA | 501(C)(3) | 11 | SAINT VINCENT HEALTH SYSTEM | 0 |
Form990 Schedule R Part III Form990ScheduleRPartIII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner |
|---|---|---|---|---|---|---|---|---|---|---|
| SAINT VINCENT NWPA SURGERY CENTER LTD | ||||||||||
| 312 WEST 25TH STREET | ERIE | PA | 16502 | 050591755 | HEALTH CARE | PA | CLINICAL SERVICES INC | RELATED | 0 | 0 |
| SAINT VINCENT PROFESSIONAL BLDG LEASEHOLD CONDO ASSN | ||||||||||
| 312 WEST 25TH STREET | ERIE | PA | 16502 | 251578290 | HEALTH CARE | PA | CLINICAL SERVICES INC | RELATED | 0 | 0 |
| SAINT VINCENT ENDOSCOPY | ||||||||||
| 2501 WEST 12TH STREET | ERIE | PA | 16506 | 208572620 | HEALTH CARE | PA | SAINT VINCENT HEALTH CENTER | RELATED | 0 | 0 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity |
|---|---|---|---|---|---|---|---|---|
| CLINICAL DEVELOPMENT INC | ||||||||
| 232 WEST 25TH STREET | ERIE | PA | 16544 | 232380381 | HEALTH CARE | PA | SAINT VINCENT HEALTH SYSTEM | C |
| CLINICAL SERVICES INC | ||||||||
| 232 WEST 25TH STREET | ERIE | PA | 16544 | 251403846 | HEALTH CARE | PA | CLINICAL DEVELOPEMENT INC | C |
| SAINT VINCENT REHAB SOLUTIONS LLC | ||||||||
| 1910 SASSAFRAS STREET SUITE 200 | ERIE | PA | 16502 | 050544042 | HEALTH CARE | PA | CLINICAL DEVELOPEMENT INC | C |
| COMPLIMENTARY CARE | ||||||||
| 232 WEST 25TH STREET | ERIE | PA | 16544 | 251612340 | HEALTH CARE | PA | CLINICAL DEVELOPEMENT INC | C |
| SAINT VINCENT CONSULTANTS IN CARDIOVASCULAR DISEASE LLC | ||||||||
| 232 WEST 25TH STREET | ERIE | PA | 16544 | 273459870 | HEALTH CARE | PA | CLINICAL SERVICES INC | C |
| 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 | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| 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 | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | 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 |