ELIZABETHTOWN COMMUNITY HOSPITAL: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- ELIZABETHTOWN COMMUNITY HOSPITAL (EIN 14-1364513)
- Tax period
- 2021-10-01 to 2022-09-30
- Filed
- 2023-08-14
- IRS object ID
- 202342269349302784
- Schema version
- 2021v4.2
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-08-14T16:08:01-05:00 | ReturnTs |
| Tax Period End | 2022-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 161226221 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FUSTCHARLES LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 S WARREN STREET | AddressLine1Txt |
| City | SYRACUSE | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13202 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 141364513 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ELIZABETHTOWN COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ELIZ | BusinessNameControlTxt |
| Phone | 5188736377 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 75 PARK STREET PO BOX 277 | AddressLine1Txt |
| City | ELIZABETHTOWN | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 12932 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ROBERT ORTMYER | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 5188733002 | PhoneNum |
| Signature | 2023-08-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | ROBERT | PersonFirstNm |
| Person Last | ORTMYER | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | THOMAS J GIUFRE | PreparerPersonNm |
| PTIN | P00841958 | PTIN |
| Phone | 3154463600 | PhoneNum |
| Preparation | 2023-08-10 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ROBERT ORTMYER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 75 PARK STREET PO BOX 277 | AddressLine1Txt |
| City | ELIZABETHTOWN | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 12932 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $56,333,805 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | ECH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1926 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | MISSION: TO PROMOTE WELLNESS IN THE COMMUNITIES WE SERVE BY PROVIDING QUALITY HEALTHCARE WITH SKILL, COMPASSION AND DIGNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 392 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | -$232,646 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,123,307 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,669,589 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $45,465,960 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $49,522,137 | CYProgramServiceRevenueAmt |
| PY Investment Income | $192,441 | PYInvestmentIncomeAmt |
| CY Investment Income | -$22,029 | CYInvestmentIncomeAmt |
| PY Other Revenue | $5,886,761 | PYOtherRevenueAmt |
| CY Other Revenue | $4,747,273 | CYOtherRevenueAmt |
| PY Total Revenue | $54,668,469 | PYTotalRevenueAmt |
| CY Total Revenue | $55,916,970 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $24,676,319 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $33,281,482 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $26,016,125 | PYOtherExpensesAmt |
| CY Other Expenses | $19,657,430 | CYOtherExpensesAmt |
| PY Total Expenses | $50,692,444 | PYTotalExpensesAmt |
| CY Total Expenses | $52,938,912 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,976,025 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,978,058 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $83,172,080 | TotalAssetsBOYAmt |
| Total Assets EOY | $77,492,427 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $35,545,645 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $29,352,074 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $47,626,435 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $48,140,353 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF ECH IS TO PROMOTE HEALTH AND WELLNESS IN THE COMMUNITY AND TO PROVIDE QUALITY HEALTHCARE WITH SKILL, COMPASSION AND DIGNITY. IN CREATING OUR COMMUNITY BENEFITS PLAN WE KEEP THIS MISSION IN MIND, CONTINUALLY LOOKING FOR WAYS TO MEET COMMUNITY HEALTH NEEDS AND TO BE A GOOD NEIGHBOR. ECH IS DRIVEN BY PEOPLE WHO LIVE IN THE SERVICE AREA AND WHO WANT TO SEE THEIR FRIENDS AND NEIGHBORS GET THE CARE AND SERVICES THEY NEED. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $9,987,211 | ExpenseAmt |
| Revenue | $9,675,381 | RevenueAmt |
| Desc | INPATIENT ACUTE UNIT AND SUBACUTE REHABILITATIVE (SWING BED) INPATIENT PROGRAM:A 25-BED NURSING UNIT PROVIDING ACUTE AND SUB ACUTE (SWING BED)CARE. THE SMALLER ATMOSPHERE CREATES A CLOSER BOND BETWEEN THE PATIENT AND PROFESSIONALS ENCOURAGING OPTIMAL HEALING AND COMPASSIONATE CARE. THE SUB-ACUTE PROGRAM IS VITAL TO AREA RESIDENTS BECAUSE FOLLOWING A HIP-REPLACEMENT, KNEE-SURGERY OR CARDIAC OPERATION, RECUPERATION AND THERAPY CAN BE DONE AT ELIZABETHTOWN COMMUNITY HOSPITAL, SAVING THE FAMILY THE TIME AND EXPENSE OF TRAVEL. THE PROGRAM PROVIDES ONE-ON-ONE THERAPEUTIC CARE. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $13,702,976 | ExpenseAmt |
| Revenue | $10,704,876 | RevenueAmt |
| Desc | CLINIC SERVICES:ECH OPERATES THE ELIZABETHTOWN COMMUNITY HEALTH CENTER, WESTPORT HEALTH CENTER LOCATED IN WESTPORT,NY, THE HIGH PEAKS HEALTH CENTER LOCATED IN WILMINGTON, NY, THE SMITH HOUSE HEALTH CENTER LOCATED IN WILLSBORO, NY, THE AU SABLE FORKS HEALTH CENTER, LOCATED IN AU SABLE FORKS, NY, AND CROWN POINT HEALTH CENTER, LOCATED IN CROWN POINT, NY. ECH OPERATES AN OUTPATIENT CHEMOTHERAPY PROGRAM, WHICH INCLUDES UPDATED INFUSION EQUIPMENT MAKING IT POSSIBLE TO PROVIDE SAFE AND EFFICIENT METHODS FOR CHEMOTHERAPY AND BLOOD-RELATED INFUSIONS. IN ADDITION, THE NEW SPECIALIZED VENTILATING HOOD ENABLES THE PREPARATION OF CHEMOTHERAPY SOLUTIONS ON-SITE. THIS IS A GREAT CONVENIENCE FOR CANCER PATIENTS, SAVING THEM THE 90-MINUTE ROUND-TRIP DRIVE TO THE CLOSEST CHEMOTHERAPY FACILITY. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $17,794,025 | ExpenseAmt |
| Revenue | $14,519,694 | RevenueAmt |
| Desc | EMERGENCY ROOM SERVICES:ECH'S PRIOR YEARS EXPANSION OF THE EMERGENCY ROOM ADDED NEW STATE OF THE ART TRAUMA ROOMS, A TELEMENTRY SYSTEM FOR PATENT MONITORING, A REGISTRATION AREA DESIGNED FOR PATIENT PRIVACY AND CONFIDENTIALITY AND NEW WAITING AREAS FOR FAMILIES AND THEIR LOVED ONES.THE HOSPITAL OPERATES AN ALL-DIGITAL RADIOLOGY DEPARTMENT, ALLOWING TECHNOLOGISTS TO OBTAIN PATIENT IMAGES ANYWHERE IN THE HOSPITAL. IN THE EVENT OF A SIGNIFICANT EMERGENCY WITH MULTIPLE TRAUMAS, THE UNIT CAN BE USED ANYWHERE IN THE BUILDING. WHEN THE HOSPITAL IS FACED WITH AN UNUSUAL SURGE IN EMERGENCY ROOM TRAUMA CASES, HOSPITAL PROCEDURES ENABLE STAFF TO TRIAGE IN NONTRADITIONAL AREAS OF THE HOSPITAL. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,163,981 | ExpenseAmt |
| Revenue | $19,566,030 | RevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $1,163,981 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $19,566,030 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $42,648,193 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 21 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 392 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NY | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SCOTT COMEAU CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5188733136 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 75 PARK STREET PO BOX 277 | AddressLine1Txt |
| City | ELIZABETHTOWN | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 12932 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| MEGAN MURPHY | ||||||||
| BOARD MEMBER | 0.80 | Yes (X) | $0 | $0 | $0 | |||
| MARTIN NEPHEW | ||||||||
| BOARD TREASURER | 0.80 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| SUSAN ALLOTT RN | ||||||||
| CHAIR | 0.80 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| GAYLE ALEXANDER | ||||||||
| BOARD MEMBER | 0.80 | Yes (X) | $0 | $0 | $0 | |||
| STEVE CACCHIO | ||||||||
| TREASURER | 0.80 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| MARGARET EMERY-GINN | ||||||||
| BOARD MEMBER | 0.80 | Yes (X) | $0 | $0 | $0 | |||
| ROLAND J ALLEN | ||||||||
| BOARD MEMBER | 0.80 | Yes (X) | $0 | $0 | $0 | |||
| DAVID SHELMIDINE | ||||||||
| VICE CHAIR | 0.80 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| EVAN GEORGE | ||||||||
| SECRETARY | 0.80 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| ROBERT ORTMYER | ||||||||
| PRESIDENT | 40.00 | Yes (X) | $177,898 | $0 | $4,901 | Yes (X) | ||
| JOSEPH BOGARDUS PHD | ||||||||
| BOARD MEMBER | 0.80 | Yes (X) | $0 | $0 | $0 | |||
| TERRI MORSE | ||||||||
| BOARD MEMBER | 0.80 | Yes (X) | $0 | $0 | $0 | |||
| ALAN JONES | ||||||||
| BOARD MEMBER | 0.80 | Yes (X) | $0 | $0 | $0 | |||
| ALAN CHARDAVOYNE | ||||||||
| CFO | 40.00 | $279,244 | $0 | $11,108 | Yes (X) | |||
| MATTHEW NOLAN | ||||||||
| COO | 40.00 | $245,072 | $0 | $9,723 | Yes (X) | |||
| JOHN REMILLARD | ||||||||
| PRESIDENT | 40.00 | $429,795 | $0 | $1,889 | Yes (X) | |||
| JULIE TROMBLEE | ||||||||
| CNO | 40.00 | $221,359 | $0 | $10,092 | Yes (X) | |||
| ROB DEMURO MD | ||||||||
| PHYSICIAN | 40.00 | $394,773 | $0 | $42,125 | Yes (X) | |||
| LAURA MULVEY | ||||||||
| PHISICIAN | 40.00 | $325,535 | $0 | $22,491 | Yes (X) | |||
| MARY HALLORAN | ||||||||
| PHYSICIAN | 40.00 | $329,457 | $0 | $43,666 | Yes (X) | |||
| DAVID MARKOWITZ | ||||||||
| ER PHYSICIAN | 40.00 | $330,713 | $0 | $14,714 | Yes (X) | |||
| JAMES RICE | ||||||||
| ER PHYSICIAN | 40.00 | $330,713 | $0 | $30,875 | Yes (X) | |||
| DAVID CLAUSS | ||||||||
| FORMER MEDICAL DIRECTOR | 40.00 | $0 | $171,206 | $22,968 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,064,559 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $171,206 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $214,552 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 43 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $562,698 | GovernmentGrantsAmt |
| All Other Contributions | $1,106,891 | AllOtherContributionsAmt |
| Total Contributions | $1,669,589 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CRITICAL ACCESS HOSPITAL | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $49,522,137 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $49,522,137 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $49,522,137 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $21,232 | TotalRevenueColumnAmt |
| Exclusion | $21,232 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $158,413 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $366,184 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$207,771 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$207,771 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | -$232,646 | UnrelatedBusinessRevenueAmt |
| Exclusion | $24,875 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $43,261 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$43,261 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$43,261 | TotalRevenueColumnAmt |
| Exclusion | -$43,261 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $18,590 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $7,390 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,200 | TotalRevenueColumnAmt |
| Exclusion | $11,200 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| 340B REVENUE | 900099 | $2,462,190 | $2,462,190 |
| MEANINGFUL USE INCOME | 900099 | $950,346 | $950,346 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,531,308 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,531,308 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $4,943,844 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $55,916,970 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $54,465,981 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | -$232,646 | UnrelatedBusinessRevenueAmt |
| Exclusion | $14,046 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,391,081 | TotalAmt |
| Management And General | $1,391,081 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,079,716 | TotalAmt |
| Program Services | $23,113,745 | ProgramServicesAmt |
| Management And General | $2,965,971 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,085,327 | TotalAmt |
| Program Services | $840,235 | ProgramServicesAmt |
| Management And General | $245,092 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,946,435 | TotalAmt |
| Program Services | $2,744,444 | ProgramServicesAmt |
| Management And General | $201,991 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,778,923 | TotalAmt |
| Program Services | $1,268,030 | ProgramServicesAmt |
| Management And General | $510,893 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $226,104 | TotalAmt |
| Management And General | $226,104 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $84,489 | TotalAmt |
| Management And General | $84,489 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,877 | TotalAmt |
| Management And General | $78,877 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,174,755 | TotalAmt |
| Program Services | $4,998,718 | ProgramServicesAmt |
| Management And General | $176,037 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,132 | TotalAmt |
| Management And General | $6,132 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,161,263 | TotalAmt |
| Program Services | $380,428 | ProgramServicesAmt |
| Management And General | $780,835 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $253,727 | TotalAmt |
| Program Services | $182,119 | ProgramServicesAmt |
| Management And General | $71,608 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $394,460 | TotalAmt |
| Program Services | $157,770 | ProgramServicesAmt |
| Management And General | $236,690 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,693,421 | TotalAmt |
| Program Services | $3,508,750 | ProgramServicesAmt |
| Management And General | $184,671 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $270,709 | TotalAmt |
| Program Services | $270,709 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| CONTRACTED, LINEN & PUR | $5,370,801 | $2,567,720 | $2,803,081 |
| BAD DEBT EXPENSE | $2,116,860 | $2,116,860 | |
| OTHER EXPENSES | $602,338 | $287,821 | $314,517 |
| PROVIDER TAX | $145,633 | $145,633 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $77,861 | TotalAmt |
| Program Services | $65,211 | ProgramServicesAmt |
| Management And General | $12,650 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,938,912 | TotalAmt |
| Program Services | $42,648,193 | ProgramServicesAmt |
| Management And General | $10,290,719 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,409,526 | BOYAmt |
| EOY | $5,452,384 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,072,661 | BOYAmt |
| EOY | $20,820,018 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,750 | BOYAmt |
| EOY | $1,750 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,333,641 | BOYAmt |
| EOY | $9,754,409 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $758,014 | BOYAmt |
| EOY | $850,159 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,140,616 | BOYAmt |
| EOY | $1,092,615 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $58,906,586 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $25,266,677 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,261,461 | BOYAmt |
| EOY | $33,639,909 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,629,254 | BOYAmt |
| EOY | $3,965,295 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,515,157 | BOYAmt |
| EOY | $1,915,888 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $83,172,080 | BOYAmt |
| EOY | $77,492,427 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,478,187 | BOYAmt |
| EOY | $5,303,829 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $66,864 | BOYAmt |
| EOY | $47,421 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,865,000 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,184,287 | BOYAmt |
| EOY | $13,240,005 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,951,307 | BOYAmt |
| EOY | $10,760,819 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,545,645 | BOYAmt |
| EOY | $29,352,074 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,396,235 | BOYAmt |
| EOY | $47,108,782 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,230,200 | BOYAmt |
| EOY | $1,031,571 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,626,435 | BOYAmt |
| EOY | $48,140,353 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $83,172,080 | BOYAmt |
| EOY | $77,492,427 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,978,058 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$2,464,140 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,230,200 | BeginningYearBalanceAmt |
| Contributions | $600,318 | ContributionsAmt |
| Investment Earnings Or Losses | -$145,736 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $653,211 | OtherExpendituresAmt |
| End Year Balance | $1,031,571 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,658,795 | BeginningYearBalanceAmt |
| Contributions | $3,105,896 | ContributionsAmt |
| Investment Earnings Or Losses | $115,670 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $3,650,161 | OtherExpendituresAmt |
| End Year Balance | $1,230,200 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,644,993 | BeginningYearBalanceAmt |
| Contributions | $8,433,494 | ContributionsAmt |
| Investment Earnings Or Losses | $49,870 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $8,469,562 | OtherExpendituresAmt |
| End Year Balance | $1,658,795 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,631,608 | BeginningYearBalanceAmt |
| Contributions | $864,223 | ContributionsAmt |
| Investment Earnings Or Losses | $35,904 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $886,742 | OtherExpendituresAmt |
| End Year Balance | $1,644,993 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $798,658 | BeginningYearBalanceAmt |
| Contributions | $3,288,805 | ContributionsAmt |
| Investment Earnings Or Losses | $41,288 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $2,497,143 | OtherExpendituresAmt |
| End Year Balance | $1,631,608 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.33333 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.66667 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,251,625 | OtherCostOrOtherBasisAmt |
| Book Value | $1,251,625 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $40,911,024 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,726,747 | DepreciationAmt |
| Book Value | $27,184,277 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,615,292 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,512,124 | DepreciationAmt |
| Book Value | $3,103,168 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,128,645 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,027,806 | DepreciationAmt |
| Book Value | $2,100,839 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $33,639,909 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MUTUAL FUNDS | Desc |
| Book Value | $3,965,295 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $3,965,295 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO AFFILIATES | $122,312 |
| THIRD PARTY PAYOR SETTLEMENTS | $7,619,830 |
| CONTRACT LIABILITY | $1,312,529 |
| OPERATING LEASE LIABILITY | $1,706,148 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $10,760,819 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | CERTAIN BOARD-DESIGNATED FUNDS HAVE BEEN ESTABLISHED TO MEET SPECIFIC CURRENT AND FUTURE NEEDS OF THE HOSPITAL OR TO ADEQUATELY DISCHARGE FUTURE LIABILITES. THESE FUNDS INCLUDE THE PLANT AND CAPITAL IMPROVEMENT FUNDS, WHICH ARE DESIGNATED FOR SPECIFIC PROJECTS SUCH AS THE SURGICAL CENTER CONSTRUCTION, AND DESIGNATED FUNDS FOR BOTH SELF-INSURANCE AND FOR CVPH'S VARIOUS EMPLOYEE BENEFIT PLANS. TEMPORARILY RESTRICTED NET ASSETS ARE INTENDED FOR THE PURCHASE OF PROPERTY AND EQUIPMENT. PERMANENTLY RESTRICTED NET ASSETS ARE TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS EXPENDABLE TO SUPPORT HEALTH CARE SERVICES, INCLUDING MEDICAL SERVICES PROVIDED TO CHILDREN, AND PROVIDING FOR CHARITY CARE. |
| PART X, LINE 2: | ENTITIES WITHIN UVM HEALTH NETWORK, WITH THE EXCEPTION OF ENTITIES SPECIFICALLY NAMED BELOW, ARE INCORPORATED AND RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS TAX-EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE). ACCORDINGLY, THE IRS HAS DETERMINED THAT THESE ORGANIZATIONS ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. HEALTH NETWORK VENTURES HOLDING, LLC, UNIVERSITY OF VERMONT HEALTH NETWORK SPECIALTY CARE TRANSPORT, LLC, UNIVERSITY OF VERMONT MEDICAL CENTER SKILLED NURSING, LLC, UNIVERSITY OF VERMONT MEDICAL CENTER EXECUTIVE SERVICES, LLC, VALCOUR IMAGING, INC., AND PORTER REAL ESTATE HOLDINGS, LLC, ARE SINGLE-MEMBER LIMITED LIABILITY CORPORATIONS. AS SUCH, FOR TAX PURPOSES, THESE ORGANIZATIONS ARE TREATED AS DIVISIONS OF THEIR SOLE MEMBER. EARNINGS AND LOSSES ARE PASSED THROUGH TO THE OWNERS, WHICH ARE TAX-EXEMPT, AND ARE TREATED IN THE SAME MANNER FOR TAX PURPOSES. NO PROVISION FOR FEDERAL INCOME TAXES HAS BEEN RECORDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR THESE ORGANIZATIONS. UVM HEALTH NETWORK HEALTH VENTURES, INC., MEDICAL EDUCATION CENTER CONDOMINIUM ASSOCIATION, INC., MEDIQUEST CORP., EMERGENCY MEDICAL TRANSPORT OF CVPH, INC., AND CHAMPLAIN VALLEY HEALTH NETWORK, INC. ARE TAXABLE CORPORATIONS FOR WHICH THE PROVISION FOR INCOME TAXES IS IMMATERIAL TO THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF | Event1Nm |
| Gross Receipts Event1 | $18,590 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $18,590 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $1,000 | CashPrizesEvent1Amt |
| Non Cash Prizes Event1 | $1,032 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $3,490 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $1,868 | FoodAndBeverageEvent1Amt |
| Gross Receipts Total | $18,590 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $18,590 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $1,000 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $1,032 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $3,490 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $1,868 | FoodAndBeverageTotalEventsAmt |
| Direct Expense Summary Events | $7,390 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $11,200 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent350 | Yes (X) | Percent350Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $301,002 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $301,002 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00590 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,173,005 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,811,277 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,361,728 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12520 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $167,136 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $167,136 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00330 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,641,143 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,811,277 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,829,866 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13440 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $77,048 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $77,048 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $45,583,018 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $37,904,446 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,678,572 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.15110 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $27,328 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $27,328 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $45,687,394 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $37,904,446 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,782,948 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.15310 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $55,328,537 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $40,715,723 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $14,612,814 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.28750 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,116,860 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $133,866 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $18,031,351 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $17,906,111 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $125,240 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ELIZABETHTOWN COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 75 PARK STREET PO BOX 277 | AddressLine1Txt |
| City | ELIZABETHTOWN | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 12932 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | 25 BEDS (ACUTE & SWING), 6 HEALTHCENTERS, CT, LAB, PHARM. PT. AMB SURG. | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ELIZABETHTOWN COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTPS://WWW.ECH.ORG/DATA/FILES/COMMUNITY%20SERVICE%20PLAN%20WITH%20COLLABOR | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | WWW.CO.ESSEX.NY.US., HTTPS://AHIHEALTH.ORG/ARHN | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTPS://WWW.ECH.ORG/DATA/FILES/COMMUNITY%20SERVICE%20PLAN%20WITH%20COLLABOR | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 350.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.ECH.ORG/DATA/FILES/ECH%20FINANCIAL%20ASSISTANCE%20SUMMARY%20202 | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.ECH.ORG/DATA/FILES/2020%20FAP%20APPLICATION%20ECH.PDF | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.ECH.ORG/DATA/FILES/2020%20FAP%20APPLICATION%20ECH.PDF | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| ELIZABETHTOWN COMMUNITY HOSPITAL | PART V, SECTION B, LINE 5: EXECUTIVES FROM THE FOLLOWING INSTITUTIONS: ADIRONDACK HEALTH, ADIRONDACK MEDICAL CENTER, ADIRONDACK RURAL HEALTH NETWORK AND ESSEX COUNTY PUBLIC HEALTH. |
| ELIZABETHTOWN COMMUNITY HOSPITAL | PART V, SECTION B, LINE 6B: COUNTY HEALTH DEPARTMENT |
| ELIZABETHTOWN COMMUNITY HOSPITAL | PART V, SECTION B, LINE 7D: ESSEX COUNTY PUBLIC HEALTH |
| ELIZABETHTOWN COMMUNITY HOSPITAL | PART V, SECTION B, LINE 11: COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY:COMMUNITY SERVED - ELIZABETHTOWN COMMUNITY HOSPITAL'S PRIMARY SERVICE AREA IS COMPOSED OF TWENTY-TWO ZIP CODES IN NORTHEASTERN ESSEX COUNTY. THE HOSPITAL IS LOCATED 45-60 MINUTES AWAY FROM ANY OTHER HOSPITAL, THROUGH A MOUNTAINOUS REGION AND MOSTLY ALONG A SERIES OF SECONDARY ROADS. THE REGION BOASTS A ROBUST SEASONAL POPULATION, SWELLING SIGNIFICANTLY THROUGHOUT THE SUMMER AND WINTER MONTHS, DUE TO THE CONSIDERABLE NUMBER OF SECOND HOMEOWNERS IN THE REGION, ALONG WITH INCREASED TOURISM.DEMOGRAPHICS OF ESSEX COUNTY: - 37,281 RESIDENTS- 23.5% ARE 65 YEARS OF AGE OR OLDER- 93.0% OF THE POPULATION IS WHITE, 3.1% IS HISPANIC, AND 3.2% IS BLACK/AFRICAN AMERICAN- 94.4% ADULTS HAVE HEALTH INSURANCESIGNIFICANT HEALTH NEEDS IDENTIFIED IN 2022 CHNA:- CHRONIC DISEASE- OBESITY- ACCESS TO HEALTHY FOOD- ACCESS TO CARE- SUBSTANCE ABUSE- BEHAVIORAL HEALTHNEEDS SELECTED FOR 2022 IMPLEMENTATION STRATEGY:- PREVENT CHRONIC DISEASE- PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE ABUSE DISORDERS- PROMOTE HEALTHY WOMEN, INFANTS AND CHILDRENNEEDS NOT SELECTED:- PROMOTE A HEALTHY AND SAFE ENVIRONMENT- PREVENT COMMUNICABLE DISEASE RATIONALE: - WHILE NOT SELECTED FOR THE COMMUNITY SERVICE PLAN, THE TWO INTERVENTIONS ARE INCORPORATED INTO THE SELECTED PRIORITIESHIGHLIGHTS FROM 2022 IMPLEMENTATION STRATEGY:- PREVENT CHRONIC DISEASE - IN 2019 INPATIENT AND OUTPATIENT P.T. FACILITIES OPENED TO STAFF AT ECH AND TICONDEROGA CAMPUS, THESE WERE TEMPORARILY PAUSED IN 2020 DUE TO COVID-19 - FOOD PANTRY IN CPHC OPENED IN 10/2019 AND FOOD PANTRY IN APHC OPENED IN 11/2019. JOINED THE REGIONAL FOOD BANK IN 9/2020 - EVENTS HELD IN 2022 - HEART HEALTH - WOMEN'S HEALTH - HUNTER'S SCREENING - MENTAL HEALTH AWARENESS - BLOOD DRIVES - DIABETES AWARENESS - STROKE READINESS - TELEHEALTH INCREASE - OUTPATIENT VISITS FOR PRIMARY CARE ADDED IN 2020. - CHRONIC DISEASE WELLNESS COACH - CERTIFIED AND TO BEGIN DIABETES PREVENTION PROGRAM- PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDER - SBIRT IMPLEMENTED IN BOTH HOSPITAL CAMPUSES AND ALL 6 PRIMARY CARE SITES - CREATION OF MEDICAL VILLAGE IN PRIMARY CARE. (ADDITION OF PRIMARY CARE 2021) - NARCAN KITS IN BOTH ED'S - 2 PROVIDERS TRAINED IN MAT AND ABLE TO PRESCRIBE - OPIOID STEWARDSHIP CREATED. PROVIDERS WILL BE MONITORED FOR PRESCRIBING PATTERNS.- PROMOTE HEALTHY WOMEN, INFANTS AND CHILDREN - TRANSITIONING FROM PEDIATRIC TO ADULT CARE PROCESS AND PROCEDURE INITIATIVE (PARTNERSHIP WITH AREA SCHOOLS) WAS PAUSED IN 2020 DUE TO COVID-19.ESTIMATED COMPLETION DATE FOR NEXT CHNA AND IMPLEMENTATION STRATEGY: - CHNA: DECEMBER 2024 - IMPLEMENTATION STRATEGY: JANUARY 2025METHODS PLANNED FOR QUALITATIVE RESEARCH FOR NEXT CHNA: - TO BE DONE AS JOINT DOCUMENT WITH ESSEX COUNTY PUBLIC HEALTH DEPARTMENT BASED ON RESULTS OF COMMUNITY STAKEHOLDER SURVEYMETHODS PLANNED FOR QUANTITATIVE RESEARCH FOR NEXT CHNA: - ADIRONDACK RURAL HEATH NETWORK (AHRN) TO ASSIST WITH DATA COLLECTION AND INTERPRETATION AS WELL AS COMMUNITY STAKEHOLDER SURVEY |
| ELIZABETHTOWN COMMUNITY HOSPITAL | PART V, SECTION B, LINE 13B: TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE FROM ELIZABETHTOWN COMMUNITY HOSPITAL, YOUR INCOME SHOULD BE AT OR BELOW THE YEARLY GUIDELINES BELOW. IF YOUR INCOME EXCEEDS THE GUIDELINES (350%) BUT YOU HAVE EXTENUATING CIRCUMSTANCES, AN APPLICATION MAY BE CONSIDERED WHEN SUBMITTED WITH A LETTER EXPLAINING YOUR EXTENUATING CIRCUMSTANCES. |
| ELIZABETHTOWN COMMUNITY HOSPITAL | PART V, SECTION B, LINE 24: THE ORGANIZATION USES A GLOBAL FEE SCHEDULE. IF THE PATIENT APPLIED AND WAS DEEMED ELIGIBLE, THE APPROPRIATE DISCOUNTS WERE GRANTED. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 7 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - ELIZABETHTOWN COMMUNITY HEALTH CENTER | ||||
| 66 PARK STREET | ELIZABETHTOWN | NY | 12932 | PRIMARY CARE HEALTH CENTER |
| 2 - HIGH PEAKS HEALTH CENTER | ||||
| 18 COMMUNITY CIRCLE | WILMINGTON | NY | 12997 | PRIMARY CARE HEALTH CENTER |
| 3 - SMITH HOUSE HEALTH CENTER | ||||
| 39 FARRELL ROAD | WILLSBORO | NY | 12996 | PRIMARY CARE HEALTH CENTER |
| 4 - WESTPORT HEALTH CENTER | ||||
| 6097 NYS ROUTE 9N | WESTPORT | NY | 12993 | PRIMARY CARE HEALTH CENTER |
| 5 - AU SABLE FORKS HEALTH CENTER | ||||
| 15 PLEASANT STREET | AU SABLE FORKS | NY | 12912 | PRIMARY CARE HEALTH CENTER |
| 6 - CROWN POINT HEALTH CENTER | ||||
| 2679 MAIN STREET | CROWN POINT | NY | 12928 | PRIMARY CARE HEALTH CENTER |
| 7 - ECH TICONDEROGA OUTPATIENT CAMPUS | ||||
| 101 ADIRONDACK DRIVE SUITE 1 | TICONDEROGA | NY | 12883 | MEDICAL FACILITY OP CAMPUS |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2,116,860. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | THE HOSPITAL STAFF PARTICIPATES IN MANY LOCAL EVENTS THAT PROVIDE COMMUNITY MEMBERS THE OPPORTUNITY TO LEARN ABOUT THE HOSPITAL AND ABOUT IMPORTANT HEALTH SCREENINGS. IN ADDITION, THE HOSPITAL HOSTS EVENTS AND OFFERS TRAINING AND SUPPORT SERVICES TO OTHER HEALTH-ORIENTED ORGANIZATIONS. ECH PARTICIPATES IN THE FOLLOWING:(1)PROVIDES ADVANCED LIFE SUPPORT TRAINING FOR REGIONAL EMERGENCY MEDICAL TECHNICIANS. (2)PROVIDES MEDICAL DIRECTORSHIP TO SEVERAL LOCAL EMS AGENCIES, PROVIDES MONTHLY COURSES AND EDUCATION FOR CME CREDITS. (3)PROVIDES MEDICAL DIRECTORSHIP TO ST. JOSEPH'S ADDICTION TREATMENT & RECOVERY CENTER (4)OFFERS FREE DIABETES HEALTH SCREENINGS AT COMMUNITY HEALTH EVENTS. (5)LENDS SPACE TO THE NORTH COUNTRY REGIONAL BLOOD DONOR CENTER FOR BLOOD DRIVES. (6)MEETING SPACE IS DONATED ON A MONTHLY BASIS TO EMS SQUADS. TECHNOLOGICAL CAPABILITIES ALLOW FOR DISTANCE TRAINING / EDUCATION. (7)WORKS WITH THE CANCER SCREENING PROGRAM TO PROVIDE INFORMATION ABOUT MAMMOGRAMS AND BONE DENSITY SCREENING AT THE ANNUAL BREAST CANCER AWARENESS EVENT. (8)HOSTS THE ESSEX COUNTY DIABETES SUPPORT GROUP MEETINGS IN THE HOSPITAL BOARDROOM. (9)EMPLOYEES FROM THROUGHOUT THE HOSPITAL USE HOSPITAL PAID TIME TO LEND THEIR EXPERTISE AND INCREASE THEIR INTERESTS IN SUCH AREAS AS THE ESSEX CO. HEALTHY LIVING PARTNERSHIP, BEHAVIOR HEALTH SERVICES NORTH, RETIRED SENIOR VOLUNTEER PROGRAM, TASK FORCE AGAINST DOMESTIC VIOLENCE, KIWANIS AND NORTH COUNTRY LIFE FLIGHT. (10)ECH'S CLINICAL STAFF COMPLETES ADDITIONAL TRAINING EACH YEAR (ACLS, PALS, BLS, VARIOUS RN / NURSING TRAINING PROGRAMS, CHEMOTHERAPY EDUCATION, PHYSICIAN EDUCATION, INFECTION CONTROL TRAINING, RADIOLOGY DEPARTMENT CONTINUING EDUCATION, LAB STAFF EDUCATION, ETC.) (11) MEETING SPACE FOR AA AND NA. (12) EACH YEAR, THE HOSPITAL ALSO HOSTS EVENTS THAT OFFER FREE HEALTH SCREENINGS TO LOCAL RESIDENTS. THE COMMUNITY HEALTH SCREENINGS ARE COORDINATED BY PUBLIC RELATIONS STAFF BUT ARE DEPENDENT UPON CLINICAL STAFF TO PERFORM EXAMS AND INTERPRET THE RESULTS. EACH EVENT IS STAFFED BY 5-8 CLINICAL STAFF MEMBERS FOR APPROXIMATELY 3-4 HOURS PER EVENT. (1)HUNTERS' HEALTH SCREENING (SEPTEMBER) IS A FREE, ANNUAL EVENT SPONSORED BY THE HOSPITAL. PARTICIPANTS RECEIVE A BASIC PHYSICAL / HEALTH SCREENING (EKG, BLOOD WORK, BLOOD PRESSURE, LAB TESTING, PHYSICIAN REVIEW AND REPORTING) AT NO COST. EVENT IS ARRANGED, COORDINATED AND PROMOTED BY ECH PUBLIC RELATIONS STAFF. IN 2022, THERE WERE 24 PARTICIPANTS AS THE EVENT REQUIRED APPOINTMENTS. (2)IN OCTOBER THE HOSPITAL HOSTS AN EVENT CO-SPONSORED BY THE CANCER SERVICES SCREENING PROGRAM OF ESSEX AND FRANKLIN COUNTIES. WOMEN WHO QUALIFIED (UN- OR UNDER-INSURED) WERE ABLE TO RECEIVE A CLINICAL BREAST EXAM AND MAMMOGRAM AT NO COST TO THEM, THROUGH THE CANCER SERVICES SCREENING PROGRAM OF ESSEX AND FRANKLIN COUNTIES. IN 2022, 10 FREE MAMMOGRAMS WERE COMPLETED DUE TO REQUIRED APPOINTMENTS. |
| PART III, LINE 4: | THE BAD DEBT INCLUDED ON LINE 2 IS DETERMINED AT COST. FINANCIAL STATEMENT FOOTNOTE FOR BAD DEBT EXPENSE:PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST PAYMENT HISTORY AND IDENTIFIES TRENDS FOR EACH MAJOR PAYOR SOURCE OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS AND FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE HOSPITAL ALSO ANALYZES AMOUNTS DUE AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE BASED ON PAST EXPERIENCE, INCLUDING CONSIDERATION OF CURRENT BUSINESS AND ECONOMIC CONDITIONS. WHEN THE HOSPITAL ESTABLISHES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS THE HOSPITAL TAKES INTO CONSIDERATION THE FACT THAT MANY SELF-PAY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS WAS 26.0% AND 25.6% OF THE RELATED PATIENT ACCOUNTS RECEIVABLE, NET OF CONTRACTUAL ALLOWANCES AT SEPTEMBER 30, 2022 AND 2021, RESPECTIVELY. |
| PART III, LINE 8: | USED MEDICARE ONLY TOTAL CHARGES FROM REVENUE REPORT FOR 2021 AND APPLIED THE RATIO OF COST TO CHARGES FROM THE 2020 COST REPORT DATA. |
| PART III, LINE 9B: | THE ELIZABETHTOWN COMMUNITY HOSPITAL'S HELPING HANDS PROGRAM OFFERS FREE OR REDUCED CARE TO OUR PATIENTS WHO ARE UNINSURED OR UNDERINSURED AND MEET THE INCOME ELIGIBILITY CRITERIA SET BY THE FOLLOWING GUIDELINES. THE FREE OR REDUCED CARE APPLIES ONLY TO THE SERVICES PROVIDED BY THE ELIZABETHTOWN COMMUNITY HOSPITAL, WESTPORT HEALTH CENTER, ELIZABETHTOWN COMMUNITY HEALTH CENTER, HIGH PEAKS HEALTH CENTER, AU SABLE FORKS HEALTH CENTER, SMITH HOUSE HEALTH CENTER, AND CROWN POINT HEALTH CENTER.AS AN ACCOMMODATION TO PATIENTS AND FAMILIES, COLLECTION ACTIVITY WAS SUSPENDED IN MARCH 2020 IN RECOGNITION OF THE FINANCIAL CHALLENGES ASSOCIATED WITH THE COVID-19 PANDEMIC. COLLECTION ACTIVITIES RESUMED IN JULY 2020. |
| PART VI, LINE 2: | A NUMBER OF COMMUNITY PARTNERS ARE INVOLVED IN ASSESSING COMMUNITY HEALTH NEEDS WITHIN THE HOSPITAL'S SERVICE AREA. MEETINGS CONTINUED VIRTUALLY EACH QUARTER IN 2021-2022.IN ADDITION TO ITS ESTABLISHED RELATIONSHIPS WITH OTHER HOSPITALS, COMMUNITY ORGANIZATIONS AND HEALTHCARE-BASED ORGANIZATIONS (EMS, PUBLIC HEALTH, MENTAL HEALTH, ETC.), ELIZABETHTOWN COMMUNITY HOSPITAL HAS PARTNERED WITH TWO REGIONAL GROUPS TO ASSESS THE REGION'S COMMUNITY HEALTH NEEDS - THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS COMMITTEE, AND THE ADIRONDACK RURAL HEALTH NETWORK.MOBILIZING FOR ACTION THROUGH PLANNING & PARTNERSHIP (MAPP): AGENCY REPRESENTATIVES FROM CLINTON, ESSEX, AND FRANKLIN COUNTIES MEET TO APPLY COMMUNITY BASED APPROACHES TO LOCAL HEALTH ISSUES. THE MAPP GROUP HAS WORKED TO CULL INFORMATION THROUGH ASSESSMENTS OF THE LOCAL PUBLIC HEALTH SYSTEMS, A CDC LOCAL PUBLIC HEALTH INDICATOR SURVEY, A QUALITY OF LIFE SURVEY OF SENIORS AND PARENTS WITH CHILDREN, AND FOCUS GROUPS. THE MAPP GROUP SHARES UPDATED INFORMATION ON A CONTINUAL BASIS TO REASSESS PRIORITIES AND GAUGE PROGRAM SUCCESS.ADIRONDACK RURAL HEALTH NETWORK (ARHN): THE ADIRONDACK RURAL HEALTH NETWORK IS A PARTNERSHIP OF PUBLIC, PRIVATE AND NON-PROFIT ORGANIZATIONS IN UPSTATE NEW YORK. ARHN MEMBERS COLLABORATE TO DEVELOP STRATEGIES ALONG WITH IMPLEMENTING, MONITORING AND EVALUATING VARIOUS INITIATIVES. THIS GROUP CONTINUES TO MEET ON A (ROUGHLY) QUARTERLY BASIS IN ORDER TO SHARE INFORMATION, STATISTICS, SUCCESSES, CHALLENGES AND OUTCOMES. ELIZABETHTOWN COMMUNITY HOSPITAL (ECH): IN ADDITION TO PARTNERSHIPS WITH THE ARHN AND THE MAPP PROCESSES, ECH INDEPENDENTLY SEEKS THE VIEWS OF COMMUNITY MEMBERS TO GAIN THEIR THOUGHTS REGARDING HEALTH CARE IN THEIR COMMUNITY AND GAIN FEEDBACK REGARDING ECH SERVICES. THROUGHOUT 2021-2022 MANY DIFFERENT METHODS WERE USED TO COMMUNICATE WITH AREA RESIDENTS. EACH YEAR THE HOSPITAL ADMINISTRATOR ATTENDS TOWN BOARD MEETINGS THROUGHOUT ESSEX COUNTY IN AN EFFORT TO UPDATE TOWN LEADERS AND COMMUNITY MEMBERS ABOUT THE HOSPITAL, ITS PLANS FOR THE FUTURE; AND TO ADDRESS ANY QUESTIONS. ANNUALLY, THE ADMINISTRATOR MEETS WITH EMS AND FIRE DEPARTMENTS WITHIN THE HOSPITAL SERVICE AREA TO ENCOURAGE OPEN COMMUNICATION AND FOSTER A GOOD WORKING RELATIONSHIP. THE ECH BOARD OF DIRECTORS IS COMPOSED OF 14 REPRESENTATIVES OF EITHER A SPECIFIC COMMUNITY AND/OR ORGANIZATION, INCLUDING THE ESSEX COUNTY OFFICE FOR THE AGING, TOWN OF ELIZABETHTOWN SUPERVISORS OFFICE, AND ESSEX COUNTY MENTAL HEALTH. A PLANNING COMMITTEE, COMPRISED OF BOARD MEMBERS, IDENTIFIES GAPS IN SERVICE AND DEVELOPS GOALS TO FILL THESE NEEDS. PATIENT SATISFACTION SURVEYS ARE CONDUCTED FOR EACH DEPARTMENT ON A CONTINUAL BASIS. |
| PART VI, LINE 4: | ELIZABETHTOWN COMMUNITY HOSPITAL'S PRIMARY SERVICE AREA HAS REMAINED UNCHANGED FOR 2022 PLANNING PURPOSES. IT IS COMPOSED OF TWENTY-TWO ZIP CODES IN NORTHEASTERN ESSEX COUNTY. THE HOSPITAL IS LOCATED 45-60 MINUTES AWAY FROM ANY OTHER HOSPITAL; THROUGH A MOUNTAINOUS REGION AND MOSTLY ALONG A SERIES OF SECONDARY ROADS.BASED ON U.S. CENSUS FOR 2020, 37,281 PEOPLE LIVE WITHIN ESSEX COUNTY OF WHICH 51.8% ARE MALE AND 48.2% ARE FEMALE. PEOPLE OVER THE AGE OF 65 CONSTITUTE 23.5% OF THE POPULATION AND INDIVIDUALS UNDER THE AGE OF 25 MAKE UP 22.9% OF THE POPULATION.ETHNICALLY, 93.0% OF THE POPULATION IS WHITE, NON-HISPANIC. |
| PART VI, LINE 5: | THE HOSPITAL STAFF PARTICIPATES IN MANY LOCAL EVENTS THAT PROVIDE COMMUNITY MEMBERS THE OPPORTUNITY TO LEARN ABOUT THE HOSPITAL AND ABOUT IMPORTANT HEALTH SCREENINGS. IN ADDITION, THE HOSPITAL HOSTS EVENTS AND OFFERS TRAINING AND SUPPORT SERVICES TO OTHER HEALTH-ORIENTED ORGANIZATIONS. ECH PARTICIPATES IN THE FOLLOWING:(1)PROVIDES ADVANCED LIFE SUPPORT TRAINING FOR REGIONAL EMERGENCY MEDICAL TECHNICIANS. (2)PROVIDES MEDICAL DIRECTORSHIP TO SEVERAL LOCAL EMS AGENCIES, PROVIDES MONTHLY COURSES AND EDUCATION FOR CME CREDITS. (3)PROVIDES MEDICAL DIRECTORSHIP TO ST. JOSEPH'S ADDICTION TREATMENT & RECOVERY CENTER (4)OFFERS FREE DIABETES HEALTH SCREENINGS AT COMMUNITY HEALTH EVENTS. (5)LENDS SPACE TO THE NORTH COUNTRY REGIONAL BLOOD DONOR CENTER FOR BLOOD DRIVES. (6)MEETING SPACE IS DONATED ON A MONTHLY BASIS TO EMS SQUADS. TECHNOLOGICAL CAPABILITIES ALLOW FOR DISTANCE TRAINING / EDUCATION. (7)WORKS WITH THE CANCER SCREENING PROGRAM TO PROVIDE INFORMATION ABOUT MAMMOGRAMS AND BONE DENSITY SCREENING AT THE ANNUAL BREAST CANCER AWARENESS EVENT. (8)HOSTS THE ESSEX COUNTY DIABETES SUPPORT GROUP MEETINGS IN THE HOSPITAL BOARDROOM. (9)EMPLOYEES FROM THROUGHOUT THE HOSPITAL USE HOSPITAL PAID TIME TO LEND THEIR EXPERTISE AND INCREASE THEIR INTERESTS IN SUCH AREAS AS THE ESSEX CO. HEALTHY LIVING PARTNERSHIP, BEHAVIOR HEALTH SERVICES NORTH, RETIRED SENIOR VOLUNTEER PROGRAM, TASK FORCE AGAINST DOMESTIC VIOLENCE, KIWANIS AND NORTH COUNTRY LIFE FLIGHT. (10)ECH'S CLINICAL STAFF COMPLETES ADDITIONAL TRAINING EACH YEAR (ACLS, PALS, BLS, VARIOUS RN / NURSING TRAINING PROGRAMS, CHEMOTHERAPY EDUCATION, PHYSICIAN EDUCATION, INFECTION CONTROL TRAINING, RADIOLOGY DEPARTMENT CONTINUING EDUCATION, LAB STAFF EDUCATION, ETC.) (11) MEETING SPACE FOR AA AND NA. (12)THE COMMUNITY HEALTH FAIR HELD ALLOWED FOR COMMUNITY MEMBERS TO LEARN ABOUT AVAILABLE RESOURCES PERTAINING TO HEALTH AND WELLNESS. ELIZABETHTOWN COMMUNITY HOSPITAL WAS ABLE TO EDUCATE 120 PARTICIPANTS ABOUT THE SERVICES OFFERED AT THE HOSPITAL AND SIX PRIMARY CARE SITES. THE 2022 COMMUNITY HEALTH FAIR WAS CO-SPONSORED BY ADIRONDACK HEALTH INSTITUTE, FIDELIS, AND THE HOSPITAL'S AUXILIARY. CLINICAL STAFF WAS ON SITE CONDUCTING BLOOD PRESSURE SCREENS, ISS TEAM MEMBERS WERE AVAILABLE FOR PEOPLE WANTING TO ENROLL IN THE PATIENT PORTAL. HEALTHY REFRESHMENTS WERE PROVIDED AND NUTRITION EDUCATION WAS AVAILABLE WITH A DIABETIC EDUCATOR. EACH YEAR, THE HOSPITAL ALSO HOSTS EVENTS THAT OFFER FREE HEALTH SCREENINGS TO LOCAL RESIDENTS. THE COMMUNITY HEALTH SCREENINGS ARE COORDINATED BY PUBLIC RELATIONS STAFF BUT ARE DEPENDENT UPON CLINICAL STAFF TO PERFORM EXAMS AND INTERPRET THE RESULTS. EACH EVENT IS STAFFED BY 5-8 CLINICAL STAFF MEMBERS FOR APPROXIMATELY 3-4 HOURS PER EVENT. (1)HUNTERS' HEALTH SCREENING (SEPTEMBER) IS A FREE, ANNUAL EVENT SPONSORED BY THE HOSPITAL. PARTICIPANTS RECEIVE A BASIC PHYSICAL / HEALTH SCREENING (EKG, BLOOD WORK, BLOOD PRESSURE, LAB TESTING, PHYSICIAN REVIEW AND REPORTING) AT NO COST. EVENT IS ARRANGED, COORDINATED AND PROMOTED BY ECH PUBLIC RELATIONS STAFF. IN 2022, THERE WERE 24 PARTICIPANTS. (2)IN OCTOBER THE HOSPITAL HOSTS AN EVENT CO-SPONSORED BY THE CANCER SERVICES SCREENING PROGRAM OF ESSEX AND FRANKLIN COUNTIES AND THE HOSPITAL'S AUXILIARY. THE EVENING FEATURES A SPEAKER, ALONG WITH THE OPPORTUNITY TO TAKE PART IN A FREE HEALTH SCREENING. WOMEN WHO QUALIFIED (UN- OR UNDER-INSURED) WERE ABLE TO RECEIVE A CLINICAL BREAST EXAM AND MAMMOGRAM AT NO COST TO THEM, THROUGH THE CANCER SERVICES SCREENING PROGRAM OF ESSEX AND FRANKLIN COUNTIES. IN 2022 THERE WERE 10 PARTICIPANTS. |
| PART VI, LINE 6: | THE UNIVERSITY OF VERMONT HEALTH NETWORK, A NOT-FOR-PROFIT CORPORATION, IS THE SOLE MEMBER OF THE HOSPITAL, ELIZABETHTOWN COMMUNITY HOSPITAL, LOCATED IN ELIZABETHTOWN, NEW YORK. ADDITIONAL AFFILIATES INCLUDE CHAMPLAIN VALLEY PHYSICIANS HOSPITAL, ALICE HYDE MEDICAL CENTER, CENTRAL VERMONT MEDICAL CENTER, PORTER MEDICAL CENTER AND HOME HEALTH AND HOSPICE. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | NY |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROB DEMURO MD | ||||||||||||||
| PHYSICIAN | $382,771 | $0 | $12,002 | $0 | $0 | $0 | $17,400 | $0 | $24,725 | $0 | $436,898 | $0 | $0 | $0 |
| JOHN REMILLARD | ||||||||||||||
| PRESIDENT | $328,367 | $0 | $36,302 | $0 | $65,126 | $0 | $0 | $0 | $1,889 | $0 | $431,684 | $0 | $0 | $0 |
| MARY HALLORAN | ||||||||||||||
| PHYSICIAN | $329,457 | $0 | $0 | $0 | $0 | $0 | $17,400 | $0 | $26,266 | $0 | $373,123 | $0 | $0 | $0 |
| JAMES RICE | ||||||||||||||
| ER PHYSICIAN | $330,713 | $0 | $0 | $0 | $0 | $0 | $6,183 | $0 | $24,692 | $0 | $361,588 | $0 | $0 | $0 |
| LAURA MULVEY | ||||||||||||||
| PHISICIAN | $324,641 | $0 | $894 | $0 | $0 | $0 | $0 | $0 | $22,491 | $0 | $348,026 | $0 | $0 | $0 |
| DAVID MARKOWITZ | ||||||||||||||
| ER PHYSICIAN | $330,713 | $0 | $0 | $0 | $0 | $0 | $6,492 | $0 | $8,222 | $0 | $345,427 | $0 | $0 | $0 |
| ALAN CHARDAVOYNE | ||||||||||||||
| CFO | $247,558 | $0 | $31,686 | $0 | $0 | $0 | $6,932 | $0 | $4,176 | $0 | $290,352 | $0 | $0 | $0 |
| MATTHEW NOLAN | ||||||||||||||
| COO | $208,874 | $0 | $36,198 | $0 | $0 | $0 | $6,935 | $0 | $2,788 | $0 | $254,795 | $0 | $0 | $0 |
| JULIE TROMBLEE | ||||||||||||||
| CNO | $193,854 | $0 | $27,505 | $0 | $0 | $0 | $5,580 | $0 | $4,512 | $0 | $231,451 | $0 | $0 | $0 |
| DAVID CLAUSS | ||||||||||||||
| FORMER MEDICAL DIRECTOR | $0 | $171,206 | $0 | $0 | $0 | $0 | $0 | $11,548 | $0 | $11,420 | $0 | $194,174 | $0 | $0 |
| ROBERT ORTMYER | ||||||||||||||
| PRESIDENT | $137,898 | $0 | $40,000 | $0 | $0 | $0 | $0 | $0 | $4,901 | $0 | $182,799 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | IN ADDITION TO THE TOOLS AND PROCESSES IDENTIFIED IN PART I, ELIZABETHTOWN COMMUNITY HOSPITAL RECEIVES GUIDANCE REGARDING ITS PRESIDENT'S COMPENSATION FROM THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES OF THE UNIVERSITY OF VERMONT HEALTH NETWORK, WHICH IS THE SOLE MEMBER OF THE HOSPITAL. THAT NETWORK COMPENSATION COMMITTEE UTILIZES THE FOLLOWING METHODS TO ESTABLISH THAT GUIDANCE: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE |
| PART I, LINE 4B | JOHN REMILLARD RECEIVED A DISTRIBUTION OF $65,126. |
| PART I, LINE 7 | ELIZABETHTOWN COMMUNITY HOSPITAL PAID AWARDS TO CERTAIN MEMBERS OF UPPER MANAGEMENT (DIRECTORS, VICE PRESIDENTS, PHYSICIAN CHAIRS AND SENIOR EXECUTIVES) THROUGH ITS ANNUAL VARIABLE PAY PLAN AS THE PLAN'S PERFORMANCE MEASURES WERE MET. THE MEASURES WERE REVIWED AND APPROVED BY THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES. THESE MEASURES INCLUDED FINANCIAL, POPULATION HEALTH & QUALITY, AND OPERATIONAL RELATED METRICS. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE UNIVERSITY OF VERMONT HEALTH NETWORK (UVHN) IS THE SOLE MEMBER OF ELIZABETHTOWN COMMUNITY HOSPITAL. |
| FORM 990, PART VI, SECTION A, LINE 7A | UVMHN, INC., AS ELIZABETHTOWN COMMUNITY HOSPITAL'S SOLE MEMBER HAS RESERVE POWERS THAT ALLOW THE UNIVERSITY OF VERMONT HEALTH NETWORK AND UVMHN, INC, TO REFUSE THE ACCEPTANCE OF NEW BOARD MEMBERS APPOINTED BY THE ELIZABETHTOWN COMMUNITY HOSPITAL'S BOARD OF DIRECTORS IF UVMHN, INC., DOES NOT AGREE WITH THE CHOICE OF APPOINTMENTS. THE PROCESS OF APPOINTING MEMBERS TO THE GOVERNING BODY IS A COLLABORATION OF THE ELIZABETHTOWN COMMUNITY HOSPITAL BOARD OF DIRECTORS AND UVMHN, INC., AS A RESULT. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE UNIVERSITY OF VERMONT HEALTH NETWORK THROUGH UVMHN, INC., HAS CERTAIN RESERVE POWERS THAT REQUIRE UVMHN, INC., TO APPROVE CERTAIN DECISIONS MADE BY THE ELIZABETHTOWN COMMUNITY HOSPITAL BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 WILL BE PROVIDED TO THE BOARD PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST POLICY AND ALL MEMBERS ARE REQUIRED TO DISCLOSE ANY CONFLICTING INTERESTS OR STATE "NONE" ON THE ANNUAL CONFLICT OF INTEREST FORM. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE GOVERNING BOARD IS PROVIDED AN INDEPENDENT REPORT OF COMPATIBLE HOSPITALS SALARY FOR THE CEO. THE GOVERNING BOARD ALSO REVIEWS VARIOUS PERFORMANCE MEASURES AND OTHER INFORMATION AND ARRIVES AT A SALARY AND BENEFIT PACKAGE FOR THE CEO. THE DIRECTOR OF HUMAN RESOURCES OBTAINS SALARY INFORMATION FROM AN INDEPENDENT SOURCE FOR LOCAL COMPATIBLE HOSPITALS FOR EACH HIGHER LEVEL POSITION AT THE HOSPITAL. THE INDEPENDENT INFORMATION CONTAINS SALARY LEVELS FOR EACH POSITION AT THE 25TH, 50TH AND 75TH PERCENTILE. THE CEO THEN CONSIDERS THIS INFORMATION AND THE PERFORMANCE FOR EACH OF THESE EMPLOYEES AND ARRIVES AT THE APPROPRIATE SALARY LEVEL. THE APPROACH AND METHODOLOGY IS ALSO PRESENTED TO THE GOVERNING BOARD. IN ADDITION TO THE TOOLS AND PROCESSES IDENTIFIED IN SCHEDULE J, PART I, ELIZABETHTOWN COMMUNITY HOSPITAL RECEIVES GUIDANCE REGARDING ITS PRESIDENT'S COMPENSATION FROM THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES OF THE UNIVERSITY OF VERMONT HEALTH NETWORK, WHICH IS THE SOLE MEMBER OF THE HOSPITAL. THAT NETWORK COMPENSATION COMMITTEE UTILIZES THE FOLLOWING METHODS TO ESTABLISH THAT GUIDANCE: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE |
| FORM 990, PART VI, SECTION C, LINE 19 | THESE DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. |
| FORM 990, PART XI, LINE 9: | CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 46,505. CHANGE IN INTEREST IN INVESTMENT POOL -2,312,015. RELEASE OF ASSETS FROM RESTRICTION -198,630. |
| FORM 990, PART XII, LINE 2C | THE FINANCE COMMITTEE (BOARD OF DIRECTORS) ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT, AND SELECTION OF AN INDEPENDENT ACCOUNTANT. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (21 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| UVM HEALTH NETWORK MEDICAL GROUP INC | |||||||||||
| 111 COLCHESTER AVE | BURLINGTON | VT | 05401 | 030225105 | PHYSICIAN SERVICES | VT | 501(C)(3) | LINE 12B, II | UVMHN | Yes (1) | |
| UVM GROUP-NEW YORK-PLLC | |||||||||||
| 70 CONSTABLE STREET | MALONE | NY | 129531324 | 203905216 | PHYSICIAN SERVICES | NY | 501(C)(3) | LINE 3 | UVMHNMG | Yes (1) | |
| UNIV OF VT MED CTR FOUNDATION INC | |||||||||||
| 111 COLCHESTER AVE | BURLINGTON | VT | 05401 | 263159849 | FUNDRAISING | VT | 501(C)(3) | LINE 12B, II | UVMMC | Yes (1) | |
| UNIV OF VT MED CTR AUXILLIARY INC | |||||||||||
| 111 COLCHESTER AVE | BURLINGTON | VT | 05401 | 208022004 | SERVICE | VT | 501(C)(3) | LINE 12D, III-O | 0 | N/A | |
| UNIV OF VT HEALTH NETWORK | |||||||||||
| 111 COLCHESTER AVE | BURLINGTON | VT | 05401 | 452880726 | HOLDING COMPANY | VT | 501(C)(3) | LINE 12B, II | 0 | N/A | |
| CENTRAL VT MEDICAL CENTER | |||||||||||
| 111 COLCHESTER AVE | BURLINGTON | VT | 05401 | 222547186 | HOSPITAL | VT | 501(C)(3) | LINE 3 | UVMHN | Yes (1) | |
| UNIVERSITY HEALTH CENTER | |||||||||||
| 111 COLCHESTER AVE | BURLINGTON | VT | 05401 | 030229931 | HOSPITAL | VT | 501(C)(3) | LINE 12D, III-O | UVMHNMG | Yes (1) | |
| COMMUNITY PROVIDERS INC | |||||||||||
| 75 BEEKMAN STREET | PLATTSBURGH | NY | 12901 | 222544844 | HLTH SVC COORD | NY | 501(C)(3) | LINE 12B, II | UVMHN | Yes (1) | |
| CHAMPLAIN VALLEY PHYSICIANS HOSPITAL | |||||||||||
| 75 BEEKMAN STREET | PLATTSBURGH | NY | 12901 | 141338471 | HOSPITAL | NY | 501(C)(3) | LINE 3 | UVMHN | Yes (1) | |
| EMERGENCY MEDICAL TRANSPORT OF CVPH INC | |||||||||||
| 75 BEEKMAN STREET | PLATTSBURGH | NY | 12901 | 061718419 | AMBULANCE SVC | NY | 501(C)(3) | LINE 12C, III-FI | CPI | Yes (1) | |
| CVPH MEDICAL CENTER FOUNDATION | |||||||||||
| 75 BEEKMAN STREET | PLATTSBURGH | NY | 12901 | 141727048 | HLTH SVC COORD | NY | 501(C)(3) | LINE 12C, III-FI | CVPH | Yes (1) | |
| UNIVERSITY MEDICAL EDUCATION ASSOCIATES | |||||||||||
| 89 BEAUMONT AVENUE | BURLINGTON | VT | 05401 | 237107832 | EDUCATIONAL | VT | 501(C)(3) | LINE 11 | UVMHNMG | Yes (1) | |
| ALICE HYDE MEDICAL CENTER | |||||||||||
| 133 PARK STREET | MALONE | NY | 12953 | 150346515 | HOSPITAL | NY | 501(C)(3) | LINE 3 | UVMHN | Yes (1) | |
| PORTER MEDICAL CENTER INC | |||||||||||
| 115 PORTER DRIVE | MIDDLEBURY | VT | 05753 | 030310862 | SUPPTG ORG | VT | 501(C)(3) | LINE 12C, III-FI | UVMHN | Yes (1) | |
| HELEN PORTER NURSING HOME | |||||||||||
| 37 PORTER DRIVE | MIDDLEBURY | VT | 05753 | 030306549 | NURSING HOME | VT | 501(C)(3) | LINE 3 | PMC | Yes (1) | |
| AUXILIARY OF PORTER MEDICAL CENTER | |||||||||||
| 37 PORTER DRIVE | MIDDLEBURY | VT | 05753 | 237363227 | SUPPTG ORG | VT | 501(C)(3) | LINE 12C, III-FI | PMC | Yes (1) | |
| PORTER HOSPITAL INC | |||||||||||
| 37 PORTER DRIVE | MIDDLEBURY | VT | 05753 | 030181058 | HOSPITAL | VT | 501(C)(3) | LINE 3 | PMC | Yes (1) | |
| THE UNIVERSITY OF VERMONT MEDICAL CENTER INC | |||||||||||
| 111 COLCHESTER AVE | BURLINGTON | VT | 05401 | 030219309 | HOSPITAL | VT | 501(C)(3) | LINE 3 | Yes (1) | N/A | |
| UVMHN HOME HEALTH AND HOSPICE | |||||||||||
| 1110 PRIM ROAD | COLCHESTER | VT | 05446 | 030179603 | HOME HEALTH CARE | VT | 501(C)(3) | LINE 10 | UVMHN | Yes (1) | |
| LAKE CHAMPLAIN PHYSICIAN SERVICES | |||||||||||
| 75 BEEKMAN STREET | PLATTSBURGH | NY | 12901 | 273785445 | PHYSICIAN SERVICES | NY | 501(C)(3) | LINE 12A, I | CVPH | Yes (1) | |
| VMC INDEMNITY COMPANY INC | |||||||||||
| 95 ST PAUL ST | BURLINGTON | VT | 05401 | 831102018 | INSURANCE | VT | 501(C)(3) | LINE 12A, I | UVMHN | Yes (1) | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Predominant Income TypePredominantIncomeTypeTxt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|---|
| ONECARE VT ACCOUNTABLE CARE | ||||||||||
| 111 COLCHESTER AVE | BURLINGTON | VT | 05401 | 455399218 | ACCOUNTABLE CARE | VT | N/A | RELATED | 0 | 0 |
| ADIRONDACK ACO LLC | ||||||||||
| 75 BEEKMAN STREET | PLATTSBURGH | NY | 12901 | 462840926 | ACCOUNTABLE CARE | NY | N/A | NA | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| UVMHN VENTURES INC | ||||||||||||||
| 111 COLCHESTER AVE | BURLINGTON | VT | 05401 | 043380045 | HOLDING COMPANY | VT | UVMHN | C | 0 | |||||
| VMC INDEMNITY COMPANY LTD | ||||||||||||||
| CAPTIVE INSURANCE | UVMMC | C | 0 | PO BOX HM 3103 | HAMILTON | BD | BD | |||||||
| UNIV OF VT MED HEALTH NETWORK CREDENTIALING & ENROLLMENT | ||||||||||||||
| 111 COLCHESTER AVE | BURLINGTON | VT | 05401 | 030333056 | ADMIN SVC | VT | UVMHN VENTURES | C | 0 | |||||
| CHARITABLE REMAINDER TRUST (5) | ||||||||||||||
| SUPPORT | VT | UVMMCCVMC | T | 0 | ||||||||||
| PERPETUAL TRUST (4) | ||||||||||||||
| SUPPORT | VT | UVMMC | T | 0 | ||||||||||
| CHARITABLE IRREVOCABLE TRUST (7) | ||||||||||||||
| SUPPORT | VT | UVMMCCVMC | T | 0 | ||||||||||
| CHAMPLAIN VALLEY HEALTH NETWORK | ||||||||||||||
| 75 BEEKMAN STREET | PLATTSBURGH | NY | 12901 | 161586102 | ADMIN SVC | NY | C | 0 | N/A | |||||
| MEDIQUEST INC | ||||||||||||||
| PO BOX 1656 | PLATTSBURGH | NY | 12901 | 141663061 | MED OFFICE LEASE | NY | C | 0 | N/A | |||||
| YANKEE MEDICAL INC | ||||||||||||||
| 276 NORTH AVENUE | BURLINGTON | VT | 05401 | 030225363 | HOME MEDICAL EQUIPMENT | VT | UVMHN | C | 0 | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | Yes (1) | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
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