TLC HEALTH NETWORK: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- TLC HEALTH NETWORK (EIN 16-0772474)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-11-15
- IRS object ID
- 201803199349316800
- Schema version
- 2017v2.3
- 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 | 2018-11-15T15:47:17-06:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 160765486 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LUMSDEN & MCCORMICK LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 369 FRANKLIN STREET | AddressLine1Txt |
| City | BUFFALO | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14202 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 160772474 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TLC HEALTH NETWORK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | TLCH | BusinessNameControlTxt |
| Phone | 7169517000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 845 ROUTES 5 20 | AddressLine1Txt |
| City | IRVING | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 140819716 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARY E LAROWE | PersonNm |
| Person Title | PRESIDENT AND CEO | PersonTitleTxt |
| Phone | 7169517000 | PhoneNum |
| Signature | 2018-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JILL M JOHNSON | PreparerPersonNm |
| PTIN | P01701478 | PTIN |
| Phone | 7168563300 | PhoneNum |
| Preparation | 2018-11-15 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 38.122.36.250 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-11-15 | IPDt |
| IP Tm | 13:14:43 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | E929E822DA4ED06B116DA1A0B819B04B4C73AA9A | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | AA119887DC433B9846D706EE2EE954C243FEEB32 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MARY E LAROWE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 845 ROUTES 5 20 | AddressLine1Txt |
| City | IRVING | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 140819716 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $38,602,510 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.TLCHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2002 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | TLC HEALTH NETWORK (TLC) IS A HEALTH SYSTEM AND DESIGNATED SAFETY NET/VITAL ACCESS PROVIDER IN WESTERN NEW YORK THAT OFFERS A VARIETY OF CRITICAL HEALTH SERVICES TO UNDERSERVED, RURAL COMMUNITIES OF CHAUTAUQUA, CATTARAUGUS, AND SOUTHERN ERIE COUNTIES. TLC WAS FORMED AS A RESULT OF A MERGER BETWEEN THE FORMER TRI-COUNTY MEMORIAL HOSPITAL IN GOWANDA, NY AND LAKE SHORE HOSPITAL (NOW LAKE SHORE HEALTH CARE CENTER) IN IRVING, NY. TLC OPERATES FACILITIES IN CHAUTAUQUA, CATTARAUGUS, AND ERIE COUNTIES INCLUDING LAKE SHORE HEALTH CARE CENTER, GOWANDA URGENT CARE & MEDICAL CENTER, FORESTVILLE PRIMARY CARE CENTER, AND OUTPATIENT CHEMICAL DEPENDENCY CLINICS IN CASSADAGA AND DERBY. WE ALSO OPERATE A HOME HEALTH CARE AGENCY THAT OPERATES THROUGHOUT THE TRI-COUNTY AREA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 496 | TotalEmployeeCnt |
| Total Volunteers | 10 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$534,200 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $6,963,829 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,627,518 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $23,106,660 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $24,455,679 | CYProgramServiceRevenueAmt |
| PY Investment Income | $72,583 | PYInvestmentIncomeAmt |
| CY Investment Income | $94,608 | CYInvestmentIncomeAmt |
| PY Other Revenue | $547,493 | PYOtherRevenueAmt |
| CY Other Revenue | $12,395,017 | CYOtherRevenueAmt |
| PY Total Revenue | $30,690,565 | PYTotalRevenueAmt |
| CY Total Revenue | $38,572,822 | 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 | $16,075,847 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $16,404,758 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $1,690 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $12,831,215 | PYOtherExpensesAmt |
| CY Other Expenses | $15,335,519 | CYOtherExpensesAmt |
| PY Total Expenses | $28,907,062 | PYTotalExpensesAmt |
| CY Total Expenses | $31,740,277 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,783,503 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $6,832,545 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $25,264,977 | TotalAssetsBOYAmt |
| Total Assets EOY | $24,384,836 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $13,988,961 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,058,298 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $11,276,016 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $18,326,538 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TLC HEALTH NETWORK'S MISSION IS TO PROVIDE A DIVERSE RANGE OF QUALITY HEALTHCARE SERVICES THROUGHOUT WESTERN NEW YORK WHILE ADHERING TO THE VALUES UPON WHICH WE WERE FOUNDED:INTEGRITY - COMPASSION - ACCOUNTABILITY - RESPECT - EXCELLENCE | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $25,201,962 | ExpenseAmt |
| Revenue | $24,455,679 | RevenueAmt |
| Desc | INPATIENT CARE: TLC HEALTH NETWORK PROVIDES INPATIENT ACUTE AND BEHAVIORAL HEALTH TO RESIDENTS OF IRVING, NY AND THE SURROUNDING AREA REGARDLESS OF ABILITY TO PAY. INPATIENT ADMISSIONS FOR 2017 TOTALED 933.OUTPATIENT, SURGICAL & EMERGENCY CARE: TLC HEALTH NETWORK PROVIDES OUTPATIENT, SURGICAL AND EMERGENCY HOSPITAL CARE TO RESIDENTS OF IRVING, NY AND THE SURROUNDING AREA REGARDLESS OF ABILITY TO PAY. OUTPATIENT, SURGICAL AND EMERGENCY CARE PATIENT ACCOUNTS FOR 2017 TOTALED 62,514.SKILLED NURSING CARE: TLC HEALTH NETWORK PROVIDES SKILLED NURSING CARE TO RESIDENTS OF IRVING, NY AND THE SURROUNDING AREA REGARDLESS OF ABILITY TO PAY. PATIENT CARE DAYS FOR 2017 TOTALED 1,867.HOME HEALTH CARE: TLC HEALTH NETWORK PROVIDES HOME HEALTH CARE TO RESIDENTS OF IRVING, NY AND THE SURROUNDING AREA REGARDLESS OF ABILITY TO PAY. HOME HEALTH CARE VISITS FOR 2017 TOTALED 23,911. | Desc |
| Total Program Service Expenses | $25,201,962 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 87 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 496 | 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | 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 | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NY | StatesWhereCopyOfReturnIsFldCd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAWN TURK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7169517000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12644 SENECA ROAD | AddressLine1Txt |
| City | IRVING | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14081 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| JAMES WILD MD | |||||||
| CHAIR & MEDICAL DIRECTOR | 15.00 | Yes (X) | Yes (X) | $61,787 | $0 | $0 | |
| TIMOTHY COOPER | |||||||
| VICE CHAIR | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| VIRGINIA COOPER | |||||||
| SECRETARY | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DANA ANDERSON MD | |||||||
| MEMBER & HOSPITALIST | 2.00 | Yes (X) | $1,137 | $0 | $0 | ||
| BRIAN FENZL | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| CHRISTINA JIMERSEON | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| THOMAS POSTLE | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| TARIQ SHEIKH MD | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| JOHN GALATI | |||||||
| PRESIDENT & CEO | 40.00 | Yes (X) | $144,972 | $0 | $10,941 | ||
| SCOTT BUTLER | |||||||
| CHIEF OPERATING OFFICER | 40.00 | Yes (X) | $64,777 | $0 | $5,384 | ||
| WENDY LUCE | |||||||
| VP, BEHAVORIAL HEALTH & PR | 40.00 | Yes (X) | $99,465 | $0 | $8,193 | ||
| PATRICIA DOLE | |||||||
| VP, PATIENT CARE SERVICES | 40.00 | Yes (X) | $110,750 | $0 | $8,749 | ||
| TARIQ HUSSAIN MD | |||||||
| ORTHOPEDIC PHYSICIAN | 40.00 | $538,218 | $0 | $18,458 | Yes (X) | ||
| ROBERT LINK | |||||||
| SR. PHYSICIAN ASSISTANT | 40.00 | $136,634 | $0 | $9,750 | Yes (X) | ||
| ROBERT PIOTROWSKI | |||||||
| PHYISICAN ASSISTANT | 40.00 | $129,723 | $0 | $8,733 | Yes (X) | ||
| CHARLES SPICOLA | |||||||
| DIRECTOR OF PHARMACY | 40.00 | $127,740 | $0 | $5,265 | Yes (X) | ||
| JOEL YOVIENE | |||||||
| PHYSICIAN | 40.00 | $132,538 | $0 | $5,612 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,547,741 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $81,085 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 12 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MENTER RUDIN & TRIVELPIECE PC | |||||
| 308 MALTBIE STREET SUITE 200 | SYRACUSE | NY | 13204 | LEGAL SERVICES | $1,285,900 |
| DELPHI HOSPITALIST SERVICE | |||||
| 1160 CHILI AVENUE SUITE 200 | ROCHESTER | NY | 14624 | DIRECTORS HEALTHCARE | $674,946 |
| JAMESTOWN PSYCHIATRIC PC | |||||
| 305 EAST FAIRMOUNT AVENUE | LAKEWOOD | NY | 14750 | PSYCHIATRIST | $595,833 |
| JAMESTOWN REHAB SERVICES | |||||
| 4482 KATHLEEN STREET | HAMBURG | NY | 14075 | REHABILITATION SERVICES | $491,511 |
| BROOKS MEMORIAL HOSPITAL | |||||
| 529 CENTRAL AVENUE | DUNKIRK | NY | 14048 | RELATED PARTY - EXPENSE REIMBURSEMENT | $351,239 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 10 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $37,862 | FundraisingAmt |
| Government Grants | $1,543,185 | GovernmentGrantsAmt |
| All Other Contributions | $46,471 | AllOtherContributionsAmt |
| Total Contributions | $1,627,518 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICE REVENUE | Desc |
| Business | 621990 | BusinessCd |
| Total Revenue Column | $24,455,679 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $24,455,679 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $24,455,679 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $92,208 | TotalRevenueColumnAmt |
| Exclusion | $92,208 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $16,296 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $16,296 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $16,296 | TotalRevenueColumnAmt |
| Exclusion | $16,296 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $2,400 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $2,400 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,400 | TotalRevenueColumnAmt |
| Exclusion | $2,400 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $6,930 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $37,862 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $29,688 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$22,758 | TotalRevenueColumnAmt |
| Exclusion | -$22,758 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| GAIN ON BANKRUPTCY SETTLEMENT | 900099 | $6,309,475 | $6,309,475 |
| NYS SAFETY NET FUNDING | 621990 | $5,425,436 | $5,425,436 |
| DSRIP FUNDING | 621990 | $375,213 | $375,213 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $291,355 | TotalRevenueColumnAmt |
| Exclusion | $291,355 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $12,401,479 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $38,572,822 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $24,455,679 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $12,489,625 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $516,155 | TotalAmt |
| Program Services | $62,924 | ProgramServicesAmt |
| Management And General | $453,231 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,160,519 | TotalAmt |
| Program Services | $10,637,460 | ProgramServicesAmt |
| Management And General | $2,523,059 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $266,710 | TotalAmt |
| Program Services | $228,513 | ProgramServicesAmt |
| Management And General | $38,197 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,481,801 | TotalAmt |
| Program Services | $1,167,137 | ProgramServicesAmt |
| Management And General | $314,664 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $979,573 | TotalAmt |
| Program Services | $767,290 | ProgramServicesAmt |
| Management And General | $212,283 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $643,109 | TotalAmt |
| Management And General | $643,109 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,571,460 | TotalAmt |
| Program Services | $2,164,489 | ProgramServicesAmt |
| Management And General | $406,971 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $79,149 | TotalAmt |
| Program Services | $33,263 | ProgramServicesAmt |
| Management And General | $45,886 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $642,888 | TotalAmt |
| Program Services | $514,310 | ProgramServicesAmt |
| Management And General | $128,578 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $168,365 | TotalAmt |
| Program Services | $136,206 | ProgramServicesAmt |
| Management And General | $32,159 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73,989 | TotalAmt |
| Program Services | $59,191 | ProgramServicesAmt |
| Management And General | $14,798 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,921,580 | TotalAmt |
| Program Services | $1,537,264 | ProgramServicesAmt |
| Management And General | $384,316 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $313,978 | TotalAmt |
| Program Services | $251,183 | ProgramServicesAmt |
| Management And General | $62,795 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| PURCHASED SERVICES | $2,879,188 | $2,233,292 | $644,763 | $1,133 |
| PROVISION FOR BAD DEBTS | $2,486,854 | $2,486,854 | ||
| MEDICAL & NON-MEDICAL S | $2,049,670 | $1,901,740 | $147,508 | $422 |
| MISCELLANEOUS | $873,723 | $532,122 | $341,466 | $135 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $631,566 | TotalAmt |
| Program Services | $488,724 | ProgramServicesAmt |
| Management And General | $142,842 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,740,277 | TotalAmt |
| Program Services | $25,201,962 | ProgramServicesAmt |
| Management And General | $6,536,625 | ManagementAndGeneralAmt |
| Fundraising | $1,690 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,270 | BOYAmt |
| EOY | $1,321 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,637,019 | BOYAmt |
| EOY | $1,250,478 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $802,775 | BOYAmt |
| EOY | $1,076,295 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,460,587 | BOYAmt |
| EOY | $2,060,207 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $578,601 | BOYAmt |
| EOY | $577,060 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $550,042 | BOYAmt |
| EOY | $542,518 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $58,101,421 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $44,254,621 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,520,802 | BOYAmt |
| EOY | $13,846,800 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,713,881 | BOYAmt |
| EOY | $5,030,157 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,264,977 | BOYAmt |
| EOY | $24,384,836 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,860,086 | BOYAmt |
| EOY | $3,292,092 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $206,250 | BOYAmt |
| EOY | $336,076 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,922,625 | BOYAmt |
| EOY | $2,430,130 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,988,961 | BOYAmt |
| EOY | $6,058,298 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,689,510 | BOYAmt |
| EOY | $15,522,055 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,586,506 | BOYAmt |
| EOY | $2,804,483 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,276,016 | BOYAmt |
| EOY | $18,326,538 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,264,977 | BOYAmt |
| EOY | $24,384,836 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $6,832,545 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $217,977 | 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 | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,586,506 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $217,977 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $2,804,483 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,615,604 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$29,098 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $2,586,506 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,805,950 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$190,346 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $2,615,604 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,861,552 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$55,602 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $2,805,950 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,731,677 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $129,875 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $2,861,552 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $697,617 | OtherCostOrOtherBasisAmt |
| Book Value | $697,617 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $25,465,661 | OtherCostOrOtherBasisAmt |
| Depreciation | $16,054,621 | DepreciationAmt |
| Book Value | $9,411,040 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,771,958 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,325,828 | DepreciationAmt |
| Book Value | $446,130 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $29,410,463 | OtherCostOrOtherBasisAmt |
| Depreciation | $26,874,172 | DepreciationAmt |
| Book Value | $2,536,291 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $755,722 | OtherCostOrOtherBasisAmt |
| Book Value | $755,722 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $13,846,800 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (5 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| INTEREST IN PERPETUAL TRUST | $2,004,483 |
| INTERCOMPANY RECEIVABLE | $303,911 |
| BANKRUPTCY ESCROW | $1,384,377 |
| AMOUNTS DESIGNATED FOR SPECIFIC PURPOSE | $1,153,338 |
| OTHER ASSETS | $184,048 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $5,030,157 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| ACCRUED PAYROLL AND RELATED LIABILITIES | $1,580,717 |
| ESTIMATED THIRD PARTY-PAYOR SETTLEMENTS | $849,413 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,430,130 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART V, LINE 4: | FormAndLineReferenceDesc |
| Explanation | FOR HOSPITAL SERVICES. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF TOURNAMENT | Event1Nm |
| Gross Receipts Event1 | $44,792 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $37,862 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $6,930 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $2,017 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $6,930 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $651 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $20,090 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $44,792 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $37,862 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $6,930 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $2,017 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $6,930 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $651 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $20,090 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $29,688 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$22,758 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 101.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | 0 | FinancialAssistanceBudgetInd |
| 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 | $185,617 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $185,617 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00630 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,180,421 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,244,754 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,935,667 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06620 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $153,517 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $153,517 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00520 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,519,555 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,244,754 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,274,801 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07770 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,872,553 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,036,212 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,836,341 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06280 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,872,553 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,036,212 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,836,341 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06280 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $23,392,108 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $19,280,966 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,111,142 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.14050 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,430,759 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $45,049 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,836,766 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,856,884 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$20,118 | 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 | 0 | 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 | TLC HEALTH NETWORK - LAKESHORE HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 845 ROUTES 5 20 | AddressLine1Txt |
| City | IRVING | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14081 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | IP MENTAL HEALTH, LONG TERM CARE, HOME HEALTH SERVICES, URGENT CARE, CLINICS | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TLC HEALTH NETWORK - LAKE SHORE 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 |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | WWW.CO.CHAUTAUQUA.NY.US | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.TLCHEALTH.ORG | 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 | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | 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 | WWW.TLCHEALTH.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit Report To Credit Agency | Yes (X) | PermitReportToCreditAgencyInd |
| Collection Activities | Yes (1) | CollectionActivitiesInd |
| Reporting To Credit Agency | Yes (X) | ReportingToCreditAgencyInd |
| None Made | Yes (X) | NoneMadeInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| TLC HEALTH NETWORK - LAKE SHORE HOSPITAL | PART V, SECTION B, LINE 5: FOR THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, TLC HEALTH NETWORK WORKED WITH THE REST OF THE CHAUTAUQUA COUNTY COMMUNITY HEALTH PLANNING TEAM (CCCHPT) TO ASSESS THE HEALTH NEEDS OF THE GREATER CHAUTAUQUA COUNTY REGION. THE CCCHPT ADOPTED A THREE-PRONGED APPROACH IN CONDUCTING THE ASSESSMENT WHICH INVOLVED GATHERING INPUT FROM COMMUNITY MEMBERS, SECONDARY DATA FROM THE NEW YORK STATE DEPARTMENT OF HEALTH AND OTHER HEALTH RESOURCES, AND INPUT FROM LOCAL CONTENT AREA EXPERTS.COMMUNITY INPUT WAS GATHERED THROUGH A PRIMARILY WEB-BASED SURVEY AND THREE COMMUNITY CONVERSATIONS IN DIFFERENT GEOGRAPHIC SECTIONS OF THE COUNTY. IN 2016, SURVEY RESPONSES WERE COLLECTED. COMMUNITY MEMBERS' PERCEPTIONS OF HEALTH ISSUES WERE ALSO GATHERED AT THREE "COMMUNITY CONVERSATIONS" SPONSORED BY THE P2 COLLABORATIVE OF WNY AND THE CHAUTAUQUA COUNTY HEALTH NETWORK. THESE CONVERSATIONS SPANNED CHAUTAUQUA COUNTY'S GEOGRAPHIC AND CULTURAL SEPARATIONS, COVERING THE "NORTH COUNTY" IN DUNKIRK, THE "SOUTH COUNTY" IN JAMESTOWN, AND THE "WEST COUNTY" IN WESTFIELD. THESE DIVERSE LOCATIONS WERE ABLE TO CAPTURE BOTH THE COUNTY'S RURAL AND URBAN POPULATIONS. IN ADDITION TO THE DATA GLEANED FROM THE PUBLIC PARTICIPATION PROCESS, THE CCCHPT THOROUGHLY EXAMINED THE NYSDOH COMMUNITY HEALTH INDICATOR REPORTS AND TRACKING INDICATORS FOR PUBLIC HEALTH PRIORITY AREAS, COMPARING COUNTY NUMBERS AND RATES OF HEALTH CONDITIONS WITH THOSE OF NEW YORK STATE AND NEW YORK STATE EXCLUDING NEW YORK CITY. DEMOGRAPHIC DATA FOR CHAUTAUQUA COUNTY WAS GLEANED FROM THE UNITED STATES CENSUS BUREAU WEBSITE. LOCAL-LEVEL DATA THAT WAS NOT CAPTURED BY THE U.S. CENSUS BUREAU WAS REQUESTED FROM LOCAL AGENCIES. THE NEW YORK STATE EDUCATION DEPARTMENT SCHOOL REPORT CARDS WERE ACCESSED TO RETRIEVE SPECIFIC INFORMATION ABOUT THE SCHOOL DISTRICTS. THE NEW YORK STATE DEPARTMENT OF HEALTH'S COMMUNITY HEALTH INDICATOR REPORTS AND TRACKING INDICATORS FOR PUBLIC HEALTH PRIORITY AREAS WERE EXTENSIVELY USED TO IDENTIFY HEALTH ISSUES IN CHAUTAUQUA COUNTY. NYS VITAL STATISTICS DATA, EXPANDED BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, AND THE STUDENT WEIGHT STATUS CATEGORY REPORTING SYSTEM WERE ALSO REFERRED TO THROUGHOUT THE PLANNING PROCESS. |
| TLC HEALTH NETWORK - LAKE SHORE HOSPITAL | PART V, SECTION B, LINE 6A: INPUT WAS PROVIDED FROM THE FOLLOWING OTHER HOSPITAL FACILITIES: WCA HOSPITAL, WESTFIELD MEMORIAL HOSPITAL, AND BROOKS MEMORIAL HOSPITAL. |
| TLC HEALTH NETWORK - LAKE SHORE HOSPITAL | PART V, SECTION B, LINE 6B: OTHER ORGANIZATIONS OTHER THAN HOSPITAL FACILITIES CONSULTED ON THIS PROJECT INCLUDE:- BLACKWELL CHAPEL BABY CAFE- CATHOLIC CHARITIES - WIC- CHAUTAUQUA COUNTY DEPARTMENT OF MENTAL HYGIENE - CHAUTAUQUA COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES- CHAUTAUQUA COUNTY HEALTH NETWORK- CHAUTAUQUA COUNTY MENTAL HEALTH ASSOCIATION- CHAUTAUQUA COUNTY OFFICE FOR THE AGING- CCE - EAT SMART NY- CHAUTAUQUA ALCOHOL AND SUBSTANCE ABUSE COUNCIL- CHAUTAUQUA OPPORTUNITIES, INC. - CHAUTAUQUA STRIDERS- COMMUNITY PARTNERS OF WNY- CORNELL COOPERATIVE EXTENSION OF CHAUTAUQUA COUNTY- E-2 CC BOCES- EVERGREEN HEALTH SERVICES- P2 OF WNY- TEENAGE EDUCATION AND MOTHERHOOD (TEAM) PROGRAM - THE CHAUTAUQUA CENTER- THE RESOURCE CENTER- UNITED WAY OF SOUTHERN CHAUTAUQUA COUNTY- YWCA OF JAMESTOWN |
| TLC HEALTH NETWORK - LAKE SHORE HOSPITAL | PART V, SECTION B, LINE 24: BILL USUAL AND CUSTOMARY FEES. |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | COST-TO-CHARGE RATIO |
| 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 $ 2,486,854. |
| PART III, LINE 2: | AMOUNT IS CALCULATED USING CHARGES ADJUSTED TO BAD DEBT, REDUCED TO COST BY RCC. |
| PART III, LINE 3: | REPRESENTS BAD DEBTS THAT WOULD QUALIFY FOR CHARITY CARE IF APPLIED FOR, REDUCED TO COST BY RCC. |
| PART III, LINE 4: | FOOTNOTE TO AUDITED FS: PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, TLC ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, TLC ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO HAVE FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), TLC RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. |
| PART III, LINE 8: | MEDICARE PAYMENTS ARE COMPARED TO MEDICARE ALLOWABLE COST. THE RESULTING SHORT FALL FROM TREATING MEDICARE PATIENTS IS A BENEFIT TO THE COMMUNITY. |
| PART VI, LINE 2: | THE HOSPITAL PARTICIPATES WITH OTHER HEALTHCARE PROVIDERS AND INTERESTED PARTIES IN THE CHAUTAUQUA COUNTY COMMUNITY HEALTH PLANNING TEAM (CCCHPT) INCLUDING ALL HOSPITALS IN THE COUNTY TO ASSESS NEED REGIONALLY. TLC ALSO WORKS WITH THE HEALTH COMMUNITY ALLIANCE AND CATTARAUGUS COUNTY HEALTH DEPARTMENT TO ASSESS THE NEEDS OF THAT COUNTY ALSO.THE HOSPITAL ALSO UTILIZES PATIENT SATISFACTION SURVEY TOOLS AND LOCAL PUBLIC INFORMATION PERTAINING TO POPULATION CHARACTERISTICS AND HEALTH STATUS.AT MONTHLY PUBLIC PRESENTATIONS OF HEALTH TOPICS, PROGRAM EVALUATION FORMS REQUEST INPUT FROM THE ATTENDEES FOR NEEDED SERVICES AND TOPICS. |
| PART VI, LINE 3: | TLC HEALTH NETWORK PARTICIPATES WITH OTHER MANY OTHER HEALTHCARE PROVIDERS AND INTERESTED PARTIES IN REGULAR CHAUTAUQUA COUNTY COMMUNITY HEALTH PLANNING TEAM (CCCHPT) MEETINGS TO ASSESS AND DISCUSS THE EVER-CHANGING HEALTH NEEDS IN THE COMMUNITY. TLC ALSO WORKS WITH THE HEALTHY COMMUNITY ALLIANCE (THE RURAL HEALTH NETWORK FOR NEIGHBORING CATTARAUGUS COUNTY) AND CATTARAUGUS COUNTY HEALTH DEPARTMENT TO ASSESS THE HEALTH NEEDS OF THAT PORTION OF TLC'S SERVICE AREA AS WELL. TLC ALSO LEADS A COMMUNITY ADVISORY GROUP DISCUSSION A FEW TIMES A YEAR TO CAPTURE COMMUNITY FEEDBACK REGARDING HEALTH NEEDS IN THE NORTHERN CATTARAUGUS AREA. TLC ALSO UTILIZES PATIENT SATISFACTION SURVEY TOOLS AND LOCAL PUBLIC INFORMATION PERTAINING TO POPULATION CHARACTERISTICS AND HEALTH STATUS. FURTHERMORE, TLC IS A PARTICIPATING MEMBER OF THE WESTERN NEW YORK HEALTHCARE ALLIANCE THAT MEETS ON A REGULAR BASIS TO DISCUSS THE HEALTH NEEDS OF VARIOUS POPULATIONS WITHIN THE WESTERN NEW YORK REGION. |
| PART VI, LINE 4: | FOR THE PURPOSES OF COMMUNITY/LOCAL HEALTH PLANNING, AND BASED ON 2010 USAGE PATTERNS AND A CORRESPONDING ZIP CODE ANALYSIS OF DISCHARGE DATA, TLC HEALTH NETWORK'S PRIMARY SERVICE AREA (TOP 75% OF ALL PATIENTS) INCLUDES THE FOLLOWING ZIP CODES: ANGOLA (14006), GOWANDA (14070), SILVER CREEK (14136), IRVING (14081), FORESTVILLE (14062), DERBY (14047), DUNKIRK (14048), NORTH COLLINS (14111), SOUTH DAYTON (14138), CATTARAUGUS (14719), PERRYSBURG (14129), COLLINS (14034), FREDONIA (14063), EDEN (14057).CURRENTLY, TLC HEALTH NETWORK CONTINUES TO PROVIDE SERVICES TO A LARGELY RURAL POPULATION IN NORTHERN CHAUTAUQUA, WESTERN CATTARAUGUS, AND SOUTHERN ERIE COUNTIES. BESIDES THE GENERAL POPULATION, TLC HEALTH NETWORK SERVES MANY VULNERABLE POPULATIONS INCLUDING THE SENECA NATION OF INDIANS (CATTARAUGUS AND ALLEGHENY RESERVATIONS), A LARGE OLD-ORDER AMISH POPULATION, AND A HOST OF SEASONAL MIGRANT WORKERS. IN ADDITION, THE SHORES OF LAKE ERIE PROVIDE AN INFLUX OF SEASONAL BEACHFRONT RESIDENTS THAT OFTEN TURN TO TLC HEALTH NETWORK FOR HEALTHCARE SUPPORT. THE SERVICE AREA HAS ALSO BEEN OFFICIALLY DESIGNATED AS A PHYSICIAN SHORTAGE AREA (PSA), AND MANY ZIP CODES HAVE AN AVERAGE HOUSEHOLD INCOME THAT IS BELOW THE NATIONAL AVERAGE - MAKING ACCESS TO QUALITY HEALTHCARE A CONSTANT CHALLENGE. |
| PART VI, LINE 5: | THE BOARD OF TRUSTEES IS A COMMUNITY BOARD, MADE UP ENTIRELY OF CIVIC AND COMMUNITY LEADERS, WHO SERVE VOLUNTARILY. THE BOARD APPOINTS THE CEO, APPROVES BUDGETS, DEVELOPS STRATEGIC PLANS AND PROVIDES OVERSIGHT FOR THE HOSPITAL IN GENERAL. POTENTIAL CONFLICT OF INTEREST BETWEEN BOARD MEMBERS AND THE HOSPITAL ARE REVIEWED ANNUALLY.THE HOSPITAL'S MEDICAL STAFF IS COMPRISED OF QUALIFIED PHYSICIANS FROM WITHIN THE COMMUNITY. THE HOSPITAL CONTRACTS DIRECTLY FOR EMERGENCY ROOM PHYSICIANS AND A PATHOLOGIST AND EMPLOYS PRIMARY CARE PHYSICIANS.THE HOSPITAL OPERATES A FULL-TIME EMERGENCY ROOM OPEN TO ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. PATIENTS COME TO THE EMERGENCY ROOM BY THEIR OWN TRANSPORTATION OR BY AMBULANCE FROM EITHER A LOCAL FIRE DEPARTMENT OR AN INDEPENDENT AMBULANCE BUSINESS THAT SERVES THE ENTIRE COUNTY. IN ORDER TO ENSURE 24 HOUR PHYSICIAN COVERAGE IN THE ER, THE HOSPITAL PROVIDES A SUBSIDY TO THE ER PHYSICIAN GROUP. NON EMERGENCY CARE IS PROVIDED BASED UPON PHYSICIAN ORDERS TO ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY.SURPLUS FUNDS ARE INVESTED IN MEDICAL EQUIPMENT UPGRADES AND NEW TECHNOLOGIES THROUGH A CAPITAL BUDGET PROCESS. THERE ARE NO "OWNERS OR STOCKHOLDERS SO NO SURPLUS FUNDS ARE PAID OUT TO OWNERS OR STOCKHOLDERS.TLC HEALTH NETWORK IS IN A MEDICALLY UNDERSERVED AREA. SIGNIFICANT ONGOING EFFORTS AT PHYSICIAN RECRUITMENT ARE EXPENDED. CURRENT PHYSICIAN SHORTAGES INCLUDE PRIMARY CARE, PEDIATRICS, OBSTETRICS, SURGERY, ORTHOPEDIC, UROLOGY, RADIATION ONCOLOGIST, NEUROLOGIST, MEDICAL ONCOLOGIST AND PULMONOLOGIST.THE HOSPITAL WORKS TO ENSURE AN ADEQUATE BLOOD SUPPLY IN THE COMMUNITY AND SURROUNDING AREAS BY HOSTING BI-MONTHLY BLOOD DRIVES IN COOPERATION WITH THE COMMUNITY BLOOD BANK.THE HOSPITAL STRIVES TO IMPROVE THE QUALITY OF PATIENT CARE BY A VARIETY OF ACCREDITATIONS, SURVEYS AND BENCHMARKS INCLUDING:- THE HOSPITAL IS ACCREDITED THROUGH DNV AND THE AMERICAN COLLEGE OF RADIOLOGY FOR MAMMOGRAPHY, CT SCAN, NUCLEAR MEDICINE AND ULTRASOUND.THE HOSPITAL TAKES A PROACTIVE APPROACH TO THE PREVENTION OF HOSPITAL-ACQUIRED INFECTIONS, INCLUDING:- INSTITUTION WIDE PROGRAM TO PROMOTE EFFECTIVE HAND WASHING.- INSTITUTION WIDE PROGRAM TO REDUCE URINARY TRACT INFECTIONS.- INSTITUTION WIDE PROGRAM TO REDUCE CENTRAL LINE INFECTIONS.- INSTITUTION WIDE PROGRAM TO REDUCE VENTILATOR-ASSOCIATED INFECTIONS.- THE HOSPITAL MONITORS NATIONAL AND STATE BENCHMARKS FOR THE USE OF ANTIBIOTICS RELATED TO SURGERY.- THE HOSPITAL MONITORS NATIONAL AND STATE BENCHMARKS FOR THE PREVENTION OF BLOOD CLOTS AFTER SURGERY.- THE HOSPITAL IMPLEMENTED BAR CODE MEDICATION ADMINISTRATION TO REDUCE/ELIMINATE MEDICATION ERRORS.- THE HOSPITAL USES PATIENT SURVEYS THROUGH BOTH PRESS GANEY AND HCAPHS. AREAS THAT MEASURED BELOW AVERAGE ARE REVIEWED WEEKLY AND BEING ADDRESSED THROUGH: - HOURLY ROUNDING- PRE-OPERATIVE JOINT EDUCATION CLASSES- POST DISCHARGE CALLS TO ASSURE PATIENTS UNDERSTAND THEIR MEDICATION INSTRUCTIONS.- CUSTOMER SERVICE TRAINING. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | NY |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JOHN GALATI | ||||||||||||||
| PRESIDENT & CEO | $144,972 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $10,941 | $0 | $155,913 | $0 | $0 | $0 |
| TARIQ HUSSAIN MD | ||||||||||||||
| ORTHOPEDIC PHYSICIAN | $538,218 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $18,458 | $0 | $556,676 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 7B | THE DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL OF BOARD MEMBERS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 IS PREPARED AND REVIEWED BY VARIOUS INDIVIDUALS WITHIN MANAGEMENT AND PROVIDED TO THE GOVERNING BODY PREVIOUS TO ITS FILING WHEN TIME ALLOWS OR AT ITS NEXT MEETING WHEN TIME DOES NOT PERMIT REVIEW PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | DEPARTMENT MANAGERS, ADMINISTRATORS, BOARD MEMBERS AND MATERIAL MANAGEMENT EMPLOYEES SIGN A CONFLICT OF INTEREST STATEMENT UPON HIRE DATE AND ANNUALLY THEREAFTER. |
| FORM 990, PART VI, SECTION B, LINE 15 | PER CORPORATE BYLAWS, THE BOARD SHALL AT LEAST ANNUALLY REVIEW THE CEO'S PERFORMANCE, COMPENSATION, AND BENEFITS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THESE DOCUMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | DEPRECIATION OF FUNDS HELD IN TRUST 217,977. |
| FORM 990, PART XII, LINE 2C | THE AUDIT OVERSIGHT PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| LAKE SHORE NURSING HOME INC | ||||||||||
| 845 ROUTES 5 20 | IRVING | NY | 14081 | 160976895 | SKILLED NURSING FACILITY | NY | 501(C)(1) | LINE 3 | TLC HEALTH NETWORK | 0 |
| LAKE SHORE CHILDCARE | ||||||||||
| 845 ROUTES 5 20 | IRVING | NY | 14081 | 161381646 | CHILD DAYCARE SERVICES | NY | 501(C)(3) | LINE 11 | TLC HEALTH NETWORK | 0 |
| LSP CORPORATION | ||||||||||
| 845 ROUTES 5 20 | IRVING | NY | 14081 | 117239014 | REAL ESTATE - MEDICAL AND ADMINISTRATIVE OFFICE FACILITY | NY | 501(C)(3) | LINE 3 | TLC HEALTH NETWORK | 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 | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |