ST JAMES HOSPITAL: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- ST JAMES HOSPITAL (EIN 16-0743310)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-11-05
- IRS object ID
- 201823099349301107
- 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 H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-11-05T10:26:19-06:00 | 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 | 160743310 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST JAMES MERCY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STJA | BusinessNameControlTxt |
| Phone | 6073248110 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 411 CANISTEO STREET | AddressLine1Txt |
| City | HORNELL | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 148432104 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BRYAN O'DONOVAN | PersonNm |
| Person Title | PRESIDENT AND CEO | PersonTitleTxt |
| Phone | 6073248110 | PhoneNum |
| Signature | 2018-10-24 | 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 | 2018-10-10 | 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 | 2018-10-24 | IPDt |
| IP Tm | 13:16:21 | IPTm |
| IP Timezone | ED | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | E929E822DA4ED06B116DA1A0B819B04B4C73AA9A | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 7F5E0ACB701E1BB487F84ED1C8C7C99ACE5AA2C1 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2018-06-14 16:35:46Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | BRYAN O'DONOVAN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 411 CANISTEO STREET | AddressLine1Txt |
| City | HORNELL | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 148432104 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $34,421,650 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.STJAMESMERCY.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1992 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | SEE SCHEDULE O.ST. JAMES MERCY HOSPITAL, GOVERNED BY A SELF-PERPETUATING COMMUNITY BASED BOARD, IS A COMMUNITY OF PERSONS COMMITTED TO BEING A TRANSFORMING, HEALING PRESENCE WITHIN THE RURAL COMMUNITIES WE SERVE, PARTICULARLY ADDRESSING THE NEEDS OF THE POOR, UNDERSERVED AND DISADVANTAGED. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 366 | TotalEmployeeCnt |
| Total Volunteers | 26 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $712,289 | PYContributionsGrantsAmt |
| CY Contributions Grants | $4,428,596 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $28,097,586 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $26,479,025 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,766 | PYInvestmentIncomeAmt |
| CY Investment Income | $53,968 | CYInvestmentIncomeAmt |
| PY Other Revenue | $4,512,180 | PYOtherRevenueAmt |
| CY Other Revenue | $3,460,061 | CYOtherRevenueAmt |
| PY Total Revenue | $33,324,821 | PYTotalRevenueAmt |
| CY Total Revenue | $34,421,650 | 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 | $14,718,785 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $15,587,975 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $18,611,648 | PYOtherExpensesAmt |
| CY Other Expenses | $14,859,670 | CYOtherExpensesAmt |
| PY Total Expenses | $33,330,433 | PYTotalExpensesAmt |
| CY Total Expenses | $30,447,645 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$5,612 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,974,005 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $15,218,065 | TotalAssetsBOYAmt |
| Total Assets EOY | $18,016,126 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $11,954,936 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $10,848,220 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,263,129 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $7,167,906 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | SEE SCHEDULE O.ST. JAMES MERCY HOSPITAL, GOVERNED BY A SELF-PERPETUATING COMMUNITY BASED BOARD, IS A COMMUNITY OF PERSONS COMMITTED TO BEING A TRANSFORMING, HEALING PRESENCE WITHIN THE RURAL COMMUNITIES WE SERVE, PARTICULARLY ADDRESSING THE NEEDS OF THE POOR, UNDERSERVED AND DISADVANTAGED. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $21,585,887 | ExpenseAmt |
| Revenue | $29,868,089 | RevenueAmt |
| Desc | ST. JAMES MERCY HOSPITAL IS AN ACUTE HEALTHCARE FACILITY PROVIDING ROUTINE, AMBULATORY AND ANCILLARY SERVICES. MAJOR SERVICES INCLUDE MEDICAL, SURGICAL, RADIOLOGY, AND LABORATORY. TOTAL ACUTE DISCHARGES FOR THE HOSPITAL WERE 810. OUTPATIENT REGISTRATIONS FOR THE HOSPITAL WERE 99,124. ST. JAMES MERCY HOSPITAL OPERATES SEVERAL PHYSICIAN PRACTICES. TOTAL OFFICE VISITS WERE 13,624, INCLUDING EXPRESS CARE. | Desc |
| Total Program Service Expenses | $21,585,887 | 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 | 0 | 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 | 0 | 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 | Yes (1) | 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 | 62 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 366 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| 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 | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | 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 | 0 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVID PIERAMICO | PersonNm |
| Phone | 6073248110 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 411 CANISTEO STREET | AddressLine1Txt |
| City | HORNELL | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14843 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| JOHN WEYAND DC | ||||||||
| CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| SUSAN GRAY PHD | ||||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| SHAWN HOGAN | ||||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| PETER D WALL | ||||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| SPENCER ANNABEL MD | ||||||||
| BOARD MEMBER | 36.00 | Yes (X) | $149,500 | $0 | $0 | |||
| ISMAIL MEHR MD | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $435,055 | $0 | $0 | |||
| BRIAN SCHU | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JENNIFER L SULLIVAN | ||||||||
| PRESIDENT/CEO | 39.00 | Yes (X) | $275,415 | $0 | $13,654 | 1.00 | ||
| STANLEY D KONOPKO | ||||||||
| CFO | 39.70 | Yes (X) | $142,230 | $0 | $7,442 | 0.30 | ||
| JOHN ROBSHAW | ||||||||
| ER PHYSICIAN AND ER MEDICAL DIRECTOR | 40.00 | $448,402 | $0 | $4,208 | Yes (X) | |||
| KEVIN WENTWORTH | ||||||||
| ER PHYSICIAN ASSISTANT | 40.00 | $312,499 | $0 | $17,815 | Yes (X) | |||
| M TARIQ RANDHAWA | ||||||||
| HOSPITALIST PHYSICIAN | 40.00 | $265,020 | $0 | $9,116 | Yes (X) | |||
| KEVIN BRICELAND | ||||||||
| CHIEF APP OFFICER AND PHYSICIAN ASSISTANT | 40.00 | $210,659 | $0 | $2,363 | Yes (X) | |||
| GIACOMO FLORIO | ||||||||
| ER PHYSICIAN | 40.00 | $158,391 | $0 | $12,095 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,397,171 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $66,693 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 14 | 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 |
|---|---|---|---|---|---|
| RAZAK ASSOCIATES ARCHITECTURE | |||||
| 2060 FAIRPORT NINE MILE RD | PENFIELD | NY | 14526 | ARCHITECTURE SERVICES | $1,473,509 |
| EXIGENCE HOSPITAL MEDICINE | |||||
| PO BOX 634850 | CINCINNATI | OH | 45263 | STAFFING SERVICES | $452,040 |
| ABADAN MEDICAL PLLC | |||||
| 325 CLEVELAND AVENUE | HORNELL | NY | 14843 | ANESTHESIOLOGY SERVICES | $435,055 |
| HARRIS BEACH PLLC | |||||
| 99 GARNSEY ROAD | PITTSFORD | NY | 14534 | LEGAL SERVICES | $416,963 |
| MEDICUS EMERGENCY ROOM SERVICES LLC | |||||
| 22 ROULSTON ROAD | WINDHAM | NH | 03087 | ER PHYSICIAN SERVICES | $388,200 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 15 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $103,552 | RelatedOrganizationsAmt |
| Government Grants | $4,325,044 | GovernmentGrantsAmt |
| Total Contributions | $4,428,596 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE | Desc |
| Business | 621990 | BusinessCd |
| Total Revenue Column | $26,479,025 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $26,479,025 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $26,479,025 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $53,968 | TotalRevenueColumnAmt |
| Exclusion | $53,968 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $215,291 | 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 | $215,291 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $215,291 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $215,291 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| NYS FUNDING | 900099 | $2,788,954 | $2,788,954 | |
| LIFELINE REVENUE | 900099 | $244,272 | $244,272 | |
| TRINITY REVENUE | 900099 | $150,681 | $79,684 | $70,997 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $60,863 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $60,863 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $3,244,770 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $34,421,650 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $29,868,089 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $124,965 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,023,296 | TotalAmt |
| Program Services | $584,555 | ProgramServicesAmt |
| Management And General | $438,741 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,184,138 | TotalAmt |
| Program Services | $7,177,608 | ProgramServicesAmt |
| Management And General | $4,006,530 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $233,549 | TotalAmt |
| Program Services | $146,754 | ProgramServicesAmt |
| Management And General | $86,795 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,256,079 | TotalAmt |
| Program Services | $1,426,222 | ProgramServicesAmt |
| Management And General | $829,857 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $890,913 | TotalAmt |
| Program Services | $559,819 | ProgramServicesAmt |
| Management And General | $331,094 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $163,187 | TotalAmt |
| Program Services | $103,754 | ProgramServicesAmt |
| Management And General | $59,433 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $973,265 | TotalAmt |
| Program Services | $321,177 | ProgramServicesAmt |
| Management And General | $652,088 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,286 | TotalAmt |
| Program Services | $6,612 | ProgramServicesAmt |
| Management And General | $13,674 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $221,260 | TotalAmt |
| Program Services | $72,112 | ProgramServicesAmt |
| Management And General | $149,148 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $517,381 | TotalAmt |
| Program Services | $204,917 | ProgramServicesAmt |
| Management And General | $312,464 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PURCHASED SERVICES | $4,300,233 | $3,082,158 | $1,218,075 |
| PHYSICIAN FEES | $2,771,338 | $2,771,338 | |
| SUPPLIES | $2,018,129 | $1,872,732 | $145,397 |
| BAD DEBT EXPENSE | $1,740,607 | $1,488,191 | $252,416 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,133,984 | TotalAmt |
| Program Services | $1,767,938 | ProgramServicesAmt |
| Management And General | $366,046 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,447,645 | TotalAmt |
| Program Services | $21,585,887 | ProgramServicesAmt |
| Management And General | $8,861,758 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,610,284 | BOYAmt |
| EOY | $2,750,768 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,000 | BOYAmt |
| EOY | $17,013 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,120,667 | BOYAmt |
| EOY | $6,172,578 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $582,843 | BOYAmt |
| EOY | $620,090 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $178,581 | BOYAmt |
| EOY | $246,676 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $6,474,350 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $296,002 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,071,555 | BOYAmt |
| EOY | $6,178,348 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,637,135 | BOYAmt |
| EOY | $2,030,653 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,218,065 | BOYAmt |
| EOY | $18,016,126 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,312,382 | BOYAmt |
| EOY | $5,900,796 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,068,455 | BOYAmt |
| EOY | $1,314,192 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,000,000 | BOYAmt |
| EOY | $2,000,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,574,099 | BOYAmt |
| EOY | $1,633,232 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,954,936 | BOYAmt |
| EOY | $10,848,220 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,694,534 | BOYAmt |
| EOY | $6,797,760 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $298,321 | BOYAmt |
| EOY | $342,414 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $270,274 | BOYAmt |
| EOY | $27,732 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,263,129 | BOYAmt |
| EOY | $7,167,906 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,218,065 | BOYAmt |
| EOY | $18,016,126 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $3,974,005 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$69,228 | 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
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,203,414 | OtherCostOrOtherBasisAmt |
| Book Value | $1,203,414 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $136,058 | OtherCostOrOtherBasisAmt |
| Depreciation | $38,339 | DepreciationAmt |
| Book Value | $97,719 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,528,273 | OtherCostOrOtherBasisAmt |
| Depreciation | $257,663 | DepreciationAmt |
| Book Value | $1,270,610 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,606,605 | OtherCostOrOtherBasisAmt |
| Book Value | $3,606,605 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $6,178,348 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| ESTIMATED THIRD PARTY PAYOR SETTLEMENTS | $435,377 |
| ASSETS WHOSE USE IS LIMITED | $1,595,276 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,030,653 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| ESTIMATED THIRD PARTY PAYOR SETTLEMENTS | $1,606,081 |
| OTHER CURRENT LIABILITIES | $27,151 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,633,232 | TotalLiabilityAmt |
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 |
| Percent300 | Yes (X) | Percent300Ind |
| 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 | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,325,961 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,132,851 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $193,110 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00670 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,842,734 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,509,578 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,333,156 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08060 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,168,695 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,642,429 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,526,266 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08730 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $55,679 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $55,679 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00190 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $30,194 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $30,194 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $48,809 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $48,809 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00170 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $134,682 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $134,682 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00460 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,303,377 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,642,429 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,660,948 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09190 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $563,674 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $10,015 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,131,564 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $7,052,148 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$920,584 | 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 | ST JAMES MERCY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 411 CANISTEO STREET | AddressLine1Txt |
| City | HORNELL | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14843 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.STJAMESMERCY.ORG | WebsiteAddressTxt |
| State License | 5002001H | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST JAMES MERCY 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 |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.STJAMESMERCY.ORG | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | HTTPS://STEUBENCONY.ORG/FILES/DOCUMENTS/PUBLICHEALTH/STEUBEN_COUNTY_CHA-CSP | OtherWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 17 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.STJAMESMERCY.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 | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| 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.STJAMESMERCY.ORG/FINANCIAL.SHTML | 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 |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| ST. JAMES MERCY HOSPITAL | PART V, SECTION B, LINE 5: THE COMMUNITY NEEDS ASSESSMENT (CHNA) WAS CONDUCTED 2016 IN COLLABORATION WITH STEUBEN COUNTY PUBLIC HEALTH. THIS INCLUDED THE THREE HOSPITALS LOCATED WITHIN THE COUNTY. IN ADDITION, THERE WERE SEVERAL OTHER PARTNERS INCLUDING REPRESENTATION FROM FEDERALLY QUALIFIED HEALTH CENTERS (FQHC), COMMUNITY BASED ORGANIZATIONS (CBO), THE LEGISLATURE, COMMUNITY ACTION ORGANIZATIONS AND REPRESENTATIVES FROM LOCAL SCHOOLS. CHNA INCLUDED REVIEW AND ANALYSIS OF CURRENT AND LOCAL DATA, NEEDS ASSESMENT INFORMATION FROM THE DELIVERY SYSTEM REFORM INCENTIVE PAYMENT (DSRIP) PROGRAM AND FROM 12 COMMUNITY FOCUS GROUPS. THE INPUT WAS USED TO INDENTIFY HEALTH FACTORS AND DISPARITIES. A FULL LIST OF PARTICIPANTS CAN BE FOUND IN THE COMMUNITY SERVICE PLAN LOCATED ON THE ST. JAMES MERCY HOSPITAL WEBSITE. |
| ST. JAMES MERCY HOSPITAL | PART V, SECTION B, LINE 6A: IRA DAVENPORT MEMORIAL HOSPITAL (ARNOT HEALTH), CORNING HOSPITAL (GUTHRIE HEALTH SYSTEM). |
| ST. JAMES MERCY HOSPITAL | PART V, SECTION B, LINE 6B: STEUBEN COUNTY PUBLIC HEALTH DEPARTMENT, IRA DAVENPORT MEMORIAL HOSPITAL (ARNOT HEALTH), CORNING HOSPITAL (GUTHRIE HEALTH SYSTEM), ST. JAMES MERCY HOSPITAL, S2AY RURAL HEALTH NETWORK, GENESEE VALLEY BOCES, COMMON GROUND HEALTH (FORMERLY KNOWN AS FINGER LAKES HEALTH SYSTEM AGENCY), FINGER LAKES COMMUNITY HEALTH, STEUBEN COUNTY LEGISLATURE, STEUBEN RURAL HEALTH NETWORK, CORNELL COOPERATIVE EXTENSION, PRO ACTION OF STEUBEN AND YATES, SOUTHERN TIER TOBACCO AWARENESS COALTION, CENTER FOR TOBACCO FREE FINGER LAKES AND CANCER SERVICES PROGRAM OF STEUBEN COUNTY. |
| ST. JAMES MERCY HOSPITAL | PART V, SECTION B, LINE 11: NEEDS IDENTIFIED VIA THE CHNA ARE BEING ADDRESSED THROUGH THE STEUBEN COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). THIS PLAN CAN BE REVIEWED WITHIN THE COMMUNITY SERVICE PLAN. THE PLAN OUTLINES PRIORITY AND FOCUS AREAS AS A RESULT OF THE CHNA. THESE FOCUS AREAS ARE FURTHER DEVELOPED INTO GOALS, OBJECTIVES, INTERVENTIONS/STRATEGIES/ACTIVITIES AND PROCESS MEASURES. PARTNER ROLES AND RESOURCES ARE ALSO DOCUMENTED IN THE CHIP. |
| PART V, SECTION B, LINE 22 | A PATIENT WHOSE HOUSEHOLD INCOME IS BETWEEN 201% AND 250% OF THE MOST RECENT FEDERAL POVERTY LEVEL QULAIFIED FOR A PARTIAL CHARITY CARE DISCOUNT. THE PATIENT LIABILITY IS 40% OF THE RATE OF REIMBURSEMENT SJMH WOULD HAVE RECEIVED FROM ITS "HIGHEST VOLUME PAYOR" (EXCELLUS BLUE CROSS) FOR LIKE SERVICES (INPATIENT, OUTPATIENT AND EMERGENCY ROOM). THE PATIENT IS ELIGIBLE FOR A CHARITY CARE DISCOUNT EQUAL TO THE DIFFERENCE BETWEEN CHARGES AND 40% OF THE EXCELLUS BLUE CROSS RATE. A PATEINT WHOSE HOUSEHOLD INCOME IS BETWEEN 251% AND 300% OF THE MOST RECENT REDERAL POVERTY LEVEL QUALIFIES FOR A PARTIAL CHARITY CARE DISCOUNT. THE PATIENT IS RESPONSIBLE FOR PAYING THE EXCELLUS BLUE CROSS RATE. THE CHARITY CARE DISCOUNT WOULD EQUAL THE DIFFERENCE BETWEEN CHARGES AND THE EXCELLUS BLUE CROSS RATE.SJMH DETERMINED THAT EXCELLUS BLUE CROSS IS THE "HIGHEST VOLUME" PAYOR AS REFERENCED IN THE NYS STATUE 2807-K. THEREFORE, FOR UNISURED PATIENTS WITH HOUSEHOLD INCOMES BELOW 300% OF THE MOST RECENT FEDERAL POVERTY LEVEL, THE PAIENT RESPONSIBILITY WILL NOT EXCEED THE RATE OF REIMBURSEMENT SJMH WOULD HAVE RECEIVED FROM EXCELLUS BLUE CROSS. |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | THE COST-TO-CHARGE RATIO IS USED FOR LINES 7A AND 7B, COMPUTED BY TAKING TOTAL EXPENSES LESS BAD DEBT DIVIDED BY TOTAL GROSS PATIENT REVENUE. |
| PART I, LN 7 COL(F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $1,488,191. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | ST. JAMES MERCY HOSPITAL ACTIVELY RECRUITS PHYSICIANS AND OTHER HEALTH PROFESSIONALS TO PROVIDE SERVICES IN AREAS WITH A MEDICAL SHORTAGE OR ARE UNDERSERVED. |
| PART III, LINE 2: | THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLES FOR ESTIMATED LOSSES RESULTING FROM THE INABILITY/UNWILLINGNESS OF PATIENTS TO MAKE PAYMENTS FOR SERVICES. THE ALLOWANCE IS DETERMINED BY ANALYZING HISTORICAL DATA AND TRENDS. ACCOUNTS RECEIVABLE ARE CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLES WHEN MANAGEMENT DETERMINES THAT RECOVERY IS UNLIKELY AND THE HOSPITAL CEASES COLLECTION EFFORTS. |
| PART III, LINE 3: | THE AMOUNT REPORTED IN PART III, SECTION A, LINE 3 IS DETERMINED BY ESTIMATING THE AMOUNT OF BAD DEBT EXPENSE THAT WOULD BE ATTRIBUTED TO PATIENTS WHO WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE BUT FOR WHOM SUFFICIENT INFORMATION WAS NOT OBTAINED TO MAKE THAT DETERMINATION. |
| PART III, LINE 4: | ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. TO EVALUATE THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS HISTORICAL DATA AND 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 TO EVALUATE THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF HISTORICAL DATA, 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 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: | TO DETERMINE MEDICARE ALLOWABLE COSTS REPORTABLE IN THE MEDICARE COST REPORT, THE COST-TO-CHARGE RATIO IS APPLIED TO GROSS PATIENT REVENUE ASSOCIATED WITH SERVICES PERFORMED FOR PATIENTS WHO ARE ELIGIBLE FOR MEDICARE. |
| PART III, LINE 9B: | A BAD DEBT RESULTS FROM A PATIENT ACCOUNT BALANCE FROM WHICH PAYMENT WAS ANTICIPATED FROM THE PATIENT, CREDIT EXTENDED AND THE ACCOUNT LATER DEEMED TO BE UNCOLLECTIBLE. A BAD DEBT DOES NOT MEET THE CRITERIA FOR CHARITY CARE, THAT IS, BAD DEBT PATIENTS ARE CONSIDERED TO HAVE THE FINANCIAL CAPABILITY AND ABILITY TO PAY, BUT ARE UNWILLING TO PAY. COLLECTION ACTIVITIES ARE ONLY PURSUED WITH RESPECT TO AMOUNTS THAT PATIENTS ARE ABLE TO PAY AS DETERMINED BY THE HOSPITAL'S CHARITY CARE POLICY. NO COLLECTION ACTIVITIES TAKE PLACE WITH RESPECT TO AMOUNTS THAT PATIENTS ARE NOT EXPECTED TO PAY UNDER THIS POLICY.A SEPARATE CHARITY CARE POLICY IS IN PLACE AND WOULD BE EXHAUSTED BEFORE A PATIENT BALANCE WOULD BE DEEMED SELF-PAY. UNDER THE CHARITY CARE POLICY, CHARITY CARE/FINANCIAL ASSISTANCE IS PROVIDED TO A PATIENT WITH A DEMONSTRATED INABILITY TO PAY. A PATIENT IS ELIBIBLE FOR CHARITY CARE/FINANCIAL ASSISTANCE CONSIDERATION BASED UPON MEETING CERTAIN INCOME ELIGIBILITY CRITERIA AS ESTABLISHED BY THE FEDERAL POVERTY INCOME GUIDELINE SLIDING SCALE. PER NYS PHL 2807K, THIS CONSIDERS PATIENTS WHOSE HOUSEHOLD INCOME IS UP TO 300% OF THE MOST RECENT FEDERAL POVERTY GUIDELINES.ALL UNINSURED, LOW-INCOME PATIENTS WITHIN ST. JAMES MERCY HOSPITAL'S PRIMARY SERVICE AREA WHO CAN DEMONSTRATE AN INABILITY TO PAY CHARGES MAY APPLY FOR CHARITY CARE/FINANCIAL ASSISTANCE FOR ADJUSTMENTS TO THEIR BALANCES FOR ALL MEDICALLY NECESSARY HEALTHCARE SERVICES, PROVIDED THAT A MEMBER, IN GOOD STANDING, OF ST. JAMES MERCY HOSPITAL'S MEDICAL STAFF DETERMINES THE NEED FOR SUCH MEDICAL CARE TREATMENT. |
| PART VI, LINE 2: | IN CONJUNCTION WITH THE COMMUNITY NEEDS ASSESSMENT THAT IS DONE EVERY THREE YEARS IN CONJUNCTION WITH STEUBEN COUNTY PUBLIC HEALTH, THE ORGANIZATION USES THE FOLLOWING TO DETERMINE THE HEALTH NEEDS OF THE COMMUNITY: COMMUNITY TOWN HALL MEETINGS, SURVEYING PARTICIPANTS AT PUBLIC HEALTH EDUCATION PROGRAMS, LOCAL CASE MANAGEMENT MEETINGS, AND PHYSICIAN/MEDICAL OFFICE INFORMATION SHARED. IN ADDITION, REGIONAL DATA AND INFORMATION FROM DSRIP PROJECTS IS USED TO ASSESS COMMUNITY NEED.ST. JAMES MERCY HOSPITAL CONDUCTS A COMMUNITY NEEDS ASSESSMENT EVERY THREE YEARS IN CONJUNCTION WITH STEUBEN COUNTY PUBLIC HEALTH. BASED ON RESIDENTS' FEEDBACK, THE COUNTY'S HEALTH CARE PRIORITIES, STRATEGIES, AND PROGRAMS ARE DETERMINED. ST. JAMES MERCY HOSPTIAL CREATES AN ANNUAL PLAN BASED ON THIS ASSESSMENT, AND THE PROGRESS OF THESE INITIATIVES IS REPORTED ANNUALLY TO THE NYS DEPARTMENT OF HEALTH. LOCAL HEALTH CARE PRIORITIES ARE ALSO IDENTIFIED THROUGH SURVEYING PARTICIPANTS AT PUBLIC HEALTH EDUCATION PROGRAMS. |
| PART VI, LINE 3: | AT THE TIME OF REGISTRATION, ALL SELF-PAY INDIVIDUALS RECEIVE AN INFORMATION SHEET DESCRIBING THE TYPES OF FEDERAL, STATE AND LOCAL GOVERNMENT PROGRAMS AVAILABLE, INCLUDING ST. JAMES MERCY HOSPITAL'S CHARITY CARE POLICY. THE ELIGIBILITY PROCESS IS COORDINATED BY A FINANCIAL COUNSELOR, WHO CONTACTS THE PATIENT OR PATIENT FAMILY MEMBER BY PHONE AND/OR LETTER. PATIENTS WHO QUALIFY FOR MEDICAID ARE ALSO DIRECTED TO AN IN-HOUSE FACILITATED ENROLLER, WHO COORDINATES THE MEDICAID APPLICATION PROCESS ON BEHALF OF THE PATIENT. |
| PART VI, LINE 4: | THE PRIMARY SERVICE AREA FOR ST. JAMES MERCY HOSPITAL IS THE 15-MILE RADIUS EXTENDING FROM HORNELL (STEUBEN COUNTY), NEW YORK, AND INCLUDES THE TOWNS OF WAYLAND TO THE NORTHEAST AND TROUPSBURG TO THE SOUTHEAST (JUST OUTSIDE OF THE 15-MILE RADIUS). THE SECONDARY SERVICE AREA IS THE 30-MILE RADIUS EXTENDING FROM HORNELL. PER THE 2010 CENSUS, THE POPULATION FOR THE PRIMARY SERVICE AREA (STEUBEN COUNTY) REMAINED RELATIVELY FLAT, INCREASING 0.3% FROM 2000 TO 2010 TO 98,990 AND IS PROJECTED TO REMAIN FLAT THROUGHOUT 2014. THE POPULATION AGED 65 AND OVER COMPRISES 16% OF THE PRIMARY SERVICE AREA COMPARED TO 13% FOR NEW YORK STATE. THE POPULATION IS RACIALLY AND ETHNICALLY HOMOGENOUS WITH 95.3% WHITE, 1.6% BLACK, 1.4% HISPANIC/LATINO, AND 1.2% ASIAN. PERSONS OVER THE AGE OF 65 REPRESENT 15.6% OF THE COUNTY, 2 PERCENTAGE POINTS HIGHER THAN THE STATE. MEDIAN HOUSEHOLD INCOME IS $42,764 COMPARED TO $54,554 FOR THE STATE. APPROXIMATELY 20% OF THE COUNTY POPULATION HAVE A BACHELOR'S DEGREE OR HIGHER COMPARED TO 32% OF STATE RESIDENTS. |
| PART VI, LINE 5: | ST. JAMES MERCY HOSPITAL IS THE LEAD AGENCY FOR THE CANCER SERVICES PROGRAM (CSP) OF STEUBEN COUNTY. A COMMUNITY-BASED, GRANT-FUNDED PROGRAM OF NEW YORK STATE DEPARTMENT OF HEALTH (NYSDOH), THE CSP SERVES UNINSURED MEN AND WOMEN WITH COMPREHENSIVE, AGE-APPROPRIATE, NO-COST SCREENINGS FOR BREAST, CERVICAL AND COLORECTAL CANCER. IN ADDITION, ST. JAMES MERCY HOSPITAL RECEIVED THE NYSDOH BREAST AND PROSTATE PEER EDUCATION PROGRAM IN 2016 AND BEGAN IMPLEMENTATION OF A COMMUNITY EDUCATION BASED PROGRAM. ST. JAMES MERCY HOSPITAL PARTICIPATES IN COORDINATING THE ANNUAL HEALTHY KIDS DAY AT THE MAPLE CITY KIDS QUARTER MILER. THIS EVENT IS DIRECTED TO PARENTS AND COMMUNITY YOUTH AND INCLUDES A PEDIATRIC HEALTH FAIR AND A LOGSTANDING COMMUNITY KIDS "FUN RUN" TO PROMOTE EXERCISE AND HEALTHY LIFESTYLES. THE ORGANIZATION PARTICIPANTES IN LOCAL HEALTH FAIRS AND WORKS WITH LOCAL BUSINESSES TO PROMOTE WORKPLACE WELLNESS VIA THE CSP PROGRAM MENTIONED ABOVE. IN ADDITION, ST. JAMES MERCY HOSPITAL OPERATES A CARDIAC REHAB PROGRAM AND A COUMADIN CLINIC THAT PROVIDE OUTPATIENT BASED SERVICES TO THE COMMUNITY. A PARTNERSHIP WITH NOYES MEMORIAL HOSPITAL SUPPORTS A DIABETES EDUCATION PROGRAM AVAILABLE TO THE COMMUNITY. ST. JAMES MERCY HOSPITAL STAFF MEMBERS THROUGHOUT THE ORGANIZATION PARTICIPATE IN COMMUNITY INITIATIVES AND HOLD SEATS ON BOARDS, INCLUDING THE STUEBEN RURAL HEALTH NETWORK, CATHOLIC CHARITIES, YMCA, UNITED WAY OF THE SOUTHERN TIER, SMART STEUBEN, STEUBEN PREVENTION COALITION AND OTHER NON-PROFIT ORGANIZATIONS WHOSE PRIMARY MISSION IS TO ASSESS AND ADDRESS COMMUNITY NEEDS. ST. JAMES MERY HOSPITAL WELCOMES COMMUNITY ORGANIZATIONS TO UTILIZE SPACE FOR MEETINGS, PROGRAMS AND ACTIVITIES THAT ARE DEEMED SUPPORTIVE TO THE HEALTH OF THE COMMUNITY. THIS INCLUDES SUPPORT GROUPS, DRIVER SAFETY PROGRAMS, BLOOD DRIVES, ETC. |
| 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 | 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ISMAIL MEHR MD | ||||||||||||||
| BOARD MEMBER | $435,055 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $435,055 | $0 | $0 | $0 |
| JENNIFER L SULLIVAN | ||||||||||||||
| PRESIDENT/CEO | $275,415 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $13,654 | $0 | $289,069 | $0 | $0 | $0 |
| JOHN ROBSHAW | ||||||||||||||
| ER PHYSICIAN AND ER MEDICAL DIRECTOR | $448,402 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $4,208 | $0 | $452,610 | $0 | $0 | $0 |
| KEVIN WENTWORTH | ||||||||||||||
| ER PHYSICIAN ASSISTANT | $312,499 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $17,815 | $0 | $330,314 | $0 | $0 | $0 |
| M TARIQ RANDHAWA | ||||||||||||||
| HOSPITALIST PHYSICIAN | $265,020 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $9,116 | $0 | $274,136 | $0 | $0 | $0 |
| KEVIN BRICELAND | ||||||||||||||
| CHIEF APP OFFICER AND PHYSICIAN ASSI | $210,659 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $2,363 | $0 | $213,022 | $0 | $0 | $0 |
| GIACOMO FLORIO | ||||||||||||||
| ER PHYSICIAN | $158,391 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $12,095 | $0 | $170,486 | $0 | $0 | $0 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| STANLEY D KONOPKO CFO | |||
| STANLEY D. KONOPKO, CFO, WAS A PARTNER AT BONADIO & CO., LLP | $138,581 | BONADIO & CO. LLP WAS PAID SERVICES PERFORMED BY MR. KONOPKO AND OTHER SERVICES PROVIDED TO THE HOSPITAL. | 0 |
| ISMAIL MEHR MD | |||
| ISMAIL MEHR, MD IS A BOARD MEMBER OF THE HOSPITAL | $435,055 | ISMAIL MEHR, MD PROVIDES ANESTHESIOLOGY SERVICES TO THE HOSPITAL THROUGH HIS COMPANY ABADAN MEDICAL, PLLC. | 0 |
| SPENCER ANNABEL MD | |||
| SPENCER ANNABEL, MD IS A BOARD MEMBER OF THE HOSPITAL. | $149,500 | SPENCER ANNABEL, MD PROVIDES PHYSICIAN SERVICES TO THE HOSPITAL. | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | STANLEY D. KONOPKO HAS SERVED AS THE ORGANIZATION'S CFO SINCE AUGUST 2013. MR. KONOPKO WAS A PARTNER OF BONADIO & CO., LLP, AN ACCOUNTING FIRM, WHICH WAS PAID $138,531 FOR MR. KONOPKO'S SERVICES IN 2017. |
| FORM 990, PART VI, SECTION B, LINE 11B | A COPY OF THE FORM 990 WAS MADE AVAILABLE TO EACH BOARD MEMBER BEFORE IT WAS FILED. ST. JAMES MERCY HOSPITAL HAS DESIGNED THE AUDIT AND COMPLIANCE COMMITTEE AS THE GROUP TO BE EDUCATED AND TO REVIEW THE RETURN. |
| FORM 990, PART VI, SECTION B, LINE 12C | A CALL FOR CONFLICTS IS PART OF EVERY BOARD MEETING. THE ANNUAL BOARD OF DIRECTORS EDUCATION SESSION WAS COMPLETED IN DECEMBER 2017. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE BOARD HAS AN INDEPENDENT COMMITTEE REVIEW AND APPROVE ALL ELEMENTS OF REMUNERATION FOR ALL DISQUALIFIED PARTIES, AS WELL AS OTHER KEY MANAGEMENT. THE BOARD/COMMITTEE HAS AN ESTABLISHED COMPENSATION PHILOSOPHY WHICH DETAILS THE OBJECTIVES OF MARKET POSITIONING AND PAY ELEMENTS. THE COMMITTEE REVIEWS MARKET DATA, APPROVES ANY SALARY ADJUSTMENTS FOR THE EXECUTIVE POPULATION, CONSIDERS BOTH REASONABLENESS AND EFFECTIVENESS OF ALL REMUNERATIVE PROGRAMS AND ESTABLISHES THE DETAILED PERFORMANCE EXPECTATIONS. ALL OF THESE DISCUSSIONS AND DECISIONS ARE DOCUMENTED THROUGH THE PROVISION OF MEETING MINUTES. |
| FORM 990, PART VI, SECTION C, LINE 19 | ORGANIZATIONAL DOCUMENTS, SUCH AS THE ARTICLES OF INCORPORATION, CORPORATE BYALWS, GOVERNANCE POLICIES BELIEVED TO BE OF INTEREST TO THE PUBLIC, CONFLICT OF INTEREST POLICIES AND THE IRS FORM 990, ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | CHANGE IN NET ASSETS OF FOUNDATION 30,392. NET ASSETS RELEASED FROM RESTRICTIONS -99,620. |
| FORM 990, PART XII, LINE 2C: | THE AUDIT AND COMPLIANCE COMMITTEE IS RESPONSIBLE FOR THE SELECTION OF THE INDEPENDENT AUDITOR AND OVERSIGHT OF THE AUDIT. THERE HAS NOT BEEN A CHANGE FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST JAMES MERCY FOUNDATION INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 411 CANISTEO STREET | AddressLine1Txt |
| City | HORNELL | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14843 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 161486437 | EIN |
| Primary Activities | FOUNDATION | PrimaryActivitiesTxt |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 7 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST JAMES MERCY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | 0 | ControlledOrganizationInd |
| 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 | Yes (1) | 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 | 0 | 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 | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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