OCONNOR HOSPITAL: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- OCONNOR HOSPITAL (EIN 16-1540394)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-11-15
- IRS object ID
- 201823199349311002
- 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 C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-11-15T13:33:55-06:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 515 Broadway 4th Floor | AddressLine1Txt |
| City | Albany | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 122072974 | 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 | 161540394 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | O'Connor Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % O'CONNOR HOSPITAL | InCareOfNm |
| Business Name Control | OCON | BusinessNameControlTxt |
| Phone | 6077460326 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 460 Andes Road | AddressLine1Txt |
| City | Delhi | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13753 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SUE E ANDREWS | PersonNm |
| Person Title | TREASURER | PersonTitleTxt |
| Phone | 6077460326 | PhoneNum |
| Signature | 2018-11-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TODD P TERESCO | PreparerPersonNm |
| PTIN | P00247720 | PTIN |
| Phone | 5184274600 | PhoneNum |
| Preparation | 2018-11-09 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 167.68.102.5 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Federal Original Submission Id | 14012520183195000017 | FederalOriginalSubmissionId |
| Federal Original Submission Id | 2018-11-15 | FederalOriginalSubmissionIdDt |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 7B5190DACD7950FB62E11B317DAE60956DD6A6E7 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 7B5190DACD7950FB62E11B317DAE60956DD6A6E7 | 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 | SCOTT BONDEROFF | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 460 Andes Road | AddressLine1Txt |
| City | Delhi | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13753 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $22,455,458 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.oconnorhosp.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1997 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | O'Connor Hospital is a 23 bed critical access hospital which serves the community in need of medical services without regard to their ability to pay for such services. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 204 | TotalEmployeeCnt |
| Total Volunteers | 11 | TotalVolunteersCnt |
| Total Gross UBI | $2,292,592 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$461,060 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $555,952 | PYContributionsGrantsAmt |
| CY Contributions Grants | $575,025 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $23,623,308 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $21,447,436 | CYProgramServiceRevenueAmt |
| PY Investment Income | $89,579 | PYInvestmentIncomeAmt |
| CY Investment Income | $153,829 | CYInvestmentIncomeAmt |
| PY Other Revenue | $271,540 | PYOtherRevenueAmt |
| CY Other Revenue | $279,168 | CYOtherRevenueAmt |
| PY Total Revenue | $24,540,379 | PYTotalRevenueAmt |
| CY Total Revenue | $22,455,458 | 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 | $9,796,341 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,126,434 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $96,698 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $12,154,786 | PYOtherExpensesAmt |
| CY Other Expenses | $11,489,294 | CYOtherExpensesAmt |
| PY Total Expenses | $21,951,127 | PYTotalExpensesAmt |
| CY Total Expenses | $21,615,728 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,589,252 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $839,730 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $28,220,421 | TotalAssetsBOYAmt |
| Total Assets EOY | $29,819,865 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,016,785 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,825,853 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $25,203,636 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $25,994,012 | NetAssetsOrFundBalancesEOYAmt |
| Mission | O'Connor Hospital is a 23 bed critical access hospital which serves the community in need of medical services without regard to their ability to pay for such services. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $15,546,022 | ExpenseAmt |
| Revenue | $21,447,436 | RevenueAmt |
| Desc | Inpatient and outpatient services provided to our patients resulted in: Hospitalizations: 485 Patient days: 2591 Clinic visits: 13,686 Surgical cases: 23 | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $66,978 | ExpenseAmt |
| Desc | Community involvement has been linked to O'Connor Hospital's mission and values since it first opened. We are working with our community to improve the quality of life for the people of our region. Our community services programs provide free services to persons who cannot afford to pay, who do not qualify for Medicaid, and who fall within the established income guidelines. In 2017 , we provided $66,978 in free care. Our doors are open 24 hours a day, 7 days a week, 365 days a year. We are proud to provide this care to our communities. Not only did we provide $66,978 in charity care, $ 561,121 in patient accounts were recorded as bad debt in 2017. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $15,613,000 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 29 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 204 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | 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 | O'CONNOR HOSPITAL | PersonNm |
| Phone | 6077460326 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 460 ANDES ROAD | AddressLine1Txt |
| City | DELHI | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13753 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| JAMES C PETERS | ||||||||
| DIRECTOR | 1.0 | 40.0 | Yes (X) | $0 | $585,837 | $32,240 | ||
| MICHAEL TENGERES | ||||||||
| DIRECTOR | 1.0 | 46.5 | Yes (X) | $0 | $479,062 | $10,976 | ||
| SUE E ANDREWS | ||||||||
| TREASURER | 5.0 | 55.0 | Yes (X) | $0 | $288,461 | $23,664 | Yes (X) | |
| PETER HAMILTON | ||||||||
| CHAIRMAN | 1.0 | 3.5 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| BRUCE MCKEEGAN | ||||||||
| VICE CHAIRMAN | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| CONNIE PELLGRINO | ||||||||
| SECRETARY | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| DONALD HARRIS PHD | ||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| CHARLOTTE HILL | ||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| DENNIS N MARSH | ||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| JOHN NADER | ||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| POLLY DELLACROSSE | ||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| CAROL SPINELLI | ||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL STEIN | ||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| CARLTON RULE MD | ||||||||
| CEO (until 2/28/17) | 24.0 | 16.0 | $0 | $40,699 | $1,035 | Yes (X) | ||
| PAMELA VOGT | ||||||||
| ASSISTANT SECRETARY | 40.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| SCOTT J BONDEROFF | ||||||||
| CEO (beginning 3/2017) | 24.0 | 16.0 | $0 | $218,123 | $15,652 | Yes (X) | ||
| ERIN KINGSBURY | ||||||||
| PHARMACIST | 40.0 | 0.0 | $144,136 | $0 | $12,924 | Yes (X) | ||
| MICHAEL VIAFORE | ||||||||
| RADIOLOGY | 40.0 | 0.0 | $125,597 | $0 | $6,614 | Yes (X) | ||
| BENJAMIN WOOD | ||||||||
| PHARMACIST | 40.0 | 0.0 | $125,300 | $0 | $11,525 | Yes (X) | ||
| CONNIE FINKLE | ||||||||
| REGISTERED NURSE | 40.0 | 0.0 | $114,103 | $0 | $7,058 | Yes (X) | ||
| DEBRA J NEALE | ||||||||
| DIRECTOR OF NURSING | 40.0 | 0.0 | $116,023 | $0 | $9,679 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $625,159 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,612,182 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $131,367 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Alliance Healcare Service | |||||
| 1900 S State College Blvd Suite 60 | Anaheim | CA | 92806 | PET / CT Services | $192,420 |
| Mayo Medical Laboratories | |||||
| 200 First Street SW | Rochester | MN | 55903 | Lab Services | $116,684 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $278,412 | RelatedOrganizationsAmt |
| Government Grants | $191,878 | GovernmentGrantsAmt |
| All Other Contributions | $104,735 | AllOtherContributionsAmt |
| Total Contributions | $575,025 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | BusinessBusinessCd | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| Direct patient services | $18,267,413 | $18,267,413 | ||
| Other program service revenue | $887,431 | $887,431 | ||
| Outpatient pharmacy | $2,292,592 | 446110 | $2,292,592 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $21,447,436 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $153,829 | TotalRevenueColumnAmt |
| Exclusion | $153,829 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $279,168 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $279,168 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $279,168 | TotalRevenueColumnAmt |
| Exclusion | $279,168 | ExclusionAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $22,455,458 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $19,154,844 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $2,292,592 | UnrelatedBusinessRevenueAmt |
| Exclusion | $432,997 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,965 | TotalAmt |
| Management And General | $45,965 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,452,771 | TotalAmt |
| Program Services | $5,400,918 | ProgramServicesAmt |
| Management And General | $2,018,923 | ManagementAndGeneralAmt |
| Fundraising | $32,930 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $325,880 | TotalAmt |
| Program Services | $234,422 | ProgramServicesAmt |
| Management And General | $87,630 | ManagementAndGeneralAmt |
| Fundraising | $3,828 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,751,357 | TotalAmt |
| Program Services | $1,274,813 | ProgramServicesAmt |
| Management And General | $476,544 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $550,461 | TotalAmt |
| Program Services | $399,156 | ProgramServicesAmt |
| Management And General | $149,211 | ManagementAndGeneralAmt |
| Fundraising | $2,094 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,882,887 | TotalAmt |
| Program Services | $830,391 | ProgramServicesAmt |
| Management And General | $2,017,496 | ManagementAndGeneralAmt |
| Fundraising | $35,000 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,701 | TotalAmt |
| Management And General | $4,701 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $755,368 | TotalAmt |
| Program Services | $549,832 | ProgramServicesAmt |
| Management And General | $205,536 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,858 | TotalAmt |
| Program Services | $25,808 | ProgramServicesAmt |
| Management And General | $9,648 | ManagementAndGeneralAmt |
| Fundraising | $16,402 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,406 | TotalAmt |
| Program Services | $50,494 | ProgramServicesAmt |
| Management And General | $18,875 | ManagementAndGeneralAmt |
| Fundraising | $37 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $300,692 | TotalAmt |
| Program Services | $218,874 | ProgramServicesAmt |
| Management And General | $81,818 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,819 | TotalAmt |
| Program Services | $33,286 | ProgramServicesAmt |
| Management And General | $12,443 | ManagementAndGeneralAmt |
| Fundraising | $90 | FundraisingAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,884 | TotalAmt |
| Program Services | $35,583 | ProgramServicesAmt |
| Management And General | $13,301 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,225,669 | TotalAmt |
| Program Services | $892,104 | ProgramServicesAmt |
| Management And General | $333,482 | ManagementAndGeneralAmt |
| Fundraising | $83 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,079 | TotalAmt |
| Program Services | $59,017 | ProgramServicesAmt |
| Management And General | $22,062 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Drugs and reagents | $3,294,623 | $3,294,623 |
| Bad debt | $561,121 | $561,121 |
| Patient care supplies | $521,525 | $521,525 |
| Charity care | $66,978 | $66,978 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,578,684 | TotalAmt |
| Program Services | $1,164,055 | ProgramServicesAmt |
| Management And General | $408,395 | ManagementAndGeneralAmt |
| Fundraising | $6,234 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,615,728 | TotalAmt |
| Program Services | $15,613,000 | ProgramServicesAmt |
| Management And General | $5,906,030 | ManagementAndGeneralAmt |
| Fundraising | $96,698 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,909 | BOYAmt |
| EOY | $16,920 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,560,843 | BOYAmt |
| EOY | $8,434,184 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $741,922 | BOYAmt |
| EOY | $637,941 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,317,334 | BOYAmt |
| EOY | $2,020,194 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $558,365 | BOYAmt |
| EOY | $576,483 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $105,576 | BOYAmt |
| EOY | $70,097 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $24,429,926 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $14,674,316 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,692,659 | BOYAmt |
| EOY | $9,755,610 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,160,244 | BOYAmt |
| EOY | $8,249,052 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $63,569 | BOYAmt |
| EOY | $59,384 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,220,421 | BOYAmt |
| EOY | $29,819,865 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $918,366 | BOYAmt |
| EOY | $1,407,297 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,626,971 | BOYAmt |
| EOY | $1,393,400 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $471,448 | BOYAmt |
| EOY | $1,025,156 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,016,785 | BOYAmt |
| EOY | $3,825,853 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,045,455 | BOYAmt |
| EOY | $25,665,764 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $158,181 | BOYAmt |
| EOY | $328,248 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,203,636 | BOYAmt |
| EOY | $25,994,012 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,220,421 | BOYAmt |
| EOY | $29,819,865 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $839,730 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$45,169 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$4,185 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $4,701 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $4,701 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1 | FormAndLineReferenceDesc |
| Explanation | American Hospital Association membership dues allocate 22.98 % towards lobbying activities. Total dues paid in 2017 = $2,727.27. HANY's membership dues allocate 21.90 % towards general lobbying activities. Total dues paid in 2017 = $0. Iroquois Healthcare Alliance membership dues allocate 34.9 % towards general lobbying activities. Total dues paid in 2017 = $1,973.60. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $99,400 | OtherCostOrOtherBasisAmt |
| Book Value | $99,400 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $14,706,040 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,868,275 | DepreciationAmt |
| Book Value | $7,837,765 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,382,169 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,806,041 | DepreciationAmt |
| Book Value | $1,576,128 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $242,317 | OtherCostOrOtherBasisAmt |
| Book Value | $242,317 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $9,755,610 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
| Total Liability | $0 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $21,778,005 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$45,169 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$632,284 | OtherRevenueAmt |
| Revenue Not Reported | -$677,453 | RevenueNotReportedAmt |
| Revenue Subtotal | $22,455,458 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $22,455,458 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $20,987,629 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $20,987,629 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $628,099 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $628,099 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $21,615,728 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PART X | FIN 48 FOOTNOTE The Hospital is a not-for-profit corporation as described in Section 501 (c)(3) of the Internal Revenue Code (the Code) and is exempt from federal income taxes pursuant to Section 501(a) of the Code. The Hospital recognizes income tax positions when it is more-likely-than-not that the position will be sustainable based on the merits of the position. Management has concluded that there are no material tax liabilities or uncertain tax positions that need to be recorded as of December 31, 2017 and 2016. |
| SCHEDULE D, PART XI, LINE 2D | BAD DEBT $(561,121) CHARITY CARE $ (66,978) UNDISTRIBUTED INTEREST IN FRIENDS OF BASSETT $ (4,185) --------------- TOTAL $(632,284) |
| SCHEDULE D, PART XII, LINE 4B | BAD DEBT $ 561,121 CHARITY CARE $ 66,978 --------------- TOTAL $ 628,009 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 300. | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | false | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 19 | PersonsServedCnt |
| Total Community Benefit Expns | $112,770 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $41,281 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $71,490 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00340 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,094,769 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,436,226 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $658,545 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03140 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $277,823 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $167,005 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $110,818 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00530 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 19 | PersonsServedCnt |
| Total Community Benefit Expns | $2,485,362 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,644,512 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $840,853 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04010 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $116,153 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $116,153 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00550 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $4,336,516 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,805,586 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $530,930 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02530 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $170,862 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $170,862 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00810 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 19 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $18,948 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $18,948 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 21 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $4,642,479 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,805,586 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $836,893 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03980 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 22 | ActivitiesOrProgramsCnt |
| Persons Served | 19 | PersonsServedCnt |
| Total Community Benefit Expns | $7,127,841 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,450,098 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,677,746 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07990 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $561,121 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $1,364 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,811,545 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,744,104 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $67,441 | 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 (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | 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 | O'CONNOR HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 460 ANDES ROAD | AddressLine1Txt |
| City | DELHI | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13753 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.OCONNORHOSP.ORG | WebsiteAddressTxt |
| State License | 1254700C | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | OUTPATIENT PRIMARY & SPECIALITY | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | O'CONNOR HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | 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 |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.OCONNORHOSP.ORG | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | WWW.BASSETT.ORG | OtherWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.OCONNORHOSP.ORG | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 300. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 0. | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | false | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | 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 (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.OCONNORHOSP.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.OCONNORHOSP.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.OCONNORHOSP.ORG | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | Yes (true) | CollectionActivitiesInd |
| Reporting To Credit Agency | Yes (X) | ReportingToCreditAgencyInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART V, LINE 3J, FACILITY 1, OCONNOR HOSPITAL | Continuing prior CHNA work on preventing chronic diseases, promoting mental health, and preventing substance abuse. |
| SCHEDULE H, PART V, LINE 5, FACILITY 1, OCONNOR HOSPITAL | This Community Health Needs Assessment has taken into account input from persons who represent the broad interests of the community served by O'Connor Hospital. All organizations providing input into this assessment, including the name and title of those individuals representative of the organization, is provided below. A) Amy Beveridge, Director of Operational Support B) Debra Neale, CNO at O'Connor Hospital C) Pamela Vogt, Administrative Manager at O'Connor Hospital D) Marcy Miles, Director of Lab Services at Tri-Town Regional E) Alisha Rule, Director of Quality at O'Connor & Tri-Town Regional Hospitals F) Amanda Walsh, Epidemiologist at Delaware County Public Health G) Regina Krzyston, Quality Consultant at O'Connor & Tri-Town Hospitals H) Karen Huxtable-Hooker, Director Public & Media at Bassett Medical Center Relations I) Dotti Kruppo, Community Relations Director at UHS Hospital J) Laurie Mozian, Community Health Coordinator at Margaretville Hospital K) Mark Pohar, Executive Director at Margaretville Hospital The Community Service Plan (also referred to as the Implementation Strategy) has taken into account input from persons who represent the broad interests of the community served by O'Connor Hospital. The primary proactive means for receiving community input was through the Regional Assessment conducted by the Southern Tier Population Health Improvement Program (PHIP). In the Southern Tier, PHIP covers five counties including Delaware County. In order to inform the direction of the Southern Tier PHIP, also known as HealthlinkNY Community Network, the team conducted a regional health assessment utilizing stakeholder interviews and consumer focus groups. The information from this assessment that specifically refers to Delaware County was utilized to direct the selection of the public health priorities for OConnor Hospital. From June 2015 through January 2016, a total of 43 one-on-one structured interviews in Delaware County were conducted with professionals working in diverse fields such as health care, education, transportation, economic development, mental health, law enforcement, public office, among others. The interview questions, 10 key questions and 5 secondary questions, centered on health disparities, key barriers to addressing them, and gaps in service provision. Consumers input was sought through focus groups which were conducted from January through March of 2016. Population Health Coordinators met with pre-existing groups including support groups, service clubs, parent groups, and senior meal sites. HealthlinkNY Community Network conducted five focus groups with 37 participants in Delaware County; they were asked about their experiences with health and health care delivery. Responses from the focus groups were collected by note-takers and summarized qualitatively by the Population Health Coordinators. In addition, OConnor Hospital is an active participant in Delaware Countys Community Health Improvement Plan process. This process included input and suggestions from Delaware County Public Health, Delaware Valley Hospital, Margaretville Hospital, Tri-Town Regional Hospital, and HealthlinkNY Community Network. |
| SCHEDULE H, PART V, LINE 6A, FACILITY 1, OCONNOR HOSPITAL | Bassett Medical Center, Tri Town Regional Hospital, Cobleskill Regional Hospital, Little Falls Hospital, AO Fox Memorial Hospital |
| SCHEDULE H, PART V, LINE 11, FACILITY 1, OCONNOR HOSPITAL | The organization addressed significant, prioritized health needs identified in its most recently conducted CHNA by adoption of a budget for provision of services that address the needs identified in the CHNA, prioritization of health needs in its community, and prioritization of services that the hospital facility will undertake to meet health needs in its community. For needs not addressed as a collaborative, we address some as an individual organization, and also continue to reprioritize highest demand of needs. |
Supplemental Information Detail SupplementalInformationDetail (16 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 3C | OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARE THE CSP (community services program) application specifies family income limits and other requirements for services to be eligible for O'Connor Hospital's CSP/free care program. |
| SCHEDULE H, PART I, LINE 6A | RELATED ORGANIZATION INFORMATION O'Connor Hospital's comprehensive Community Service Plan is summarized in an annual report and posted on the O'Connor Hospital website, www.oconnorhosp.org. Printed copies are available to the public in patient waiting rooms or upon request. |
| SCHEDULE H, PART I, LINE 7, COLUMN (F) | EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE The percent of total expense in Part 1, Line 7, column (f) is calculated by dividing column (e), net community benefit expense, by total expense. The bad debt expense of $561,121 was subtracted from the total expense value used to calculate the percentages in Part 1, Line 7, Column f. |
| SCHEDULE H, PART I, LINE 7 | COSTING METHODOLOGY EXPLANATION Worksheet 2 was used to develop a cost-to-charge ratio. It was used for patient care services. For non- patient care services, charges were reduced to cost for those services to non-patients where a mark-up is readily identifiable. |
| SCHEDULE H, PART II | COMMUNITY BUILDING ACTIVITIES All O'Connor Community Building Activities are included in Part I and described above. |
| SCHEDULE H, PART III, LINE 2 | BAD DEBTS EXPENSE METHODOLOGY The ratio of approved applications for financial assistance to total applications was applied to arrive at charges presumed eligible for financial assistance. The cost-to-charge ratio was then applied to charges to arrive at cost. |
| SCHEDULE H, PART III, LINE 3 | BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE The cost-to-charge ratio was used to reduce bad debt charges to cost. The ratio of approved applications to total applications for financial assistance was applied to the bad debt cost to estimate amount presumed eligible, had patients completed the application process. |
| SCHEDULE H, PART III, LINE 4 | BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS Financial statements, page 8, footnote (i), Provision for Uncollectible Patient Accounts Receivable: The Hospital grants credit without collateral to patients, most of who are local residents and are insured under third party agreements. Services rendered to individuals when payment is expected and ultimately not received are written off to the allowance for estimated uncollectible account. Additions to the allowance for estimated uncollectible accounts are made by means of the provision for uncollectible accounts. Accounts written off as uncollectible are deducted from the allowance and subsequent recoveries are added. The amount of the provision for uncollectible accounts is based upon management's assessment of historical expected net collections, business and economic conditions, trends in federal and state governmental healthcare coverage, and other collection indicators. Financial statements, page 8, footnote (k), Charity Care: The Hospital has adopted a formal charity care policy whereby patients in need of medical services, who meet certain criteria under the policy, are treated without regard to their ability to pay for such services. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The Hospital maintains records to identify and monitor the level of charity care it provides. The Hospital's charity care policy was revised effective January 1, 2016 to be compliant with Internal Revenue Code (IRC) Section 501(r). |
| SCHEDULE H, PART III, LINE 8 | MEDICARE EXPLANATION O'Connor is a critical access hospital, so cost is calculated on the settlement sheets of the cost report. It was compared to Medicare reimbursement, which is also calculated on the cost report. |
| SCHEDULE H, PART III, LINE 9B | COLLECTION PRACTICES EXPLANATION For patients or guarantors who do not qualify for financial assistance, Bassett must undertake to ensure an adequate understanding on the part of the patients and those responsible for their care of their financial obligations to OConnor Hospital. OConnor Hospital will, in compliance with all existing laws and regulations, take the necessary steps to recover self-pay accounts receivable as well preserve the patient-provider relationship and keep the necessity of referring accounts to third party bad debt collection agencies or law firms to a minimum. It is expected that any third party collection agency or law firm retained by Bassett will refrain from any conduct that violates the Fair Debt Collection Practices Act, as well as any applicable state law or regulations. The arrest or body attachment of a judgement debtor on contempt proceedings, or foreclosure of a judgement debtor's principal residence will never be considered appropriate pursuit of an open balance in the name of OConnor Hospital. |
| SCHEDULE H, PART VI, LINE 2 | NEEDS ASSESSMENT In addition to public and agency input, a variety of data from the NYS Department of Health, Delaware Co. Behavioral Risk Factor Surveillance System. Delaware County Public Health Nursing Services Community Health Assessment and other sources were used to assess priorities, including the rising percentage of adults with diabetes and rising obesity rate. Based on the priority items, the following strategies were identified: 1. Access to Quality Healthcare and Preventive Care Services a.) Recruitment of primary care providers for community based health centers by Bassett Medical Center in areas of the county where access to primary care is an issue. b.) O'Connor Hospital, Tri-Town Regional Hospital (TRH) and Bassett Medical Center will continue to identify grant opportunities to assist in attracting physicians to Delaware Co. c.) O'Connor Hospital and TRH will continue to evaluate the need for specialty services and expand or develop specialty clinics as needed to increase access. d.) O'Connor Hospital and Tri-Town Wellness Network will continue to offer and expand worksite wellness and occupational health services. e.) O'Connor Hospital will increase access through the provision of physician coverage at Countryside Care center nursing home. f.) O'Connor Hospital and TRH will work with Bassett's Cancer Services Program and community partners to increase access to preventive cancer screening services throughout the county. g.) Bassett Medical Center and O'Connor Hospital will work to increase access to dental health care by recruiting a dentist/oral surgeon for the Bassett Medical Center's Delhi Dental Clinic. h.) O'Connor Hospital and TRH will continue to provide and expand smoking cessation classes to area residents as well as to offer support to individuals who have recently become non-tobacco users. 2. Physical Activity and Nutrition a.) O'Connor Hospital, TRH and the Tri-Town Wellness Network will promote adoption of healthy lifestyle behaviors through group sessions to improve understanding of nutrition, diabetes medications and issues important to diabetics and those at risk of becoming diabetic. b.) O'Connor Hospital and TRH will collaborate with the Delaware Co. Public Health Nursing Services to encourage area residents to increase their personal physical activity via information about available programs in the region and encouragement to participate in these programs. c.) O'Connor Hospital will continue to collaborate with the Delaware Co. Rural Health Alliance to develop and implement community wellness and preventive programs. 3. Overall Goals a.) Increase access to preventive health care by recruiting primary care providers, expanding workplace and community-based wellness programs, and providing cancer screening services in underserved areas of the county b.) Improve community worksite access to smoking cessation programs through additional class offerings and follow-up sessions c.) Establish formal diabetes support and educational sessions on prevention and wellness topics of particular interest to diabetics and those who care for and about them d.) Promote physical activity by raising awareness of existing opportunities in the area and by offering additional activities and rewards programs for participation. O'Connor Hospital will continue to offer free educational programming, health screenings and events to increase knowledge about chronic diseases, women's health, aging, occupational health and other topics/prevention priorities. These include lectures, presentations, support groups and participation in community wellness events. |
| SCHEDULE H, PART VI, LINE 3 | PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE A major component of the O'Connor Hospital Community Services program is to actively identify patients who may be eligible for charity care. The process begins with an organizational policy and procedure that defines the program and serves as an education tool for all O'Connor employees. The policy is updated annually, distributed to key personnel and posted in the online policy and procedure manual that is accessible to all employees. The program is supported by a four page plain language brochure that includes an application. Brochures are prominently displayed and available at all facilities and all clinic locations. Clinical and support staff are made aware of the program and able to direct patients to specialists who can assist in the application process. All patients who are registered as self-pay are provided a brochure either in person or by mail. Patients who are in the hospital receive information as part of a personal visit geared to help the patient navigate financial assistance including, but not limited to, the Community Services Program. Government program opportunities are also referenced and a directory of local social services agencies is provided based on the patient's county of residence. Patient referral to the Delaware County Medicaid Examiner is facilitated by the Finance Director at the O'Connor Hospital. A listing of all self-pay accounts is produced and reviewed daily to insure that a Community Services brochure has been provided. The self-pay billing office identifies patients during the billing and collections process that may require additional help understanding the program. Self-pay accounts for patients who have been approved for Community Services within the prior 120 days are automatically included with the prior approval. |
| SCHEDULE H, PART VI, LINE 4 | COMMUNITY INFORMATION According to the 2017 United States census estimate, Delaware County, New York, has a population of 45,001 and is approximately the size of the state of Rhode Island. The county has four hospitals covering an area of 1,442.44 square miles with 33.3 people per square mile. O'Connor's service area includes the Delhi community, as well as, surrounding communities stretching from Grand Gorge, through Stamford, South Kortright, Bovina, Andes, Bloomville, Hamden and Franklin to Treadwell, and covering many hamlets in between. This large service area represents the eastern branch and areas of the northeastern part of Delaware County. |
| SCHEDULE H, PART VI, LINE 5 | PROMOTION OF COMMUNITY HEALTH O'Connor Hospital is a critical access hospital in Delhi, New York providing a full range of acute and preventative health care services, including acute inpatient care, restorative/rehabilitative (swing bed) care, an emergency services department where practitioners have the ability to interface with board-certified neurologists in Cooperstown through telemedicine connections, same-day surgery, a state-of-the-art medical imaging suite, laboratory services, an outpatient pharmacy, physical and occupational therapy, dietary consultations, an Eye Wear Center, a dental clinic and a wide range of specialty services. O'Connor has served the Delhi Community since 1922 and has been affiliated with The Mary Imogene Bassett Hospital (dba Bassett Medical Center) since 1988. O'Connor is an entity of the Bassett Healthcare Network. It is governed by a 13 member Board of Trustees consisting of community volunteers. O'Connor Hospital programs address chronic disease management and prevention, women's health, aging, tobacco and unintentional injury. They include: 1.) Cancer Services Program of Delaware, Otsego and Schoharie Counties 2.) Bassett Cancer Institute medical screening coach equipped with digital technology for mammography and other cancer screenings for men and women. 3.) O'Connor Dental Clinic operating since 2005 through a partnership with Bassett Medical Center 4.) Occupational Health - through a partnership with HealthWorks, a part of Bassett's New York Center for Agricultural Medicine & Health, O'Connor provides post-hire screenings to area employers and offers health screenings for firefighters and EMS personnel 5.) O'Connor Hospital provides space for diabetes, Alzheimer's, mental health and Parkinson's support groups on a monthly basis. 6.) O'Connor Hospital webinars are offered twice a month on healthy eating and other topics 7.) O'Connor offers a six-week facilitated group smoking cessation program 8.) O'Connor offers spring and fall flu shot clinics 9.) O'Connor provides free community assessments, screenings and educational events including health fairs, blood pressure screenings, free eye screenings for children (ages 1 - 5), balance assessment, fitness assessment tests for strength, and free lunch and learn workshops throughout the year. 10.) A program for expectant parents is offered in the O'Connor Specialty Clinic 11.) Rehabilitation Services department at O'Connor provides a fall prevention program and a wheelchair clinic O'Connor Hospital is continually engaging in quality improvement activities to ensure high quality health care and programs are available in Delaware County. O'Connor has a community board who are actively engaged in the hospital both supporting the growth and the investment in programs that bring health and wellness benefits to the community. O'Connor continually invests in programs, equipment and people to ensure high quality service is available in the community they serve. |
| SCHEDULE H, PART VI, LINE 6 | AFFILIATED HEALTH CARE SYSTEM O'Connor Hospital is part of the Bassett Healthcare Network that provides health services in more than 20 communities spanning 5,600 square miles and seven counties. The network focuses its community services programs in the counties where the six affiliated hospitals and greatest patient populations are located. Otsego County - population 60,094; Delaware County - population 45,001; Herkimer County - population 62,240; Schoharie County - population 31,420 (according to the 2017 U.S. Census estimates). a) O'Connor Hospital, a critical access hospital in Delhi, Delaware County b) The Mary Imogene Bassett Hospital - an acute care inpatient teaching facility, an outpatient primary and specialty care center, a regional network of 26 community based outpatient health centers, 20 school based health centers, two ambulatory surgery centers, and a fully salaried medical staff in Cooperstown, Otsego County c) Cobleskill Regional Hospital, an acute care facility in Cobleskill, Schoharie County d) Little Falls Hospital, a critical access hospital in Little Falls, Herkimer County e) Tri-Town Regional Hospital, a 24/7 emergency care facility in Sidney, Delaware County f) A.O. Fox Memorial Hospital, an acute care facility in Oneonta, Otsego County g) Valley Health Services, a residential health care and rehabilitation facility h) At Home Care, a certified home care agency i) First Community Care of Bassett, a medical supply company All of the above make up the Bassett Healthcare Network and provide health services to this seven county region in central New York. |
| SCHEDULE H, PART VI, LINE 7 | STATE FILING OF COMMUNITY BENEFIT REPORT New York |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAMES C PETERS | ||||||||||||||
| DIRECTOR | $0 | $565,837 | $0 | $20,000 | $0 | $0 | $0 | $24,612 | $0 | $7,628 | $0 | $618,077 | $0 | $0 |
| MICHAEL TENGERES | ||||||||||||||
| DIRECTOR | $0 | $412,662 | $0 | $66,400 | $0 | $0 | $0 | $8,912 | $0 | $2,064 | $0 | $490,038 | $0 | $0 |
| SUE E ANDREWS | ||||||||||||||
| TREASURER | $0 | $268,936 | $0 | $19,525 | $0 | $0 | $0 | $17,600 | $0 | $6,064 | $0 | $312,125 | $0 | $0 |
| ERIN KINGSBURY | ||||||||||||||
| PHARMACIST | $144,136 | $0 | $0 | $0 | $0 | $0 | $7,717 | $0 | $5,207 | $0 | $157,060 | $0 | $0 | $0 |
| SCOTT J BONDEROFF | ||||||||||||||
| CEO (beginning 3/2017) | $0 | $218,123 | $0 | $0 | $0 | $0 | $0 | $13,016 | $0 | $2,636 | $0 | $233,775 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | RELATED ORG METHODS USED FOR COMPENSATION EXPLANATION The Mary Imogene Bassett Hospital (dba Bassett Medical Center) provides the compensation for the Presidents of O'Connor Hospital, A.O. Fox Memorial Hospital, Cobleskill Regional Hospital, and Little Falls Hospital. Bassett Medical Center uses the following methods to establish compensation for said individuals: A) compensation committee, B) independent compensation consultant, C) written employment contract, D) compensation survey or study and, E) approval by the board or compensation committee. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, LINE 11B | ORGANIZATIONS PROCESS TO REVIEW FORM 990 The Treasurer of the Board presents the draft 990 to the Executive and Finance Committee of the Board prior to any filing. Any member of the Board who wishes to attend this presentation may attend. Any questions raised are answered and once approved, the 990 can be electronically filed. A complete copy of the organization's final form 990, including all required schedules, as ultimately filed with the IRS, is made available, upon request, to each member of the Board before it's filing with the IRS. |
| FORM 990, PART VI, LINE 12C | ENFORCEMENT OF CONFLICTS POLICY The organization's conflict of interest policy applies to the Board of Directors, board members, and key persons such as the Chief Executive Officer. Each board member, officer, or key person of the hospital shall complete a conflict of interest questionnaire annually. All completed questionnaires are reviewed and all disclosures of potential conflicts will be brought to the Chief Executive Officer. The CEO or his/her designee will take action to eliminate the potential conflict of interest. All disclosures of potential conflicts of interest in the completed questionnaires shall be compiled and reported by the Assistant Treasurer to the Executive and Finance Committee of the board to determine if the reported disclosure and resolution is satisfactory. If the actions taken are not satisfactory, the Executive and Finance Committee shall determine further action as it deems appropriate. |
| FORM 990, PART VI, LINE 15A | COMPENSATION PROCESS FOR TOP OFFICIAL The Chief Executive Officer's salary is paid by a related organization under a management services agreement. O'Connor Hospital reviews the formal process that is used to determine the base compensation of the CEO. The CEO workplan and accomplishments for the year are reviewed. The CEO's salary is submitted as part of the management services agreement, which is approved by the board. |
| FORM 990, PART VI, LINE 19 | GOVERNING DOCUMENTS DISCLOSURE EXPLANATION O'Connor Hospital makes its governing documents, conflict of interest policy, and financial statements available to the public upon written request. Parties desiring to obtain copies of such must present themselves at the administrative offices of O'Connor Hospital or by sending a self-addressed stamped envelope and payment for copying of the requested material to O'Connor Hospital Administrative offices. The cost of copying shall be equal to the costs imposed by the IRS for copying public documents. |
| FORM 990, PART XI, LINE 9 | OTHER CHANGES IN NET ASSETS UNDISTRIBUTED INTEREST IN FRIENDS OF BASSETT $(4,185) |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (11 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| Bassett Healthcare Network | ||||||||||
| One Atwell Road | Cooperstown | NY | 13326 | 133218680 | Support | NY | 501c3 | 12c | None | false |
| Bassett Regional Corporation (BRC) | ||||||||||
| One Atwell Road | Cooperstown | NY | 13326 | 133522783 | Support | NY | 501c3 | N/A | BHN | false |
| Friends of Bassett | ||||||||||
| One Atwell Road | Cooperstown | NY | 13326 | 237041610 | Fundraiser | NY | 501c3 | 7 | BHN | false |
| AO Fox Memorial Hospital | ||||||||||
| One Norton Avenue | Oneonta | NY | 13820 | 150539039 | Healthcare | NY | 501c3 | 3 | BHN | false |
| Bassett Hospital Schoharie County | ||||||||||
| 178 Grandview Drive | Cobleskill | NY | 12043 | 141772971 | Healthcare | NY | 501c3 | 3 | BHN | false |
| Little Falls Hospital | ||||||||||
| 140 Burwell Street | Little Falls | NY | 13365 | 150533578 | Healthcare | NY | 501c3 | 3 | BHN | false |
| Mary Imogene Bassett Hospital | ||||||||||
| One Atwell Road | Cooperstown | NY | 13326 | 135596796 | Healthcare | NY | 501c3 | 3 | BHN | false |
| Templeton Foundation | ||||||||||
| One Atwell Road | Cooperstown | NY | 13326 | 133317084 | Landlord | NY | 501c3 | 10 | BHN | false |
| Tri Town Regional Healthcare | ||||||||||
| 43 Pearl Street | Sidney | NY | 13838 | 260169584 | Healthcare | NY | 501c3 | 3 | BHN | false |
| Valley Health Services | ||||||||||
| 690 West German Street | Herkimer | NY | 13350 | 222511614 | Elder Care | NY | 501c3 | 3 | BHN | false |
| Bassett PPS LLC | ||||||||||
| 6181 State Highway 7 | Oneonta | NY | 13820 | 811749905 | Healthcare | NY | 501c3 | 12a | MIBH | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
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