MOSES-LUDINGTON HOSPITAL: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- MOSES-LUDINGTON HOSPITAL (EIN 14-1372647)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-14
- IRS object ID
- 201633199349301403
- Schema version
- 2015v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-11-14T08:07:28-06:00 | ReturnTs |
| Tax Period End | 2015-12-31 | 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 | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 141372647 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOSES-LUDINGTON HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MOSE | BusinessNameControlTxt |
| Phone | 5185853864 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1019 WICKER STREET | AddressLine1Txt |
| City | TICONDEROGA | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 12883 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOHN REMILLARD | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 5185853864 | PhoneNum |
| Signature | 2016-11-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J GRIMALDI | PreparerPersonNm |
| PTIN | P01295846 | PTIN |
| Phone | 7168563300 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JOHN REMILLARD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1019 WICKER STREET | AddressLine1Txt |
| City | TICONDEROGA | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 12883 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $12,088,807 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.INTERLAKESHEALTH.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1908 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | A CARING, COMMUNITY RESPONSIVE HEALTHCARE PARTNER THAT PROMOTES WELLNESS, INDIVIDUAL DIGNITY, QUALITY, AND VALUE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 174 | TotalEmployeeCnt |
| Total Volunteers | 15 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $230,012 | PYContributionsGrantsAmt |
| CY Contributions Grants | $275,379 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $11,930,802 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $11,384,980 | CYProgramServiceRevenueAmt |
| PY Investment Income | $116,756 | PYInvestmentIncomeAmt |
| CY Investment Income | $113,405 | CYInvestmentIncomeAmt |
| PY Other Revenue | $157,558 | PYOtherRevenueAmt |
| CY Other Revenue | $315,043 | CYOtherRevenueAmt |
| PY Total Revenue | $12,435,128 | PYTotalRevenueAmt |
| CY Total Revenue | $12,088,807 | 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 | $6,585,361 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,203,942 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,342,678 | PYOtherExpensesAmt |
| CY Other Expenses | $5,623,617 | CYOtherExpensesAmt |
| PY Total Expenses | $12,928,039 | PYTotalExpensesAmt |
| CY Total Expenses | $11,827,559 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$492,911 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $261,248 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $8,220,402 | TotalAssetsBOYAmt |
| Total Assets EOY | $8,542,770 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $13,701,241 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $13,762,361 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$5,480,839 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$5,219,591 | NetAssetsOrFundBalancesEOYAmt |
| Mission | A CARING, COMMUNITY RESPONSIVE HEALTHCARE PARTNER THAT PROMOTES WELLNESS, INDIVIDUAL DIGNITY, QUALITY AND VALUE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $9,556,994 | ExpenseAmt |
| Revenue | $11,384,980 | RevenueAmt |
| Desc | MOSES-LUDINGTON HOSPITAL BEGAN PROVIDING HEALTH CARE SERVICES IN JUNE 1908. TODAY THE HOSPITAL IS A 15 BED CRITICAL ACCESS HOSPITAL WITH A 24-HOUR EMERGENCY ROOM AND HELICOPTER TRANSPORT CAPABILITY, OUTPATIENT CLINIC, PHYSICAL AND OCCUPATIONAL THERAPY CENTERS, CARDIAC REHABILITATION CENTER, OUTPATIENT SURGICAL SERVICES, AND EARLY PREVENTION CENTER. | Desc |
| Total Program Service Expenses | $9,556,994 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 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 | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 17 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 174 | 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | 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 | JENNIFER OLCOTT | PersonNm |
| Phone | 5185852831 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1019 WICKER STREET | AddressLine1Txt |
| City | TICONDEROGA | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 12883 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| ROLAND ALLEN | ||||||||
| CHAIRPERSON | 2.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ROBERT DEDRICK | ||||||||
| VICE-CHAIRPERSON | 2.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ROSS KELLEY | ||||||||
| TREASURER | 2.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| CHATTIE VAN WERT | ||||||||
| SECRETARY | 2.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DR GLEN CHAPMAN | ||||||||
| PRESIDENT MEDICAL STAFF | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL DISKIN | ||||||||
| TRUSTEE | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| WALTER LENDER | ||||||||
| TRUSTEE | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| DAVID SHELMIDINE | ||||||||
| TRUSTEE | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| DAWN STODDARD | ||||||||
| TRUSTEE | 2.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| RODNEY C BOULA | ||||||||
| INTERIM CHIEF EXECUTIVE OF | 20.00 | 20.00 | Yes (X) | $0 | $0 | $0 | ||
| ALAN CHARDAVOYNE | ||||||||
| INTERIM CHIEF FINANCIAL OF | 20.00 | 20.00 | Yes (X) | $0 | $0 | $0 | ||
| NANCY CAFFREY | ||||||||
| PHYSICIAN ASSISTANT | 40.00 | $168,305 | $0 | $16,282 | Yes (X) | |||
| MATTHEW HINGE | ||||||||
| PHYSICIAN ASSISTANT | 40.00 | $115,461 | $0 | $0 | Yes (X) | |||
| JAMES HOGAN | ||||||||
| PHYSICIAN ASSISTANT | 40.00 | $133,777 | $0 | $16,281 | Yes (X) | |||
| JAMES L'EPISCOPO | ||||||||
| PHYSICIAN ASSISTANT | 40.00 | $133,197 | $0 | $5,711 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $550,740 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $38,274 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| UNIDINE CORPORATION | |||||
| 1000 WASHINGTON STREET SUITE 510 | BOSTON | MA | 02118 | DIETARY SERVICES | $625,426 |
| CARDINAL HEALTH - PHARMACY MANAGEMENT | |||||
| 1330 ENCLAVE PARKWAY | HOUSTON | TX | 77077 | PHARMACY SERVICES | $256,624 |
| COMMUNITY PROVIDERS | |||||
| 75 BEEKMAN STREET | PLATTSBURGH | NY | 12901 | CEO CHARGES | $222,000 |
| NIXON PEABODY | |||||
| 677 BROADWAY 10TH FLOOR | ALBANY | NY | 12207 | LEGAL SERVICES | $131,166 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $273,220 | GovernmentGrantsAmt |
| All Other Contributions | $2,159 | AllOtherContributionsAmt |
| Total Contributions | $275,379 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE | Desc |
| Business | 621990 | BusinessCd |
| Total Revenue Column | $11,384,980 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,384,980 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $11,384,980 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $113,405 | TotalRevenueColumnAmt |
| Exclusion | $113,405 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| MEANINGFUL USE INCENTIVE PAYMENTS | 621990 | $236,901 | $236,901 |
| CAFETERIA | 722210 | $56,017 | $56,017 |
| REBATES AND REFUNDS | 900099 | $13,092 | $13,092 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,033 | TotalRevenueColumnAmt |
| Exclusion | $9,033 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $315,043 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,088,807 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,384,980 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $428,448 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,859,329 | TotalAmt |
| Program Services | $3,999,228 | ProgramServicesAmt |
| Management And General | $860,101 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $994,546 | TotalAmt |
| Program Services | $818,511 | ProgramServicesAmt |
| Management And General | $176,035 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $350,067 | TotalAmt |
| Program Services | $288,105 | ProgramServicesAmt |
| Management And General | $61,962 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $184,881 | TotalAmt |
| Management And General | $184,881 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,606 | TotalAmt |
| Management And General | $53,606 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,695,492 | TotalAmt |
| Program Services | $1,181,558 | ProgramServicesAmt |
| Management And General | $513,934 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,347,783 | TotalAmt |
| Program Services | $1,181,846 | ProgramServicesAmt |
| Management And General | $165,937 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $716,587 | TotalAmt |
| Program Services | $409,675 | ProgramServicesAmt |
| Management And General | $306,912 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,783 | TotalAmt |
| Program Services | $5,510 | ProgramServicesAmt |
| Management And General | $4,273 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,063 | TotalAmt |
| Management And General | $4,063 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $357,276 | TotalAmt |
| Program Services | $321,548 | ProgramServicesAmt |
| Management And General | $35,728 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $96,293 | TotalAmt |
| Program Services | $17,044 | ProgramServicesAmt |
| Management And General | $79,249 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PROVISION FOR BAD DEBTS | $972,186 | $972,186 | |
| EQUIPMENT RENTAL & MAIN | $738,855 | $307,157 | $431,698 |
| SHARED SERVICES | $100,532 | $28,893 | $71,639 |
| PROFESSIONAL DEVELOPMEN | $43,742 | $25,733 | $18,009 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$697,462 | TotalAmt |
| Management And General | -$697,462 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,827,559 | TotalAmt |
| Program Services | $9,556,994 | ProgramServicesAmt |
| Management And General | $2,270,565 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $652,376 | BOYAmt |
| EOY | $232,565 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $316,228 | BOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,113,797 | BOYAmt |
| EOY | $1,156,679 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $268,297 | BOYAmt |
| EOY | $247,149 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $80,380 | BOYAmt |
| EOY | $53,796 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $6,360,115 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,811,093 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,394,090 | BOYAmt |
| EOY | $1,549,022 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,395,234 | BOYAmt |
| EOY | $5,303,559 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,220,402 | BOYAmt |
| EOY | $8,542,770 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,361,769 | BOYAmt |
| EOY | $1,835,085 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $377,045 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,168,472 | BOYAmt |
| EOY | $11,429,231 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,171,000 | BOYAmt |
| EOY | $121,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,701,241 | BOYAmt |
| EOY | $13,762,361 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$5,812,271 | BOYAmt |
| EOY | -$5,551,867 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,366 | BOYAmt |
| EOY | $3,210 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $329,066 | BOYAmt |
| EOY | $329,066 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$5,480,839 | BOYAmt |
| EOY | -$5,219,591 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,220,402 | BOYAmt |
| EOY | $8,542,770 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $261,248 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $331,432 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $844 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $332,276 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $330,674 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $758 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $331,432 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $329,823 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $851 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $330,674 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $329,231 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $592 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $329,823 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $329,066 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $165 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $329,231 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.99030 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00970 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $318,586 | OtherCostOrOtherBasisAmt |
| Depreciation | $158,888 | DepreciationAmt |
| Book Value | $159,698 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,540,099 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,652,205 | DepreciationAmt |
| Book Value | $887,894 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $501,430 | OtherCostOrOtherBasisAmt |
| Book Value | $501,430 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,549,022 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| INTER-COMPANY A/R | $4,739,273 |
| ASSETS LIMITED AS TO USE | $332,276 |
| OTHER RECEIVABLES | $232,010 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $5,303,559 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | Desc |
| Amt | $121,000 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $121,000 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL IS A 501(C)(3) ORGANIZATION EXEMPT FROM INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE HOSPITAL BELIEVES IT IS NO LONGER SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES FOR YEARS PRIOR TO 2012. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | 0 | FPGReferenceFreeCareInd |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 300.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | 0 | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $51,925 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $51,925 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00480 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,391,313 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $862,298 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,529,015 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.14090 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $51,925 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $51,925 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00480 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,495,163 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $862,298 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,632,865 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.15050 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,686,640 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,776,240 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,910,400 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.17600 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,686,640 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,776,240 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,910,400 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.17600 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,181,803 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,638,538 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,543,265 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.32650 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $550,484 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $244,063 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $4,460,126 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $4,471,018 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$10,892 | 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 | MOSES-LUDINGTON HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1019 WICKER STREET | AddressLine1Txt |
| City | TICONDEROGA | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 12883 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | HTTP://WWW.INTERLAKESHEALTH.COM/ | WebsiteAddressTxt |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOSES-LUDINGTON 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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.INTERLAKESHEALTH.COM | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | 0 | StrategyPostedWebsiteInd |
| Strategy Attached | Yes (1) | StrategyAttachedInd |
| 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 Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| 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 |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTP://WWW.INTERLAKESHEALTH.COM/ | FAPAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit Report To Credit Agency | Yes (X) | PermitReportToCreditAgencyInd |
| Permit Legal Judicial Process | Yes (X) | PermitLegalJudicialProcessInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| MOSES-LUDINGTON HOSPITAL | PART V, SECTION B, LINE 5: THE 81 QUESTION SURVEY WAS DEVELOPED THROUGH A COLLABORATIVE EFFORT BY A SEVEN-MEMBER SURVEY ARHN SUBCOMITTEE DURING THE AUTUMN OF 2012. THE SEVEN VOLUNTEER MEMBERS ARE REPRESENTATIVES OF THE COUNTY PUBLIC HEALTH DEPARTMENTS AND HOSPITALS IN THE REGION THAT ARE INVOLVED IN THE ADIRONDACK RURAL HEALTH NETWORK (ARHN). SUBCOMITTEE MEMBERS IDENTIFIED THE BROAD RESEARCH QUESTIONS TO BE ADDRESSED BY THE SURVEY, DRAFTED THE INDIVIDUAL SURVEY QUESTIONS, AND DEVELOPED THE LIST OF RELEVANT HEALTH CARE STAKEHOLDERS THAT RECEIVED THE SURVEY. A MORE DETAILED DESCRIPTION OF THE PROCESS IS INCLUDED IN THE FULL REGIONAL REPORT.THE SURVEY WAS ADMINISTERED ELECTRONICALLY USING A WEB-BASED SURVEY PROGRAM AND DISTRIBUTED TO AN EMAIL CONTACT LIST OF 624. ULTIMATELY, 285 SURVEYS WERE COMPLETED DURING THE SIX-WEEK SURVEY PERIOD, A RESPONSE RATE OF 45.7%. OF ALL 285 RESPONSES, 86 INDICATED THAT ESSEX COUNTY WAS PART OF THEIR SERVICE AREA; HOWEVER IT SHOULD BE NOTED THAT MANY OF THE RESPONDING HEALTHCARE STAKEHOLDERS SERVICE MULTIPLE COUNTIES WITHIN THE LARGER ARHN REGION.IN ADDITION TO THE COMMUNITY SURVEY, MOSES-LUDINGTON, IN COLLABORATION WITH ESSEX COUNTY PUBLIC HEALTH AND ARHN, HELD MEETINGS FOR BOTH INTERNAL AND EXTERNAL STAKEHOLDERS ENTITLED "ESSEX COUNTY: THE HEALTH OF OUR COMMUNITIES" ON MAY 2, 2013. THE MEETINGS PROVIDED AN OVERVIEW OF HOSPITAL AND PUBLIC HEALTH REPORTING REQUIREMENTS, A BRIEFING WITH RESPECT TO THE PREVENTION AGENCY 2013-2017, ESSEX COUNTY'S QUALITATIVE DATA (COMMUNITY SURVEY RESULTS), ESSEX COUNTY'S QUANTITATIVE DATA AND GENERAL DISCUSSION. AREAS OF DISCUSSION INVOLVED PRIORITIZATION AS IT RELATED TO FACTORS SUCH AS:- ALIGNMENT WITH OTHER PRORITIES - WHAT IS THE COMMUNITY ALREADY DOING- PUBLIC HEALTH LAW - MANDATORY SERVICES- STRATEGIC PLANS- MEDICAL HOME- ACCOUNTABLE CARE ORGANIZATIONS- ACCREDITATION- AVAILABLE RESOURCES - SUSTAINABILITY- CAPACITY TO IMPLEMENT INTERVENTIONS- PRECEPTION VERSUS REALITY - ALIGNMENTPARTICIPANTS INCLUDED:MOSES-LUDINGTON INTERNAL ATTENDEES:- VICKI WHEATON-SARACINI, DIRECTOR OF CORPORATE PLANNING AND SERVICE - ADIRONDACK HEALTH INSTITUTE- ROBERT MARTINIANO, PROJECT DIRECTOR - CENTER FOR HEALTH WORKFORCE STUDIES- CHIP HOLMES, CHIEF EXECUTIVE OFFICER - INTER-LAKES HEALTH- TRISTAN GLANVILLE, CHIEF FINANCIAL OFFICER - INTER-LAKES HEALTH- LISA BUSBY, CHIEF INFORMATION OFFICER - INTER-LAKES HEALTH- LAURA TIRADO, NH ADMINISTRATOR - INTER-LAKES HEALTH- TARA JOUBERT, DIRECTOR OF SUPPORT SERVICES - INTER-LAKES HEALTH- SUE HUNTINGTON, DIRECTOR OF HIM / COMPLIANCE OFFICER - INTER-LAKES HEALTH- TAMARA EVENS, DIRECTOR OF HUMAN RESOURCES - INTER-LAKES HEALTH- KRISTEN THOMPSON, DIRECTOR OF CLINICAL SERVICES - INTER-LAKES HEALTH- TAMMY J. SMITH, REVENUE CYCLE DIRECTOR - INTER-LAKES HEALTH- HEIDI SCHEMPP, DIRECTOR OF SOCIAL SERVICES - INTER-LAKES HEALTH- KATE SHMULSKY, DIRECTOR OF PHARMACY - INTER-LAKES HEALTH- MERRIBETH ELLING, DIRECTOR OF THERAPY SERVICES - INTER-LAKES HEALTH- ELIZABETH BARRETT, DIRECTOR OF RADIOLOGY - INTER-LAKES HEALTH- BRENDA DUSHANE, NH DIRECTOR OF NURSING - INTER-LAKES HEALTH- BONNIE MAIOLO, DIRECTOR OF MATERIALS MANAGEMENT - INTER-LAKES HEALTH- MARIA WATERS, ACTIVITIES DIRECTOR - INTER-LAKES HEALTH- MARY ELLEN LARSON, NURSE MANAGER / STAFF EDUCATOR - INTER-LAKES HEALTH- GORDONNA BLODGETT, DENTAL PRACTICE MANAGER - INTER-LAKES HEALTH- CHRIS SHAFFER, REGISTRATION MANAGER - INTER-LAKES HEALTH- BARB WRIGHT, COMPLIANCE SPECIALIST - INTER-LAKES HEALTHEXTERNAL ATTENDEES:- BILL OWENS - CONGRESSMAN NEW YORK'S 21ST DISTRICT- VICKI WHEATON-SARACINI - ADIRONDACK HEALTH INSTITUTE- ROBERT MARTINIANO - CENTER FOR HEALTH WORKFORCE STUDIES- JESSICA DARNEY BUEHLER - ESSEX COUNTY PUBLIC HEALTH- CHERI MARTELL - PLANNED PARENTHOOD MOHAWK HUDSON- DONNA GORTON - HUDSON HEADWATERS HEALTH NETWORK- MARK JOHNS - TICONDEROGA POLICE DEPARTMENT CHIEF OF POLICE- PETER M SAYERS - MOUNTAIN FAMILY CARE PHYSICIAN AND OWNER- SHARON REYNOLDS - PRIDE OF TICONDEROGA EXECUTIVE DIRECTOR- CHRIS MALLON - INTERNATIONAL PAPER TICONDEROGA MILL MANAGER- MATTHEW COURTRIGHT - TICONDEROGA AREA CHAMBER OF COMMERCE- DOUG TERBEEK - PREVENTION TEAM- DEBRA MALANEY - TOWN OF TICONDEROGA - SUPERVISOR- HEIDI PALMER - ESSEX COUNTY OFFICE OF THE AGING- KRISTINA CHARBONEAU-WELLS - ST JOSEPH'S ADDICTION, TREATMENT & RECOVERY CENTERS- CHATTIE VAN WERT - INTER-LAKES HEALTH BOARD OF DIRECTORS- ROSS KELLY - INTER-LAKES HEALTH BOARD OF DIRECTORS- ROLLY ALLEN - INTER-LAKES HEALTH BOARD OF DIRECTORS VICE CHAIR- SANDRA BOLTON - INTER-LAKES HEALTH BOARD OF DIRECTORS BOARD CHAIR- TAMMY J. SMITH - INTER-LAKES HEALTH |
| MOSES-LUDINGTON HOSPITAL | PART V, SECTION B, LINE 6A: OTHER HOSPITALS INCLUDE ELIZABETHTOWN COMMUNITY HOSPITAL AND ADIRONDACK MEDICAL CENTER.DATA WAS GATHERED AND ANALYZED BY ARHN - A REGIONAL MULTI-STAKEHOLDER COALITION THAT CONDUCTS COMMUNITY HEALTH PLANNING ACTIVITIES BY PROVIDING THE FORUM FOR LOCAL PUBLIC HEALTH SERVICES, COMMUNITY HEALTH CENTERS, HOSPITALS, COMMUNITY MENTAL HEALTH PROGRAMS, EMERGENCY MEDICAL SERVICES, AND OTHER COMMUNITY-BASED ORGANIZATIONS TO ASSESS REGIONAL NEEDS AND THE EFFECTIVENESS OF THE RURAL HEALTH CARE DELIVERY SYSTEM. |
| MOSES-LUDINGTON HOSPITAL | PART V, SECTION B, LINE 11: OTHER HIGH RANKING ISSUES IDENTIFIED IN OUR COMMUNITY HEALTH NEEDS ASSESSMENT WHICH WE WILL NOT BE DIRECTLY ADDRESSING INCLUDE:- MATERNAL AND INFANT HEALTH: AS A SMALL, CRITICAL ACCESS HOSPITAL WITHOUT ONSITE SPECIALTY SERVICES, WE FEEL ILL-EQUIPPED TO ADDRESS THIS IDENTIFIED NEED.- BUILT ENVIRONMENT: WE FEEL THIS ISSUE BETTER ALIGNS WITH THE MISSION OF OTHER ORGANIZATIONS IN THE DEVELOPMENT OF COMMUNITY WALKING PATHS AND COMMUNAL GARDENS.- SUBSTANCE ABUSE AND MENTAL, EMOTIONAL AND BEHAVORIAL HEALTH: ESSEX COUNTY HAS VERY LIMITED MENTAL HEALTH RESOURCES TO HANDLE THE NEEDS OF THE POPULATION. ALTHOUGH IDENTIFIED AS A SIGNIFICANT NEED IN OUR COMMUNITY, MOSES-LUDINGTON CANNOT DEVELOP AND MAINTAIN INTERVENTIONS TO ADDRESS IT. SUBSTANCE ABUSE AND MENTAL HEALTH ARE NOT IN MLH'S CORE MISSION OR SKILL SET.- TOBACCO USE AND SECOND HAND SMOKE EXPOSURE: MOSES-LUDINGTON HAS IMPLEMENTED POLICY CHANGES TO PROHIBIT TOBACCO USED ON ITS CAMPUS. WE ASSESS EACH PATIENT FOR SMOKING STATUS AND PROVIDE EDUCATIONAL INSTRUCTION UPON DISCHARGE. FOR PATIENTS OVER THE AGE OF 13, SMOKING STATUS IS CAPTURED AND REPORTED AS PART OF MEANINGFUL USE STAGE 1. ONE OF THE BIGGEST CONTRIBUTORS TO THE PROBLEM IN OUR COUNTY IS THE NUMBER OF REGISTERED TOBACCO VENDORS WHICH IS 31% OVER THE UPSTATE BENCHMARK. MOSES-LUDINGTON DID NOT FEEL IT COULD MAKE A SIGNIFICANT IMPACT ON THIS AREA OF NEED. |
| MOSES-LUDINGTON HOSPITAL | PART V, SECTION B, LINE 22D: IN ACCORDANCE WITH HFAL SECTION 2807-K(9-A) OF THE NEW YORK PUBLIC HEALTH LAW, THE PATIENT'S LIABILITY WILL BE BASED ON A DISCOUNT FROM THE FACILITY'S INTERIM RATES FOR ITS HIGHEST VOLUME PAYOR, MEDICARE. FOR PATIENTS WHOSE INCOME IS AT OR BELOW 100% OF THE FEDERAL POVERTY LEVEL (FPL) THEIR LIABILITY WILL BE 0% OF FACILITY'S INTERIM MEDICARE RATE. FOR PATIENTS WHOSE INCOME IS BETWEEN 100.1% AND 150% OF FLP THEIR LIABILITY WILL BE 20% OF THE FACILITY'S INTERIM MEDICARE RATE. FOR PATIENTS WHOSE INCOME IS BETWEEN 150.1% AND 200% OF FLP THEIR LIABILITY WILL BE 50% OF THE FACILITY'S INTERIM MEDICARE RATE. FOR PATIENTS WHOSE INCOME IS BETWEEN 200.1% AND 250% OF FPL THEIR LIABILITY WILL BE 75% OF THE FACILITY'S INTERIM MEDICARE RATE. FOR PATIENTS WHOSE INCOME IS BETWEEN 250.1% AND 300% OF FPL THEIR LIABILITY WILL BE 100% OF THE FACILITY'S INTERIM MEDICARE RATE. PATIENTS WHOSE INCOME IS GREATER THAN 300% OF FPL WILL NOT QUALIFY FOR FINANCIAL ASSISTANCE. |
| MOSES-LUDINGTON HOSPITAL | PART V, SECTION B, LINE 24: SELF-PAY PATIENTS ARE CHARGED GROSS CHARGES UNTIL THEY CONTACT THE HOSPITAL FOR A PROMPT PAYMENT DISCOUNT OR FINANCIAL ASSISTANCE. THE HOSPITAL DOES NOT ROUTINELY DISCOUNT SELF-PAY BILLS. |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | MOSES-LUDINGTON HOSPITAL DOES NOT PROVIDE COMPLETELY FREE CARE TO LOW INCOME INDIVIDUALS. THE HOSPITAL CHARGES AT LEAST $1 FOR SERVICES. |
| PART I, LINE 7: | IN CALCULATING LINE 7, COLUMN E, WE USED THE WORKSHEETS PROVIDED IN THE INSTRUCTIONS FOR THIS SCHEDULE. THE CHARGES AND COSTS THAT WE USED WERE FROM THE COST REPORT AND INCLUDED ALL SERVICES PROVIDED BY THE HOSPITAL. WHERE A COST TO CHARGE RATIO WAS NEEDED, WE USED THE COST TO CHARGE RATIO FROM WORKSHEET C ON THE FILED 2015 MEDICARE COST REPORT. |
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 972,186. |
| PART III, LINE 4: | ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, INTER-LAKES HEALTH ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, INTER-LAKES HEALTH ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO HAVE FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), INTER-LAKES HEALTH RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. |
| PART III, LINE 8: | SINCE MOSES-LUDINGTON IS A CRITICAL ACCESS HOSPITAL, WE TOOK THE MEDICARE ALLOWABLE COSTS CALCULATED ON THE COST REPORT AND REPORTED THEM ABOVE ON LINE 6. |
| PART III, LINE 9B: | PER THE MOSES-LUDINGTON FINANCIAL ASSISTANCE POLICY:1. WHEN A PATIENT HAS COMPLETED AND RETURNED AN APPLICATION FOR FINANCIAL ASSISTANCE, THE CLAIM WILL NOT BE FORWARDED TO A COLLECTION AGENCY, PENDING DETERMINATION OF ELIGIBILITY.2. THE HOSPITAL WILL NOT FORECLOSE, REQUIRE A FORCED SALE OR PLACE A LIEN ON THE APPLICANT'S PRIMARY RESIDENCE.3. PATIENTS WILL BE NOTIFIED AT LEAST 30 DAYS PRIOR TO FORWARDING AN ACCOUNT TO THE COLLECTION AGENCY.4. MOSES-LUDINGTON HOSPITAL WILL PROVIDE WRITTEN CONSENT TO A COLLECTION AGENCY PRIOR TO COMMENCING LEGAL ACTION ON AN ACCOUNT.5. COLLECTION AGENCIES CONTRACTED BY MOSES-LUDINGTON HOSPITAL WILL FOLLOW THE HOSPITAL'S FINANCIAL AID POLICIES AND PROCEDURES, INCLUDING THE MEANS OF APPLYING FOR AID.6. COLLECTIONS ARE PROHIBITED FROM PATIENTS ELIGIBLE FOR MEDICAID AT THE TIME OF SERVICE.7. A FAVORABLE DETERMINATION STILL ENABLES THE PATIENT TO MAKE INSTALLMENT PAYMENTS AT NO GREATER THAN 10% OF GROSS MONTHLY INCOME. THE PATIENT WILL BE REQUIRED TO SIGN A PAYMENT AGREEMENT IN THIS INSTANCE.PATIENTS KNOWN TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE ARE MAINTAINED IN A SPREADSHEET ACCESSIBLE BY REGISTRATION AND PATIENT ACCOUNTING. ACCOUNTS ARE PROACTIVELY ADJUSTED TO THE DISCOUNTED RATES. |
| PART VI, LINE 2: | MOSES-LUDINGTON HOSPITAL (MLH) REGULARLY SOLICITS FEEDBACK AND INPUT FROM THE RESIDENTS OF OUR COMMUNITIES REGARDING THEIR HEALTH CARE NEEDS AND PREFERENCES. THIS ALLOWS MLH TO ENSURE THAT ESSENTIAL HEALTH CARE SERVICES ARE PRESERVED AND DEVELOPED AS NEEDED. TO THIS END, MLH SERVES ON THE ADIRONDACK RURAL HEALTH NETWORK (ARHN), COMMUNITY HEALTH PLANNING COMMITTEE (CHPC) AND COMMUNITY HEALTH ASSESSMENT (CHA) TASKFORCE.THE ARHN IS A COMMUNITY PARTNERSHIP OF PUBLIC, PRIVATE AND NON-PROFIT ORGANIZATIONS IN UPSTATE NEW YORK. THE ARHN FACILITATES A COLLABORATIVE PROCESS FOR DEVELOPING STRATEGIES AND FOR IMPLEMENTING, MONITORING AND EVALUATING THE REGIONAL HEALTH CARE SYSTEM. AS A LONG TIME MEMBER OF THE ARHN, MLH ACTIVELY SUPPORTS AND PARTICIPATES IN THIS GATHERING OF INFORMATION FROM A VARIETY OF STAKEHOLDERS. THIS PROCESS IS CONDUCTED REGIONALLY AND IS REPEATED EVERY THREE TO FIVE YEARS.MLH ALSO SOLICITS INDIVIDUAL PATIENT FEEDBACK REGULARLY THROUGH MULTIPLE PATIENT SATISFACTION SURVEYS. THESE SURVEYS ARE DEPARTMENT SPECIFIC AND ARE A VALUABLE METHOD OF MEASURING PUBLIC PERCEPTION OF PATIENT CARE. BOTH IN-PATIENT AND OUT-PATIENT DEPARTMENT DISCHARGES ARE SURVEYED, IN WRITTEN FORM AND BY TELEPHONE. |
| PART VI, LINE 3: | BY VIRTUE OF ITS EXEMPTION FROM FEDERAL AND STATE TAXES, AND AS PART OF THE HOSPITAL'S MISSION TO SERVE THE HEALTHCARE NEEDS OF THE COMMUNITY, MLH PROVIDES CHARITY CARE TO PATIENTS WITHOUT HEALTH INSURANCE OR THE FINANCIAL MEANS TO PAY FOR HOSPITAL SERVICES. CHARITY CARE IS PROVIDED TO ALL PATIENTS IN NEED IN FULL COMPLIANCE WITH TITLE VI OF THE CIVIL RIGHTS ACT, WITHOUT REGARD TO RACE, CREED, COLOR OR NATIONAL ORIGIN. CHARITY CARE SERVICES INCLUDE THOSE WHO ARE CLASSIFIED AS FINANCIALLY OR MEDICALLY INDIGENT ACCORDING TO THE HOSPITAL'S ELIGIBILITY SYSTEM.MLH PUBLISHES A FINANCIAL ASSISTANCE SUMMARY, UPDATED ANNUALLY, THAT ANSWERS ELIGIBILITY QUESTIONS AND DESCRIBES THE APPLICATION PROCESS. MLH EMPLOYS PATIENT ACCOUNTING REPRESENTATIVES FOR THIS PURPOSE. REGISTRATION STAFF IS TRAINED TO EDUCATE PATIENTS WHO NEED FINANCIAL ASSISTANCE WHEN THEY PRESENT FOR SERVICES. UNINSURED PATIENTS ARE PROVIDED A PACKET OF INFORMATIONAL MATERIAL, INCLUDING A FINANCIAL ASSISTANCE APPLICATION. SERVICES OF A TRANSLATOR ARE AVAILABLE FOR NON-ENGLISH SPEAKING OR HEARING IMPAIRED PATIENTS.IN THE EVENT THAT IT IS DETERMINED THAT A PATIENT DOES NOT QUALIFY FOR FREE OR LOW-COST INSURANCE, MLH'S FINANCIAL COUNSELOR OR PATIENT ACCOUNTING REPRESENTATIVE WILL ASSIST THEM IN APPLYING FOR A DISCOUNT. |
| PART VI, LINE 4: | MLH'S SERVICE AREA IS DEFINED BY ZIP CODE, AND IS COMPOSED PRIMARILY OF SIX ZIP CODES IN SOUTHEASTERN ESSEX COUNTY AND NORTHEASTERN WARREN AND WASHINGTON COUNTIES. HISTORICALLY, ABOUT 90% OF MLH'S PATIENTS RESIDE WITHIN THIS GEOGRAPHY, WITH THE REMAINING 10% BEING SEASONAL RESIDENTS. MLH SERVES AN INDEFINABLE TOURIST POPULATION AS WELL, SINCE THIS REGION IS A POPULAR NATIONAL VACATION SPOT. MLH IS LOCATED IN CONGRESSIONAL DISTRICT 23, 57 MILES FROM THE NEAREST ACUTE CARE NEW YORK STATE HOSPITAL, AND IS GEOGRAPHICALLY REMOTE FROM THREE COUNTY SEATS. THE TOWN OF TICONDEROGA IS LOCATED WITHIN THE 6 MILLION ACRE ADIRONDACK PARK. THE AREA'S SMALL VILLAGES AND HAMLETS ARE AT RISK FOR COMPLETE ISOLATION DURING ALL SEASONS BECAUSE OF THE SEVERE WEATHER CONDITIONS, FREQUENT POWER OUTAGES, ROAD IMPASSABILITY, AND MOUNTAINOUS TOPOGRAPHY. FOR THESE REASONS, AREA RESIDENTS TEND TO BE PLACE-BOUND AND ISOLATED. PUBLIC TRANSPORTATION IS VIRTUALLY NON-EXISTENT, AND THERE ARE FEW SECONDARY ROADS. MLH OPERATES A GRANT FUNDED BUS FOR PATIENT TRANSPORT TO AND FROM THE HOSPITAL AND PHYSICIAN'S OFFICES FOR THOSE WHO NEED TRANSPORTATION. THE TOWN OF TICONDEROGA ALSO OWNS AND OPERATES A SENIOR BUS AS LOW COST TRANSPORTATION FOR THE OTHERWISE HOME-BOUND ELDERLY.THE ECONOMY IS PRIMARILY GOVERNMENTAL OR SEASONAL, AND INCLUDES LAW ENFORCEMENT, PRISONS, EDUCATION, AND HEALTHCARE. MLH/ILH IS ONE OF THE TOP THREE EMPLOYERS IN THE TICONDEROGA AREA, FOLLOWED BY THE SCHOOL SYSTEM AND INTERNATIONAL PAPER'S TICONDEROGA MILL. MUCH OF THE AREA'S EMPLOYMENT OPPORTUNITIES FOCUS ON SEASONAL TOURISM, ALTHOUGH THIS HAS BEEN THINNING OVER THE YEARS. IT REACHED AN ALL-TIME LOW AFTER RISING GAS PRICES MET THE DWINDLING ECONOMIC CLIMATE NATIONWIDE. SEASONAL EMPLOYMENT USUALLY COMES WITHOUT HEALTHCARE BENEFITS, AND SO EXPANDS THE NUMBER OF WORKING COMMUNITY MEMBERS WITHOUT MEDICAL INSURANCE. LACKING SUBSTANTIAL EMPLOYMENT WITHOUT COMPREHENSIVE BENEFIT PLANS CONTRIBUTES TO THE POVERTY OF THE AREA'S RESIDENTS. IN THIS REGION, CHILDREN BETWEEN THE AGES OF 5 AND 17 LIVE IN POVERTY AT A RATE ALMOST 25% HIGHER THAN THE NATIONAL AVERAGE.BASED ON THE U.S. CENSUS ESTIMATES FOR 2008, APPROXIMATELY 14,000 PEOPLE LIVE YEAR-ROUND WITHIN MLH'S SERVICE AREA, OF WHICH 50.4% ARE MALE AND 49.6% ARE FEMALE. OF THE TOTAL FEMALE POPULATION, APPROXIMATELY 38% ARE OF CHILDBEARING AGE. PEOPLE OVER THE AGE OF 65 CONSTITUTE 17.3% OF THE POPULATION. ETHNICALLY, NEARLY 100% OF THE POPULATION IS WHITE AND/OR NON-HISPANIC. THE GREATEST POPULATION GROWTH TREND IN OUR SERVICE AREA WILL BE FOR PEOPLE BETWEEN THE AGES 45 AND 75. |
| PART VI, LINE 5: | MOSES-LUDINGTON HOSPITAL (MLH) AND ITS PARENT INTER-LAKES HEALTH (ILH) ARE GOVERNED BY A VOLUNTEER BOARD MADE UP OF COMMUNITY MEMBERS. MANY MEMBERS OF OUR BOARD SERVE IN A PUBLIC CAPACITY, EITHER AS A MEMBER OR OFFICER ON ANOTHER NOT-FOR-PROFIT BOARD OR COMMITTEE, OR IN A POSITION WITHIN PUBLIC HEALTH, OR AS A MEMBER OF A NON-FOR-PROFIT SERVICE ORGANIZATION WITHIN THE SAME SERVICE AREA.MLH PARTICIPATES IN THE HRSA BIOTERRORISM GRANT PROGRAM, A FEDERAL PROGRAM ADMINISTERED THROUGH THE NYS DEPARTMENT OF HEALTH'S GRANT ADMINISTRATION OFFICES. THIS PROGRAM PROVIDES ONGOING INDIVIDUAL AND GROUP TRAINING IN MANY ASPECTS OF EMERGENCY PREPAREDNESS. MLH'S ENVIRONMENT OF CARE (EOC) MANAGER FACILITATES THE GRANT AND OVERSEES THE HOSPITAL SAFETY PROGRAM AND DECONTAMINATION TEAM. SHE PARTICIPATES IN REGULAR DRILLS IN COOPERATION WITH AREA ORGANIZATIONS, INCLUDING BUT NOT LIMITED TO LOCAL EMS SQUADS, THE VOLUNTEER FIRE DEPARTMENT, LOCAL POLICE AND COUNTY AUTHORITIES.FOR 15 YEARS, MLH HAS BEEN OFFERING AN OSTEOPOROSIS PREVENTION CLASS DESIGNED AROUND WEIGHT-BEARING EXERCISES AND HOSTED BY THE ESSEX COUNTY OFFICE OF THE AGING. THIS CLASS IS FREE, OPEN TO THE PUBLIC, HELD WEEKLY AND GENERALLY HAS BETWEEN 9 AND 15 PARTICIPANTS. MLH ALSO HOSTS WEIGHT WATCHERS WEEKLY MEETING FOR THE TICONDEROGA AREA. A NUMBER OF NOT-FOR-PROFIT COMMUNITY-BASED ORGANIZATIONS USE SPACE AT MLH TO HOST COMMUNITY SERVICE-ORIENTED MEETINGS, FREE AND OPEN TO THE PUBLIC, INCLUDING BUT NOT LIMITED TO ALCOHOLICS ANONYMOUS AND CELEBRATE RECOVERY.MLH DONATES PRIVATE CONSULTATION SPACE ON CAMPUS FOR THE ESSEX COUNTY MENTAL HEALTH ASSOCIATION TO UTILIZE AS A CLINIC OFFICE TO COUNSEL PATIENTS FROM OUR SERVICE AREA THAT MAY NOT HAVE RELIABLE TRANSPORTATION TO TRAVEL THE 50-MILE TRIP TO THE ASSOCIATION'S ELIZABETHTOWN HEADQUARTERS. |
| PART VI, LINE 6: | IN JUNE OF 2010, INTER-LAKES HEALTH SIGNED AN AFFILIATION AGREEMENT WITH FLETCHER ALLEN HEALTH CARE (FAHC). THE INTENT BEHIND THIS AGREEMENT WAS TO "RAISE THE BAR" OF CLINICAL AND MANAGERIAL EXPERTISE AT MOSES-LUDINGTON HOSPITAL. THE AFFILIATION AGREEMENT WILL ENABLE BOTH ORGANIZATIONS TO WORK MORE CLOSELY TOGETHER TO MEET THE HEALTH CENTER NEEDS OF THE SOUTHERN ADIRONDACKS AND GREATER TICONDEROGA AREA. FAHC BRINGS A WEALTH OF RESOURCES TO THE TABLE WITH THEIR PARTNERS AT THE UNIVERSITY OF VERMONT COLLEGE OF MEDICINE AND THE COLLEGE OF NURSING AND HEALTH SCIENCES. A MANAGEMENT AGREEMENT IS IN PLACE BETWEEN THE TWO FACILITIES. FAHC HAS BEEN INSTRUMENTAL IN THE SEARCH AND ACQUISITION OF A PERMANENT CEO FOR MLH. THIS INDIVIDUAL SERVES AS PRESIDENT AND CEO OF ALL OF INTER-LAKES HEALTH, INC. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | NY |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NANCY CAFFREY | ||||||||||||||
| PHYSICIAN ASSISTANT | $168,305 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $16,282 | $0 | $184,587 | $0 | $0 | $0 |
| JAMES HOGAN | ||||||||||||||
| PHYSICIAN ASSISTANT | $133,777 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $16,281 | $0 | $150,058 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | INTER-LAKES HEALTH, INC. IS THE SOLE CORPORATE MEMBER OF MOSES-LUDINGTON HOSPITAL. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE PRESIDENT AND INTERIM CFO REVIEW PRIOR TO THE FILING OF FORM 990. A FINAL COPY IS SHARED WITH THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE POLICY IS MONITORED AND ENFORCED THROUGH REGULAR EDUCATION AND INVOLVEMENT BY THE CORPORATE COMPLIANCE COMMITTEE. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION IS DETERMINED BY BOARD AND HUMAN RESOURCES REVIEW AS WELL AS SALARY SURVEYS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE POLICIES ARE MADE AVAILABLE VIA THE WEBSITE AND BY REQUEST. |
| FORM 990, PART IX, LINE 11G | OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 709,775. MANAGEMENT AND GENERAL EXPENSES 486,542. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,196,317. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 471,783. MANAGEMENT AND GENERAL EXPENSES 27,392. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 499,175. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| INTER-LAKES HEALTH INC | |||||||||||
| 1019 WICKER STREET | TICONDEROGA | NY | 12883 | 141746088 | SOLE CORPORATE MEMBER OF THE HOSPITAL, NURSING HOME, FOUNDATION, LORD HOWE | NY | 501(C)(3) | 11 | N/A | 0 | |
| MOSES-LUDINGTON NURSING HOME | |||||||||||
| 1019 WICKER STREET | TICONDEROGA | NY | 12883 | 237304957 | PROVIDER OF LONG TERM HEALTH CARE SERVICES OF PATIENTS | NY | 501(C)(3) | 9 | 0 | INTER-LAKES HEALTH INC | |
| INTER-LAKES FOUNDATION INC | |||||||||||
| 1019 WICKER STREET | TICONDEROGA | NY | 12883 | 810566557 | PROMOTE AND SUPPORT COMMUNITY HEALTHCARE SERVICES | NY | 501(C)(3) | 7 | 0 | INTER-LAKES HEALTH INC | |
| LORD HOWE ESTATES HOUSING DEVELOPMENT FUND CORPORATION | |||||||||||
| 1019 WICKER STREET | TICONDEROGA | NY | 12883 | 242434840 | PROVIDING SUBSIDIZED HOUSING FOR THE ELDERLY AND HANDICAPPED | NY | 501(C)(3) | 9 | 0 | INTER-LAKES HEALTH INC | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | 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 | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Comments