ST JAMES HOSPITAL: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- ST JAMES HOSPITAL (EIN 16-0743310)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-11
- IRS object ID
- 201643169349302004
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule N
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-11-11T10:04:02-06:00 | 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 | 160743310 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST JAMES MERCY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STJA | BusinessNameControlTxt |
| Phone | 6073248000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 411 CANISTEO STREET | AddressLine1Txt |
| City | HORNELL | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 148432104 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JENNIFER L SULLIVAN | PersonNm |
| Person Title | PRESIDENT & CEO | PersonTitleTxt |
| Phone | 6073248000 | 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 | JENNIFER L SULLIVAN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 411 CANISTEO STREET | AddressLine1Txt |
| City | HORNELL | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 148432104 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $46,230,245 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.STJAMESMERCY.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1992 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | SEE SCHEDULE O.ST. JAMES MERCY HOSPITAL, GOVERNED BY A SELF-PERPETUATING COMMUNITY BASED BOARD, IS A COMMUNITY OF PERSONS COMMITTED TO BEING A TRANSFORMING, HEALING PRESENCE WITHIN THE RURAL COMMUNITIES WE SERVE, PARTICULARLY ADDRESSING THE NEEDS OF THE POOR, UNDERSERVED AND DISADVANTAGED. | ActivityOrMissionDesc |
| Contract Termination | Yes (X) | ContractTerminationInd |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 594 | TotalEmployeeCnt |
| Total Volunteers | 50 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,641,382 | PYContributionsGrantsAmt |
| CY Contributions Grants | $478,689 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $38,201,913 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $35,822,731 | CYProgramServiceRevenueAmt |
| PY Investment Income | $26,755 | PYInvestmentIncomeAmt |
| CY Investment Income | -$128,162 | CYInvestmentIncomeAmt |
| PY Other Revenue | $797,806 | PYOtherRevenueAmt |
| CY Other Revenue | $10,056,987 | CYOtherRevenueAmt |
| PY Total Revenue | $42,667,856 | PYTotalRevenueAmt |
| CY Total Revenue | $46,230,245 | 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 | $26,892,751 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $24,738,233 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $20,921,806 | PYOtherExpensesAmt |
| CY Other Expenses | $24,286,419 | CYOtherExpensesAmt |
| PY Total Expenses | $47,814,557 | PYTotalExpensesAmt |
| CY Total Expenses | $49,024,652 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$5,146,701 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,794,407 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $21,883,237 | TotalAssetsBOYAmt |
| Total Assets EOY | $13,999,388 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $23,073,281 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $10,758,517 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$1,190,044 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,240,871 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | SEE SCHEDULE O.ST. JAMES MERCY HOSPITAL, GOVERNED BY A SELF-PERPETUATING COMMUNITY BASED BOARD, IS A COMMUNITY OF PERSONS COMMITTED TO BEING A TRANSFORMING, HEALING PRESENCE WITHIN THE RURAL COMMUNITIES WE SERVE, PARTICULARLY ADDRESSING THE NEEDS OF THE POOR, UNDERSERVED AND DISADVANTAGED. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | Yes (1) | SignificantChangeInd |
| Expense | $34,201,265 | ExpenseAmt |
| Revenue | $36,682,393 | RevenueAmt |
| Desc | ST. JAMES MERCY HOSPITAL IS AN ACUTE HEALTHCARE FACILITY PROVIDING ROUTINE, AMBULATORY AND ANCILLARY SERVICES. MAJOR SERVICES INCLUDE MEDICAL, SURGICAL, X-RAY, LABORATORY AND MATERNITY (MATERNITY THROUGH 4/30/15). TOTAL ACUTE DISCHARGES FOR THE HOSPITAL WERE 791 (59 MATERNITY). OUTPATIENT REGISTRATIONS FOR THE HOSPITAL WERE 111,918 AND ADDICTION DAYS WERE 3,016 (THROUGH SEPTEMBER 2015). ST. JAMES MERCY HOSPITAL OPERATES A 112 BED LONG-TERM CARE SKILLED NURSING FACILITY. THE LONG-TERM CARE FACILITY SPECIALIZES IN SKILLED NURSING, ASSISTED LIVING AND REHABILITATION SERVICES. TOTAL PATIENT DAYS FOR THE LONG-TERM CARE FACILITY WERE 38,771. ST. JAMES MERCY HOSPITAL OPERATES SEVERAL PHYSICIAN PRACTICES. TOTAL OFFICE VISITS WERE 19,049, INCLUDING EXPRESS CARE. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $271,167 | ExpenseAmt |
| Revenue | $288,551 | RevenueAmt |
| Desc | LIFE LINE SERVICES - REVENUE GENERATED FROM RENTAL OF LIFE LINE UNITS TO THE ELDERY FOR MEDICAL ALERT. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $34,472,432 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | Yes (1) | 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 | 108 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 594 | 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 | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NY | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | STANLEY D KONOPKO | PersonNm |
| Phone | 6073248110 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 411 CANISTEO STREET | AddressLine1Txt |
| City | HORNELL | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14843 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| JOHN WEYAND DC | ||||||||
| CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| SUSAN GRAY PHD | ||||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| PHILIP LOREE | ||||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| PETER D WALL | ||||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| SHAWN HOGAN | ||||||||
| MAYOR, CITY OF HORNELL | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ADRIAN ASHDOWN MD | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ROBERT DONIUS | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ISMAIL MEHR MD | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| RHONDA PETERSON MD | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MANINDER VIRDEE | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MARY FRAN WEGMAN RSM | ||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JENNIFER L SULLIVAN | ||||||||
| PRESIDENT/CEO | 39.00 | Yes (X) | $691,400 | $0 | $16,810 | 1.00 | ||
| STANLEY D KONOPKO | ||||||||
| CFO | 40.00 | Yes (X) | $0 | $0 | $0 | |||
| KATHY J BRODBECK | ||||||||
| CHIEF NURSING OFFICER | 40.00 | Yes (X) | $161,921 | $0 | $3,622 | |||
| NEVA BOSSARD | ||||||||
| INTERIM CHIEF NURSING OFFICER | 40.00 | Yes (X) | $109,283 | $0 | $19,222 | |||
| PATRICIA DAGON | ||||||||
| VP CONTINUING CARE/CORPORATE COMPLIANCE OFFICER | 40.00 | Yes (X) | $236,766 | $0 | $20,060 | |||
| SYLVIA BRYANT | ||||||||
| VP OF MISSION/DIRECTOR OF FOUNDATION | 18.00 | Yes (X) | $61,403 | $71,892 | $6,100 | 22.00 | ||
| TAMERA S SUZANNE | ||||||||
| PEDIATRIC NURSE PRACTITIONER | 40.00 | $167,887 | $0 | $2,334 | Yes (X) | |||
| DR IFRAN A RIZVI | ||||||||
| PHYSICIAN | 40.00 | $163,773 | $0 | $7,495 | Yes (X) | |||
| DR SCOTT S LEE | ||||||||
| PHYSICIAN | 40.00 | $206,889 | $0 | $8,514 | Yes (X) | |||
| CHARLES M EDGECOMB | ||||||||
| PHARMACY DIRECTOR | 40.00 | $165,585 | $0 | $21,117 | Yes (X) | |||
| DENISE BECHER | ||||||||
| MANAGER, DECISION SUPPORT/PLANNING | 40.00 | $155,627 | $0 | $10,450 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,120,534 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $71,892 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $115,724 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 15 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ELDERWOOD ADMINISTRATIVE SERVICES | |||||
| 7 LIMESTONE DRIVE | WILLIAMSVILLE | NY | 14221 | NURSING HOME STAFFING ASSISTANCE | $3,943,309 |
| EXIGENCE | |||||
| PO BOX 643850 | CINCINNATI | OH | 45263 | ER PHYSICIANS | $1,332,147 |
| EXIGENCE HOSPITAL MEDICINE | |||||
| PO BOX 643850 | CINCINNATI | OH | 45263 | HOSPITALISTS | $855,179 |
| ROCHESTER GENERAL HOSPITAL | |||||
| 1425 PORTLAND AVENUE | ROCHESTER | NY | 14621 | ORTHOPEDIC PHYSICIAN SERVICES, BUSINESS | $735,107 |
| ABADAN MEDICAL PLLC | |||||
| 325 CLEVELAND AVENUE | HORNELL | NY | 14843 | ANESTHESIOLOGY SERVICES | $571,011 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 14 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $294,215 | GovernmentGrantsAmt |
| All Other Contributions | $184,474 | AllOtherContributionsAmt |
| Total Contributions | $478,689 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621990 | $35,534,180 | $35,534,180 |
| LIFE LINE SERVICES | 621610 | $288,551 | $288,551 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $35,822,731 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$128,162 | TotalRevenueColumnAmt |
| Exclusion | -$128,162 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $109,190 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $109,190 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $109,190 | TotalRevenueColumnAmt |
| Exclusion | $109,190 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| NYS FUNDING - VAPAP | 900099 | $3,749,436 | $3,749,436 | |
| NYS FUNDING - IAAF | 900099 | $2,753,296 | $2,753,296 | |
| TRINITY REVENUE | 900099 | $2,227,789 | $1,079,576 | $1,148,213 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,217,276 | TotalRevenueColumnAmt |
| Exclusion | $1,217,276 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $9,947,797 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $46,230,245 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $36,970,944 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $8,780,612 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,323,297 | TotalAmt |
| Program Services | $1,103,835 | ProgramServicesAmt |
| Management And General | $219,462 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,210,056 | TotalAmt |
| Program Services | $12,175,996 | ProgramServicesAmt |
| Management And General | $5,034,060 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,907 | TotalAmt |
| Program Services | $59,552 | ProgramServicesAmt |
| Management And General | $26,355 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,792,017 | TotalAmt |
| Program Services | $3,420,261 | ProgramServicesAmt |
| Management And General | $1,371,756 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,326,956 | TotalAmt |
| Program Services | $949,940 | ProgramServicesAmt |
| Management And General | $377,016 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $249,445 | TotalAmt |
| Program Services | $152,459 | ProgramServicesAmt |
| Management And General | $96,986 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,896 | TotalAmt |
| Program Services | $49,443 | ProgramServicesAmt |
| Management And General | $31,453 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,164,431 | TotalAmt |
| Program Services | $711,693 | ProgramServicesAmt |
| Management And General | $452,738 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,619,678 | TotalAmt |
| Program Services | $796,804 | ProgramServicesAmt |
| Management And General | $822,874 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,118 | TotalAmt |
| Program Services | $25,742 | ProgramServicesAmt |
| Management And General | $16,376 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,530 | TotalAmt |
| Program Services | $8,269 | ProgramServicesAmt |
| Management And General | $5,261 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $116,075 | TotalAmt |
| Program Services | $57,103 | ProgramServicesAmt |
| Management And General | $58,972 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $638,287 | TotalAmt |
| Program Services | $314,007 | ProgramServicesAmt |
| Management And General | $324,280 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $493,186 | TotalAmt |
| Program Services | $242,624 | ProgramServicesAmt |
| Management And General | $250,562 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PURCHASED SERVICES | $7,325,813 | $4,477,490 | $2,848,323 |
| PHYSICIAN FEES | $4,894,446 | $4,894,446 | |
| SUPPLIES | $4,424,195 | $2,704,040 | $1,720,155 |
| ALL OTHER EXPENSES | $1,545,598 | $944,659 | $600,939 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,678,721 | TotalAmt |
| Program Services | $1,384,069 | ProgramServicesAmt |
| Management And General | $294,652 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,024,652 | TotalAmt |
| Program Services | $34,472,432 | ProgramServicesAmt |
| Management And General | $14,552,220 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,071,632 | BOYAmt |
| EOY | $1,700,934 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,291 | BOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,026,659 | BOYAmt |
| EOY | $6,468,357 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,340,889 | BOYAmt |
| EOY | $555,132 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $128,994 | BOYAmt |
| EOY | $212,893 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $297,596 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,917 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,663,503 | BOYAmt |
| EOY | $292,679 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,613,269 | BOYAmt |
| EOY | $4,769,393 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,883,237 | BOYAmt |
| EOY | $13,999,388 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,466,361 | BOYAmt |
| EOY | $6,513,345 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $2,768,922 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,606,920 | BOYAmt |
| EOY | $1,476,250 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,073,281 | BOYAmt |
| EOY | $10,758,517 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$1,468,270 | BOYAmt |
| EOY | $2,700,146 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $278,226 | BOYAmt |
| EOY | $270,451 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $270,274 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$1,190,044 | BOYAmt |
| EOY | $3,240,871 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,883,237 | BOYAmt |
| EOY | $13,999,388 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$2,794,407 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $16,761 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $7,208,561 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $297,596 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,917 | DepreciationAmt |
| Book Value | $292,679 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $292,679 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| ESTIMATED THIRD PARTY PAYOR SETTLEMENTS | $6,575 |
| ASSETS WHOSE USE IS LIMITED | $1,333,908 |
| ASSETS HELD FOR SALE | $3,428,910 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $4,769,393 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| ESTIMATED THIRD PARTY PAYOR SETTLEMENTS | $1,273,403 |
| OTHER CURRENT LIABILITIES | $202,847 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,476,250 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| 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 | $1,803,787 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $599,632 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,204,155 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02500 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $16,560,902 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,145,198 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,415,704 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09180 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,364,689 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,744,830 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,619,859 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11680 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $47,491 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $47,491 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $102,050 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $103,077 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$1,027 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $36,719 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $36,719 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $186,260 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $103,077 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $83,183 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00180 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,550,949 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,847,907 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,703,042 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11860 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $190 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $190 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $190 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $190 | NetCommunityBenefitExpnsAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $524,438 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $8,045 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $7,749,920 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,834,440 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $915,480 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST JAMES MERCY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 411 CANISTEO STREET | AddressLine1Txt |
| City | HORNELL | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14843 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.STJAMESMERCY.ORG | WebsiteAddressTxt |
| State License | 5002001H | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST JAMES MERCY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.STJAMESMERCY.ORG/PDF/2012-COMMUNITY-HEALTH-NEEDS-ASSESSMENT.PDF | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.STJAMESMERCY.ORG/PDF/SJMH-2013-2015-COMMUNITY-SERVICE-PLAN.PDF | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | 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 Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.STJAMESMERCY.ORG/FINANCIAL.SHTML | FAPAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| 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 |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| 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 |
|---|---|
| ST. JAMES MERCY HOSPITAL | PART V, SECTION B, LINE 5: THE COMMUNITY NEEDS ASSESSMENT SURVEY WAS DISTRIBUTED TO COMMUNITY STAKEHOLDERS INCLUDING THE SJMH BOARD OF DIRECTORS, LOCAL GOVERNMENT LEADERS, AND SOCIAL SERVICE AGENCY DIRECTORS. THE INPUT WAS USED TO IDENTIFY HEALTH FACTORS AND DISPARITIES AND ALSO TO FURTHER IDENTIFY SURVEY PARTICIPANTS FROM ACROSS THE COMMUNITY. |
| ST. JAMES MERCY HOSPITAL | PART V, SECTION B, LINE 6A: IRA DAVENPORT MEMORIAL HOSPITAL, ARNOT HEALTH, CORNING HOSPITAL AND GUTHRIE HEALTH. |
| ST. JAMES MERCY HOSPITAL | PART V, SECTION B, LINE 6B: S2AY RURAL HEALTH NETWORK, STEUBEN COUNTY PUBLIC HEALTH DEPARTMENT, STEUBEN RURAL HEALTH NETWORK, HEALTH MINISTRY OF THE SOUTHERN TIER AND CANCER SERVICES PROGRAM OF STEUBEN COUNTY. |
| ST. JAMES MERCY HOSPITAL | PART V, SECTION B, LINE 11: NEEDS IDENTIFIED ARE ADDRESSED IN THE COMMUNITY SERVICE PLAN. |
| ST. JAMES MERCY HOSPITAL | PART V, SECTION B, LINE 22D: A PATIENT WHOSE HOUSEHOLD INCOME IS BETWEEN 201% AND 250% OF THE MOST RECENT FEDERAL POVERTY LEVEL QUALIFIED FOR A PARTIAL CHARITY CARE DISCOUNT. THE PATIENT LIABILITY IS 40% OF THE RATE OF REIMBURSEMENT SJMH WOULD HAVE RECEIVED FROM ITS "HIGHEST VOLUME PAYOR" (EXCELLUS BLUE CROSS) FOR LIKE SERVICES (INPATIENT, OUTPATIENT, ED). THE PATIENT IS ELIGIBLE FOR A CHARITY CARE DISCOUNT EQUAL TO THE DIFFERENCE BETWEEN CHARGES AND 40% OF THE EXCELLUS BLUE CROSS RATE. A PATIENT WHOSE HOUSEHOLD INCOME IS BETWEEN 251% AND 300% OF THE MOST RECENT FEDERAL POVERTY LEVEL QUALIFIES FOR A PARTIAL CHARITY CARE DISCOUNT. THE PATIENT IS RESPONSIBLE FOR PAYING THE EXCELLUS BLUE CROSS RATE. THE CHARITY CARE DISCOUNT WOULD EQUAL THE DIFFERENCE BETWEEN CHARGES AND THE EXCELLUS BLUE CROSS RATE.SJMH DETERMINED THAT EXCELLUS BLUE CROSS IS THE "HIGHEST VOLUME" PAYOR AS REFERENCED IN THE NYS STATUTE 2807-K. THEREFORE, FOR UNINSURED PATIENTS WITH HOUSEHOLD INCOMES BELOW 300% OF THE MOST RECENT FEDERAL POVERTY LEVEL, THE PATIENT RESPONSIBILITY WILL NOT EXCEED THE RATE OF REIMBURSEMENT SJMH WOULD HAVE RECEIVED FROM EXCELLUS BLUE CROSS. |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | THE COST-TO-CHARGE RATIO IS USED FOR LINES 7A AND 7B, COMPUTED BY TAKING TOTAL EXPENSES LESS BAD DEBT DIVIDED BY TOTAL GROSS PATIENT REVENUE. |
| PART I, 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 $ 920,884. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | ST. JAMES MERCY HOSPITAL ACTIVELY RECRUITS PHYSICIANS AND OTHER HEALTH PROFESSIONALS TO PROVIDE SERVICES IN AREAS WITH A MEDICAL SHORTAGE OR ARE UNDERSERVED. |
| PART III, LINE 2: | THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLES FOR ESTIMATED LOSSES RESULTING FROM THE INABILITY/UNWILLINGNESS OF PATIENTS TO MAKE PAYMENTS FOR SERVICES. THE ALLOWANCE IS DETERMINED BY ANALYZING HISTORICAL DATA AND TRENDS. ACCOUNTS RECEIVABLE ARE CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLES WHEN MANAGEMENT DETERMINES THAT RECOVERY IS UNLIKELY AND THE HOSPITAL CEASES COLLECTION EFFORTS. |
| PART III, LINE 3: | THE AMOUNT REPORTED IN PART III, SECTION A, LINE 3 IS DETERMINED BY ESTIMATING THE AMOUNT OF BAD DEBT EXPENSE THAT WOULD BE ATTRIBUTED TO PATIENTS WHO WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE BUT FOR WHOM SUFFICIENT INFORMATION WAS NOT OBTAINED TO MAKE THAT DETERMINATION. |
| PART III, LINE 4: | ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. TO EVALUATE THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS HISTORICAL DATA AND TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE TO EVALUATE THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF HISTORICAL DATA, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. |
| PART III, LINE 8: | TO DETERMINE MEDICARE ALLOWABLE COSTS REPORTABLE IN THE MEDICARE COST REPORT, THE COST-TO-CHARGE RATIO IS APPLIED TO GROSS PATIENT REVENUE ASSOCIATED WITH SERVICES PERFORMED FOR PATIENTS WHO ARE ELIGIBLE FOR MEDICARE. |
| PART III, LINE 9B: | A BAD DEBT RESULTS FROM A PATIENT ACCOUNT BALANCE FROM WHICH PAYMENT WAS ANTICIPATED FROM THE PATIENT, CREDIT EXTENDED AND THE ACCOUNT LATER DEEMED TO BE UNCOLLECTIBLE. A BAD DEBT DOES NOT MEET THE CRITERIA FOR CHARITY CARE, THAT IS, BAD DEBT PATIENTS ARE CONSIDERED TO HAVE THE FINANCIAL CAPABILITY AND ABILITY TO PAY, BUT ARE UNWILLING TO PAY. COLLECTION ACTIVITIES ARE ONLY PURSUED WITH RESPECT TO AMOUNTS THAT PATIENTS ARE ABLE TO PAY AS DETERMINED BY THE HOSPITAL'S CHARITY CARE POLICY. NO COLLECTION ACTIVITIES TAKE PLACE WITH RESPECT TO AMOUNTS THAT PATIENTS ARE NOT EXPECTED TO PAY UNDER THIS POLICY.A SEPARATE CHARITY CARE POLICY IS IN PLACE AND WOULD BE EXHAUSTED BEFORE A PATIENT BALANCE WOULD BE DEEMED SELF-PAY. UNDER THE CHARITY CARE POLICY, CHARITY CARE/FINANCIAL ASSISTANCE IS PROVIDED TO A PATIENT WITH A DEMONSTRATED INABILITY TO PAY. A PATIENT IS ELIGIBLE FOR CHARITY CARE/FINANCIAL ASSISTANCE CONSIDERATION BASED UPON MEETING CERTAIN INCOME ELIGIBILITY CRITERIA AS ESTABLISHED BY THE FEDERAL POVERTY INCOME GUIDELINE SLIDING SCALE. PER NYS PHL 2807-K, THIS CONSIDERS PATIENTS WHOSE HOUSEHOLD INCOME IS UP TO 300% OF THE MOST RECENT FEDERAL POVERTY GUIDELINES.ALL UNINSURED, LOW-INCOME PATIENTS WITHIN ST. JAMES MERCY HOSPITAL'S PRIMARY SERVICE AREA WHO CAN DEMONSTRATE AN INABILITY TO PAY CHARGES MAY APPLY FOR CHARITY CARE/FINANCIAL ASSISTANCE FOR ADJUSTMENTS TO THEIR BALANCES FOR ALL MEDICALLY NECESSARY HEALTHCARE SERVICES, PROVIDED THAT A MEMBER, IN GOOD STANDING, OF ST. JAMES MERCY HOSPITAL'S MEDICAL STAFF DETERMINES THE NEED FOR SUCH MEDICAL CARE TREATMENT. |
| PART VI, LINE 2: | ST. JAMES MERCY HOSPITAL CONDUCTS A COMMUNITY NEEDS ASSESSMENT EVERY THREE YEARS IN CONJUNCTION WITH STEUBEN COUNTY PUBLIC HEALTH. BASED ON RESIDENTS' FEEDBACK, THE COUNTY'S HEALTH CARE PRIORITIES, STRATEGIES, AND PROGRAMS ARE DETERMINED. ST. JAMES MERCY HOSPITAL CREATES AN ANNUAL PLAN BASED ON THIS ASSESSMENT, AND THE PROGRESS OF THESE INITIATIVES IS REPORTED ANNUALLY TO THE NYS DEPARTMENT OF HEALTH. LOCAL HEALTH CARE PRIORITIES ARE ALSO IDENTIFIED THROUGH SURVEYING PARTICIPANTS AT PUBLIC HEALTH EDUCATION PROGRAMS. |
| PART VI, LINE 3: | AT THE TIME OF REGISTRATION, ALL SELF-PAY INDIVIDUALS RECEIVE AN INFORMATION SHEET DESCRIBING THE TYPES OF FEDERAL, STATE AND LOCAL GOVERNMENT PROGRAMS AVAILABLE, INCLUDING ST. JAMES MERCY HOSPITAL'S CHARITY CARE POLICY. THE ELIGIBILITY PROCESS IS COORDINATED BY A FINANCIAL COUNSELOR, WHO CONTACTS THE PATIENT OR PATIENT FAMILY MEMBER BY PHONE AND/OR LETTER. PATIENTS WHO QUALIFY FOR MEDICAID ARE ALSO DIRECTED TO AN IN-HOUSE FACILITATED ENROLLER, WHO COORDINATES THE MEDICAID APPLICATION PROCESS ON BEHALF OF THE PATIENT. |
| PART VI, LINE 4: | THE PRIMARY SERVICE AREA FOR ST. JAMES MERCY HOSPITAL IS THE 15-MILE RADIUS EXTENDING FROM HORNELL (STEUBEN COUNTY), NEW YORK, AND INCLUDES THE TOWNS OF WAYLAND TO THE NORTHEAST AND TROUPSBURG TO THE SOUTHEAST (JUST OUTSIDE OF THE 15-MILE RADIUS). THE SECONDARY SERVICE AREA IS THE 30-MILE RADIUS EXTENDING FROM HORNELL. PER THE 2010 CENSUS, THE POPULATION FOR THE PRIMARY SERVICE AREA (STEUBEN COUNTY) REMAINED RELATIVELY FLAT, INCREASING 0.3% FROM 2000 TO 2010 TO 98,990 AND IS PROJECTED TO REMAIN FLAT THROUGHOUT 2014. THE POPULATION AGED 65 AND OVER COMPRISES 16% OF THE PRIMARY SERVICE AREA COMPARED TO 13% FOR NEW YORK STATE. THE POPULATION IS RACIALLY AND ETHNICALLY HOMOGENOUS WITH 95.3% WHITE, 1.6% BLACK, 1.4% HISPANIC/LATINO, AND 1.2% ASIAN. PERSONS OVER THE AGE OF 65 REPRESENT 15.6% OF THE COUNTY, 2 PERCENTAGE POINTS HIGHER THAN THE STATE. MEDIAN HOUSEHOLD INCOME IS $42,764 COMPARED TO $54,554 FOR THE STATE. APPROXIMATELY 20% OF THE COUNTY POPULATION HAVE A BACHELOR'S DEGREE OR HIGHER COMPARED TO 32% OF STATE RESIDENTS. |
| PART VI, LINE 5: | ST. JAMES MERCY HOSPITAL IS THE LEAD AGENCY FOR THE CANCER SERVICES PROGRAM (CSP) OF STEUBEN COUNTY. A COMMUNITY-BASED, GRANT-FUNDED PROGRAM OF NEW YORK STATE DEPARTMENT OF HEALTH, THE CSP SERVES UNINSURED MEN AND WOMEN WITH COMPREHENSIVE, AGE-APPROPRIATE, NO-COST SCREENINGS FOR BREAST, CERVICAL AND COLORECTAL CANCER. ST. JAMES MERCY HOSPITAL PARTICIPATES IN COORDINATING THE PEDIATRIC HEALTH FAIR. THIS EVENT IS DIRECTED TO PARENTS AND COMMUNITY YOUTH AND IS HELD IN CONJUNCTION WITH A LONGSTANDING COMMUNITY KIDS "FUN RUN" TO PROMOTE EXERCISE AND HEALTHY LIFESTYLES. ST. JAMES MERCY HOSPITAL STAFF MEMBERS THROUGHOUT THE ORGANIZATION PARTICIPATE IN COMMUNTIY INITIATIVES AND HOLD SEATS ON BOARDS, INCLUDING THE STEUBEN RURAL HEALTH NETWORK, CATHOLIC CHARITIES, YMCA, UNITED WAY OF THE SOUTHERN TIER, STEUBEN CO. HEALTH PRIORITIES TEAM, AND OTHER NON-PROFIT ORGANIZATIONS WHOSE PRIMARY MISSION IS TO ASSESS AND ADDRESS COMMUNITY NEEDS. ST. JAMES MERCY HOSPITAL HAS ALSO COLLABORATED IN A PILOT PROGRAM IN COLLABORATION WITH THE HORNELL CITY SCHOOL DISTRICT AND IS DESIGNED TO ADDRESS THE ISSUE OF STUDENTS WITHOUT HEALTH INSURANCE IN PRE-K THROUGH GRADE 6, THROUGH EDUCATIONAL MATERIALS TO PARENTS AND MEDICAID ENROLLMENT ASSISTANCE. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | NY |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | 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 | Yes (1) | 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 (8 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JENNIFER L SULLIVAN | ||||||||||||||
| PRESIDENT/CEO | $288,156 | $0 | $65,623 | $0 | $337,621 | $0 | $2,852 | $0 | $13,958 | $0 | $708,210 | $0 | $0 | $0 |
| KATHY J BRODBECK | ||||||||||||||
| CHIEF NURSING OFFICER | $98,492 | $0 | $15,167 | $0 | $48,262 | $0 | $525 | $0 | $3,097 | $0 | $165,543 | $0 | $0 | $0 |
| PATRICIA DAGON | ||||||||||||||
| VP CONTINUING CARE/CORPORATE COMPLIA | $119,182 | $0 | $28,412 | $0 | $89,172 | $0 | $6,102 | $0 | $13,958 | $0 | $256,826 | $0 | $0 | $0 |
| TAMERA S SUZANNE | ||||||||||||||
| PEDIATRIC NURSE PRACTITIONER | $78,245 | $0 | $77,642 | $0 | $12,000 | $0 | $386 | $0 | $1,948 | $0 | $170,221 | $0 | $0 | $0 |
| DR IFRAN A RIZVI | ||||||||||||||
| PHYSICIAN | $158,616 | $0 | $5,000 | $0 | $157 | $0 | $2,288 | $0 | $5,207 | $0 | $171,268 | $0 | $0 | $0 |
| DR SCOTT S LEE | ||||||||||||||
| PHYSICIAN | $205,820 | $0 | $0 | $0 | $1,069 | $0 | $2,285 | $0 | $6,229 | $0 | $215,403 | $0 | $0 | $0 |
| CHARLES M EDGECOMB | ||||||||||||||
| PHARMACY DIRECTOR | $151,978 | $0 | $0 | $0 | $13,607 | $0 | $7,231 | $0 | $13,886 | $0 | $186,702 | $0 | $0 | $0 |
| DENISE BECHER | ||||||||||||||
| MANAGER, DECISION SUPPORT/PLANNING | $101,530 | $0 | $3,958 | $0 | $50,139 | $0 | $3,334 | $0 | $7,116 | $0 | $166,077 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 6 | THE PERFORMANCE MEASURES USED TO DETERMINE INCENTIVE COMPENSATION WERE BASED ON ACHIEVING A REDUCTION IN THE NET LOSS AS COMPARED TO THE FISCAL PRIOR YEAR. |
| SCHEDULE J, PART I, LINE 4A | PRIOR TO APRIL 30, 2015, ST. JAMES MERCY HOSPITAL WAS A MEMBER OF TRINITY HEALTH CORPORATION. TRINITY HEALTH CORPORATION OPERATES ON A FISCAL YEAR BASIS WHICH BEGAN ON JULY 1, 2014 AND ENDED ON JUNE 30, 2015. PRIOR TO TRINITY HEALTH CORPORATION'S YEAR END, ST. JAMES MERCY HOSPITAL WAS DIVESTED FROM TRINITY HEALTH CORPORATION AND BECAME AN INDEPENDENT COMMUNITY ORGANIZATION GOVERNED BY A SELF-PERPETUATING COMMUNITY BOARD. AS PART OF THAT DIVESTITURE, CERTAIN INDIVIDUALS RECEIVED INCENTIVE COMPENSATION BASED UPON CONTRACTUAL ARRANGEMENTS WITH TRINITY HEALTH CORPORATION WHEREBY A PORTION OF THEIR TOTAL COMPENSATION WAS CONSIDERED "AT RISK AND ONLY PAID IN THE EVENT THAT CERTAIN PERFORMANCE MEASURES WERE ACHIEVED RELATED TO QUALITY, FINANCE, GROWTH AND PEOPLE. THE FINANCE PERFORMANCE MEASURE WAS TIED TO REDUCING THE OVERALL NET LOSS OF THE ORGANIZATION. ALL INCENTIVE COMPENSATION AND SEVERANCE WAS PAID BY TRINITY HEALTH CORPORATION. THE FOLLOWING INDIVIDUALS RECEIVED INCENTIVE COMPENSATION (INCLUDED IN COLUMN B(II) OF SCHEDULE J AND SEVERANCE PAYMENTS (INCLUDED IN COLUMN B(III) OF SCHEDULE J): JENNIFER L. SULLIVAN, PRESIDENT AND CEO, RECEIVED $65,623 IN INCENTIVE COMPENSATION AND $337,500 IN SEVERANCE PAYMENTS IN 2015 WHICH WERE PAID BY TRINITY HEALTH CORPORATION IN 2015 RELATED TO HER SERVICE PROVIDED PRIOR TO MAY 1, 2015. KATHY J. BRODBECK, CHIEF NURSING OFFICER, RECEIVED $15,167 IN INCENTIVE COMPENSATION AND $48,000 IN SEVERANCE PAYMENTS IN 2015 WHICH WERE PAID BY TRINITY HEALTH CORPORATION IN 2015 RELATED TO HER SERVICE PROVIDED PRIOR TO MAY 1, 2015. PATRICIA DAGON, VP CONTINUING CARE, RECEIVED $28,412 IN INCENTIVE COMPENSATION AND $88,971 IN SEVERANCE PAYMENTS IN 2015 WHICH WERE PAID BY TRINITY HEALTH CORPORATION IN 2015 RELATED TO HER SERVICE PROVIDED PRIOR TO MAY 1, 2015. CHARLES M. EDGECOMB, PHARMACY DIRECTOR, RECEIVED $4,250 IN SEVERANCE PAYMENTS IN 2015 WHICH WERE PAID BY TRINITY HEALTH CORPORATION IN 2015 RELATED TO HIS SERVICE PROVIDED PRIOR TO MAY 1, 2015. DENISE BECHER, DIRECTOR REVENUE CYCLE AND DECISION SUPPORT RECEIVED $3,958 IN INCENTIVE COMPENSATION AND $49,997 IN SEVERANCE PAYMENTS IN 2015 WHICH WERE PAID BY TRINITY HEALTH CORPORATION IN 2015 RELATED TO HER SERVICE PROVIDED PRIOR TO MAY 1, 2015. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| STANLEY D KONOPKO CFO | |||
| STANLEY D. KONOPKO, CFO, IS A PARTNER AT BONADIO & CO., LLP | $308,864 | BONADIO & CO. LLP IS PAID SERVICES PERFORMED BY MR. KONOPKO. | 0 |
| ISMAIL MEHR MD | |||
| DR. MEHR IS A BOARD MEMBER OF THE HOSPITAL | $571,011 | DR. MEHR PROVIDES ANESTHESIOLOGY SERVICES TO THE HOSPITAL THROUGH HIS COMPANY ABADAN MEDICAL, PLLC. | 0 |
Schedule N IRS990ScheduleN
Disposition Of Assets Detail DispositionOfAssetsDetail (4 entries)
| Assets Distri Or Expnss PaidAssetsDistriOrExpnssPaidDesc | DistributionDistributionDt | Fair Market Value Of AssetFairMarketValueOfAssetAmt | Method Of FMV DeterminationMethodOfFMVDeterminationTxt | EINEIN | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | IRC SectionIRCSectionTxt |
|---|---|---|---|---|---|---|---|---|---|
| ST JAMES MERCY HEALTH SYSTEM INC | |||||||||
| CASH AND CASH EQUIVALENTS | 2015-04-30 | $4,326,000 | CASH VALUE | 223127184 | 411 CANISTEO STREET | HORNELL | NY | 14843 | 501(C)(3) |
| ST JAMES MERCY HEALTH SYSTEM INC | |||||||||
| PATIENT ACCOUNTS RECEIVABLE, NET | 2015-04-30 | $2,788,000 | NBV | 223127184 | 411 CANISTEO STREET | HORNELL | NY | 14843 | 501(C)(3) |
| ST JAMES MERCY HEALTH SYSTEM INC | |||||||||
| PREPAID EXPENSES AND INVENTORIES | 2015-04-30 | $689,000 | CASH VALUE | 223127184 | 411 CANISTEO STREET | HORNELL | NY | 14843 | 501(C)(3) |
| ST JAMES MERCY HEALTH SYSTEM INC | |||||||||
| PROPERTY AND EQUIPMENT, NET | 2015-04-30 | $7,263,000 | NBV | 223127184 | 411 CANISTEO STREET | HORNELL | NY | 14843 | 501(C)(3) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor2 | 0 | DirectorOfSuccessor2Ind |
| Employee Of Successor2 | 0 | EmployeeOfSuccessor2Ind |
| Owner Of Successor2 | 0 | OwnerOfSuccessor2Ind |
| Receive Compensation2 | Yes (1) | ReceiveCompensation2Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE N, PART II, LINE 2D | FormAndLineReferenceDesc |
| Explanation | IN ADDITION TO THE DISPOSITION OF $15,066,000 ASSETS TO TRINITY HEALTH CORPORATION, TRINITY HEALTH CORPORATION ALSO ASSUMED APPROXIMATELY $22,568,000 OF LIABILITIES RESULTING IN A TRANSFER OF A NET LIABILITY OF $7,502,000.JENNIFER L. SULLIVAN, PRESIDENT AND CEO, RECEIVED $65,623 IN INCENTIVE COMPENSATION AND $337,500 IN SEVERANCE PAYMENTS IN 2015 WHICH WERE PAID BY TRINITY HEALTH CORPORATION IN 2015 RELATED TO HER SERVICE PROVIDED PRIOR TO MAY 1, 2015.KATHY J. BRODBECK, CHIEF NURSING OFFICER, RECEIVED $15,167 IN INCENTIVE COMPENSATION AND $48,000 IN SEVERANCE PAYMENTS IN 2015 WHICH WERE PAID BY TRINITY HEALTH CORPORATION IN 2015 RELATED TO HER SERVICE PROVIDED PRIOR TO MAY 1, 2015.PATRICIA DAGON, VP CONTINUING CARE, RECEIVED $28,412 IN INCENTIVE COMPENSATION AND $88,971 IN SEVERANCE PAYMENTS IN 2015 WHICH WERE PAID BY TRINITY HEALTH CORPORATION IN 2015 RELATED TO HER SERVICE PROVIDED PRIOR TO MAY 1, 2015.CHARLES M. EDGECOMB, PHARMACY DIRECTOR, RECEIVED $4,250 IN SEVERANCE PAYMENTS IN 2015 WHICH WERE PAID BY TRINITY HEALTH CORPORATION IN 2015 RELATED TO HIS SERVICE PROVIDED PRIOR TO MAY 1, 2015.DENISE BECHER, DIRECTOR REVENUE CYCLE AND DECISION SUPPORT RECEIVED $3,958 IN INCENTIVE COMPENSATION AND $49,997 IN SEVERANCE PAYMENTS IN 2015 WHICH WERE PAID BY TRINITY HEALTH CORPORATION IN 2015 RELATED TO HER SERVICE PROVIDED PRIOR TO MAY 1, 2015. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 3 | IN 2014, THE HOSPITAL ANNOUNCED IT HAD ENTERED INTO AGREEMENTS FOR THE SALE OF BOTH ITS LONG-TERM CARE AND DIALYSIS SERVICES. THE COMPONENTS' OPERATING RESULTS FOR 2014 AND 2015 ARE REFLECTED AS DISCONTINUED OPERATIONS ON THE FINANCIAL STATEMENTS. ON APRIL 12, 2016, THE HOSPITAL COMPLETED THE SALE OF ITS LONG-TERM CARE SERVICE LINE. IN SEPTEMBER 2015, INPATIENT AND OUTPATIENT ADDICTION SERVICES WERE CLOSED AND ASSUMED BY LOYOLA RECOVERY FOUNDATION, INC. |
| FORM 990, PART VI, SECTION A, LINE 3 | STANLEY D. KONOPKO HAS SERVED AS THE ORGANIZATION'S CFO SINCE AUGUST 2013. MR. KONOPKO IS A PARTNER OF BONADIO & CO., LLP, AN ACCOUNTING FIRM, WHICH WAS PAID $308,864 FOR MR. KONOPKO'S SERVICES IN 2015. |
| FORM 990, PART VI, SECTION A, LINE 4 | THE BYLAWS WERE AMENDED AND RESTATED EFFECTIVE MAY 1, 2015 TO REMOVE ST. JAMES MERCY HEALTH SYSTEM AS THE SOLE CORPORATE MEMBER OF THE HOSPITAL. |
| FORM 990, PART VI, SECTION B, LINE 11 | A COPY OF THE FORM 990 WAS MADE AVAILABLE TO EACH BOARD MEMBER BEFORE IT WAS FILED. ST. JAMES MERCY HOSPITAL HAS DESIGNED THE AUDIT AND COMPLIANCE COMMITTEE AS THE GROUP TO BE EDUCATED AND TO REVIEW THE RETURN. |
| FORM 990, PART VI, SECTION B, LINE 12C | A CALL FOR CONFLICTS IS PART OF EVERY BOARD MEETING. THE ANNUAL BOARD OF DIRECTORS EDUCATION SESSION WAS COMPLETED IN AUGUST 2015. |
| FORM 990, PART VI, SECTION B, LINE 15 | THROUGH APRIL 30, 2015, THE ORGANIZATION HAD ADOPTED TRINITY HEALTH CORPORATION'S PROCESS FOR DETERMINING COMPENSATION WHICH INCLUDED THE FOLLOWING: THE BOARD HAS AN INDEPENDENT COMMITTEE REVIEW AND APPROVE ALL ELEMENTS OF REMUNERATION FOR ALL DISQUALIFIED PARTIES, AS WELL AS OTHER KEY MANAGEMENT. THE BOARD/COMMITTEE HAS AN ESTABLISHED COMPENSATION PHILOSOPHY WHICH DETAILS THE OBJECTIVES OF MARKET POSITIONING AND PAY ELEMENTS. THE COMMITTEE ENGAGES WITH EXTERNAL CONSULTANTS TO PROVIDE MARKET DATA AND GUIDANCE COMPARING THE ORGANIZATION'S ROLES TO SIMILARLY SIZED HEALTH SYSTEMS UTILIZING BOTH TITLE AND JOB CONTENT COMPARISONS. THE COMMITTEE REVIEWS THE MARKET ANALYSIS, APPROVES ANY SALARY ADJUSTMENTS FOR THE EXECUTIVE POPULATION, CONSIDERS BOTH REASONABLENESS AND EFFECTIVENESS OF ALL REMUNERATIVE PROGRAMS AND ESTABLISHES THE DETAILED PERFORMANCE EXPECTATIONS WHICH ARE INCORPORATED INTO THE INCENTIVE PLAN. ALL OF THESE DISCUSSIONS AND DECISIONS ARE DOCUMENTED THROUGH THE PROVISION OF MEETING MINUTES. EFFECTIVE MAY 1, 2015, THE TRINITY HEALTH CORPORATION DIVESTED ITSELF OF ITS INTEREST IN THE ORGANIZATION AND THE ORGANIZATION BECAME AN INDEPENDENT HOSPITAL GOVERNED BY A SELF-PERPETUATING COMMUNITY BASED BOARD. THE ORGANIZATION CONTINUED TO FOLLOW THE PROCESS FOR DETERMINING COMPENSATION EXCEPT FOR THE ENGAGEMENT OF EXTERNAL CONSULTANTS. THE BOARD/COMMITTEE UTILIZED OTHER SOURCES OF MARKET DATA AND FOLLOWED THE SAME PROCEDURES AS OUTLINED ABOVE TO DETERMINE COMPENSATION. THERE WERE NO INCENTIVE COMPENSATION PLANS IN EFFECT FROM MAY 1, 2015 THROUGH DECEMBER 31, 2015. |
| FORM 990, PART VI, SECTION C, LINE 19 | ORGANIZATIONAL DOCUMENTS, SUCH AS THE ARTICLES OF INCORPORATION, CORPORATE BYALWS, GOVERNANCE POLICIES BELIEVED TO BE OF INTEREST TO THE PUBLIC, CONFLICT OF INTEREST POLICIES AND THE IRS FORM 990, ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | NET ASSETS CONTRIBUTION FROM TRINITY 7,502,000. TRANSFERS (TO) FROM AFFILIATES -226,000. OTHER CHANGES IN NET ASSETS -67,439. |
| FORM 990, PART XII, LINE 2C: | THE AUDIT AND COMPLIANCE COMMITTEE IS RESPONSIBLE FOR THE SELECTION OF THE INDEPENDENT AUDITOR AND OVERSIGHT OF THE AUDIT. THERE HAS NOT BEEN A CHANGE FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| ST JAMES MERCY FOUNDATION INC | ||||||||||
| 411 CANISTEO STREET | HORNELL | NY | 14843 | 161486437 | FOUNDATION | NY | 501(C)(3) | LINE 7 | ST JAMES MERCY HOSPITAL | 0 |
| ST JAMES MERCY HEALTH SYSTEM INC | ||||||||||
| 411 CANISTEO STREET | HORNELL | NY | 14843 | 223127184 | HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT | NY | 501(C)(3) | LINE 11B, II | TRINITY HEALTH CORPORATION | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SJM PROPERTIES INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 411 CANISTEO STREET | AddressLine1Txt |
| City | HORNELL | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14843 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 161294991 | EIN |
| Primary Activities | PROPERTY HOLDINGS | PrimaryActivitiesTxt |
| Legal Domicile State | NY | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST JAMES MERCY HEALTH SYSTEM INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
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