WESTFIELD MEMORIAL HOSPITAL FOUNDATION INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- WESTFIELD MEMORIAL HOSPITAL FOUNDATION INC (EIN 22-2270533)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-08-10
- IRS object ID
- 201642239349300424
- 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 G
- Schedule I
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-08-10T06:41:49-07:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAMES W VANSTROM & COMPANY | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 532 | AddressLine1Txt |
| City | FALCONER | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 147330532 | 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 | 222270533 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WESTFIELD MEMORIAL HOSPITAL FOUNDATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WEST | BusinessNameControlTxt |
| Phone | 7167932237 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 189 EAST MAIN STREET | AddressLine1Txt |
| City | WESTFIELD | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14787 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TERESA CASLER | PersonNm |
| Person Title | TREASURER | PersonTitleTxt |
| Phone | 7167932237 | PhoneNum |
| Signature | 2016-08-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | HAROLD L BRUNACINI CPA | PreparerPersonNm |
| Phone | 7166613960 | PhoneNum |
| Preparation | 2016-08-10 | PreparationDt |
| Self Employed | Yes (X) | SelfEmployedInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2016-12-15 16:53:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | PATRICIA DIPALMA | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 189 E MAIN STREET | AddressLine1Txt |
| City | WESTFIELD | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14787 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $252,908 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.westfieldhospitalfoundation.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1978 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | THE FOUNDATION IS OPERATED FOR THE PURPOSE OF PROMOTING COMMUNITY PHILANTHROPIC SUPPORT OF WESTFIELD MEMORIAL HOSPITAL AND TO PROVIDE FUNDING FOR EXPANSION AND MODERNIZATION OF THE HOSPITAL'S EQUIPMENT AND FACILITIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 13 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $190,055 | PYContributionsGrantsAmt |
| CY Contributions Grants | $235,850 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $3,612 | PYInvestmentIncomeAmt |
| CY Investment Income | -$405 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$34,269 | PYOtherRevenueAmt |
| CY Other Revenue | -$37,972 | CYOtherRevenueAmt |
| PY Total Revenue | $159,398 | PYTotalRevenueAmt |
| CY Total Revenue | $197,473 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $11,395 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $13,552 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $72,225 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $83,590 | PYOtherExpensesAmt |
| CY Other Expenses | $85,575 | CYOtherExpensesAmt |
| PY Total Expenses | $94,985 | PYTotalExpensesAmt |
| CY Total Expenses | $99,127 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $64,413 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $98,346 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $533,637 | TotalAssetsBOYAmt |
| Total Assets EOY | $665,952 | TotalAssetsEOYAmt |
| Total Liabilities EOY | $33,969 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $533,637 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $631,983 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE FOUNDATION IS OPERATED | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $13,552 | ExpenseAmt |
| Grant | $13,552 | GrantAmt |
| Revenue | $197,473 | RevenueAmt |
| Desc | PROVIDED GRANT FUNDING TOTALING $13,552 TO WESTFIELD MEMORIAL HOSPITAL FOR NECESSARY EQUIPMENT PURCHASES. | Desc |
| Total Program Service Expenses | $13,552 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | false | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | false | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (true) | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Employment Tax Returns Filed | false | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (true) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | false | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | false | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NY | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | WESTFIELD MEMORIAL HOSPITAL FOUNDAT | PersonNm |
| Phone | 7167932237 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 189 EAST MAIN STREET | AddressLine1Txt |
| City | WESTFIELD | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 147871126 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| ROSE VAN VOLKENBURG | ||||||
| PRESIDENT | 15.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| MARY ANN WOLEBEN | ||||||
| VICE PRESIDENT | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| ANN E WEIDMAN | ||||||
| SECRETARY | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| TERESA L CASLER | ||||||
| TREASURER | 15.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| NANCY HANKS | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| MARILYN HEMMER | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| DIANA S HOLT | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| TERRY EGGLESTON | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| ROBERT MCCLURE | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| MICHAEL RICKETTS | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| DAN SMITH | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| KIM UNDERWOOD | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| BRENDA HAYES | ||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |
| PATRICIA DIPALMA | ||||||
| DIR. OF DEVELOPMENT | 35.00 | Yes (X) | $0 | $54,983 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Reportable Comp Rltd Org | $54,983 | TotReportableCompRltdOrgAmt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Fundraising | $81,157 | FundraisingAmt |
| Related Organizations | $50,000 | RelatedOrganizationsAmt |
| All Other Contributions | $104,693 | AllOtherContributionsAmt |
| Noncash Contributions | $39,309 | NoncashContributionsAmt |
| Total Contributions | $235,850 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$405 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $17,463 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $81,157 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $55,435 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$37,972 | TotalRevenueColumnAmt |
| Exclusion | -$37,972 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $197,473 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$405 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | -$37,972 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,552 | TotalAmt |
| Program Services | $13,552 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,150 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $3,150 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,194 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $1,194 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,097 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $610 | ManagementAndGeneralAmt |
| Fundraising | $5,487 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $987 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $987 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| OTHER EXPENSES | $1,320 | $0 | $1,320 | $0 |
| SEE ATTACHED SCHEDULE | $72,827 | $0 | $7,283 | $65,544 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $99,127 | TotalAmt |
| Program Services | $13,552 | ProgramServicesAmt |
| Management And General | $13,350 | ManagementAndGeneralAmt |
| Fundraising | $72,225 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,642 | BOYAmt |
| EOY | $47,279 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,000 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $520,995 | BOYAmt |
| EOY | $618,673 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $533,637 | BOYAmt |
| EOY | $665,952 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $33,969 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $33,969 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,642 | BOYAmt |
| EOY | $13,310 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $474,633 | BOYAmt |
| EOY | $572,011 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,362 | BOYAmt |
| EOY | $46,662 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $533,637 | BOYAmt |
| EOY | $631,983 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $533,637 | BOYAmt |
| EOY | $665,952 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $98,346 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | Yes (true) | AccountantCompileOrReviewInd |
Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FS Audited | false | FSAuditedInd |
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type3 Func Int | Yes (X) | SupportingOrgType3FuncIntInd |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WESTFIELD MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 160743222 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (true) | GoverningDocumentListedInd |
| Support | $13,552 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $13,552 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
| Public Support Total170 | $0 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY170 | 0 | PublicSupportCY170Pct |
| Public Support Total509 | $0 | PublicSupportTotal509Amt |
| Public Support CY509 | 0 | PublicSupportCY509Pct |
| Investment Income CY | 0 | InvestmentIncomeCYPct |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (true) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | false | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | false | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | false | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | false | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | false | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | false | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | false | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | false | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | false | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | false | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | false | ExcessBusinessHoldingsRulesInd |
| Excess Business Holdings | false | ExcessBusinessHoldingsInd |
| Contribution Controller | false | ContributionControllerInd |
| Contribution Family | false | ContributionFamilyInd |
| Contribution35 Controlled | false | Contribution35ControlledInd |
Form990 Sch A Type3 Sprt Org All Form990SchAType3SprtOrgAllGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timely Provided Documents | Yes (true) | TimelyProvidedDocumentsInd |
| Officers Close Relationship | false | OfficersCloseRelationshipInd |
| Supported Org Voice Investment | false | SupportedOrgVoiceInvestmentInd |
Form990 Sch A Type3 Func Int Form990SchAType3FuncIntGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Test | Yes (X) | ActivitiesTestInd |
| Activities Further Exempt Prps | Yes (true) | ActivitiesFurtherExemptPrpsInd |
| Activities Engaged Org Invlmnt | Yes (true) | ActivitiesEngagedOrgInvlmntInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pt IV Sec D Ln 2 | MANAGEMENT OF THE SUPPORTED ORGANIZATION ARE INVITED TO ATTEND MEETINGS OF THE FOUNDATION BOARD OF DIRECTORS AND ARE PROVIDED WITH MONTHLY FINANCIAL STATEMENTS. |
| Pt IV Sec E Ln 2a | THE FOUNDATION IS OPERATED FOR THE PURPOSE OF PROMOTING COMMUNITY PHILANTHROPIC SUPPORT OF WESTFIELD MEMORIAL HOSPITAL AND TO PROVIDE FUNDING FOR EXPANSION AND MODERNIZATION OF THE HOSPITAL'S EQUIPMENT AND FACILITIES, WHICH ARE KEY TO FURTHERING THE HOSPITAL'S EXEMPT PURPOSES. THE FOUNDATION IS RESPONSIVE TO THE HOSPITAL THROUGH ONGOING DISCUSSIONS REGARDING THE HOSPITAL'S NEEDS. |
| Pt IV Sec E Ln 3b | THE FOUNDATION'S ACTIVITIES INCLUDE FUNDRAISING ACTIVITIES TO PROVIDE FUNDING FOR EXPANSION AND MODERNIZATION OF THE HOSPITAL'S EQUIPMENT AND FACILITIES, AS WELL AS COMMUNITY EDUCATION AND AWARENESS ACTIVIES REGARDING PUBLIC HEALTH ISSUES. THESE ARE ALL ACTIVIES THAT WOULD BE CONDUCTED BY THE HOSPITAL, WAS IT NOT FOR THE INVOLVEMENT OF THE FOUNDATION. |
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 | $62,715 | BeginningYearBalanceAmt |
| Contributions | $3,650 | ContributionsAmt |
| Investment Earnings Or Losses | -$1,876 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $64,489 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $60,316 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $2,399 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $62,715 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $52,044 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $8,272 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $60,316 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $47,366 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $4,678 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $52,044 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $48,964 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$1,598 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $47,366 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.24270 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.75730 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (true) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DONOR RESTRICTED PROMISES TO GIVE | $50,000 |
| DONOR RESTRICTED CASH AND CASH EQUIVALENTS | $504,184 |
| ENDOWMENT FUND | $64,489 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $618,673 | TotalBookValueOtherAssetsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Pt V, Line 4 | FormAndLineReferenceDesc |
| Explanation | AN ENDOWMENT FUND IS HELD AT THE NORTHERN CHAUTAUQUA COMMUNITY FOUNDATION FOR THE PURPOSE OF PROMOTING PHILANTHROPIC SUPPORT OF WESTFIELD MEMORIAL HOSPITAL AND TO PROVIDE FUNDING FOR THE EXPANSION AND MODERNIZATION OF THE HOSPITAL'S EQUIPMENT AND FACILITIES. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF TOURNAMENT | Event1Nm |
| Gross Receipts Event1 | $94,160 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $79,512 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $14,648 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $26,165 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $16,555 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $9,781 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $1,079 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $94,160 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $79,512 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $14,648 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $26,165 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $16,555 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $9,781 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $1,079 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $53,580 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$38,932 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WESTFIELD MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 189 E MAIN STREET | AddressLine1Txt |
| City | WESTFIELD | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14787 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 160743222 | RecipientEIN |
| Cash Grant | $13,552 | CashGrantAmt |
| Valuation Method Used | BOOK | ValuationMethodUsedDesc |
| Non Cash Assistance | N/A | NonCashAssistanceDesc |
| Purpose Of Grant | FACILITY IMPR | PurposeOfGrantTxt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Pt I Line 2 | FormAndLineReferenceDesc |
| Explanation | GRANT REQUESTS ARE RECEIVED IN WRITING FROM HOSPITAL ADMINISTRATOR. REQUEST IS REVIEWED AND APPROVED BY FOUNDATION BOARD OF DIRECTORS PRIOR TO PAYMENT OF GRANT. | ExplanationTxt |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp (3 entries)
| DescDesc | ContributionContributionCnt | Noncash Contributions Rpt F990NoncashContributionsRptF990Amt | Method Of Determining RevenuesMethodOfDeterminingRevenuesTxt |
|---|---|---|---|
| GOLF TOURNAMENT EXPENSES | 106 | $37,667 | FAIR MARKET VALUE |
| WINE & CHEESE GIK | 5 | $915 | FAIR MARKET VALUE |
| SUPPLIES | 3 | $727 | FAIR MARKET VALUE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (true) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pt VI, Line 11b | FORM 990 IS REVIEWED IN DETAIL BY THE ORGANIZATION'S EXECUTIVE OFFICERS PRIOR TO FILING, WHO REVIEW IT WITH THE BOARD OF DIRECTORS SUBSEQUENT TO FILING. |
| Pt VI, Line 12c | COMPLIANCE IS MONITORED ON AN ANNUAL BASIS THROUGH UPDATED DISCLOSURES. |
| Pt VI, Line 19 | DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| Form 990EZ, Part I, Line 16 | MARKETING EXPENSES |
| Form 990EZ, Part I, Line 16 | OTHER ADMINISTRATIVE EXPENSES |
| Form 990EZ, Part II, Line 24 | PROMISES TO GIVE |
| Form 990EZ, Part II, Line 24 | DONOR RESTRICTED ASSETS |
| Form 990EZ, Part II, Line 26 | GRANTS PAYABLE |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WESTFIELD MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 189 MAIN ST | AddressLine1Txt |
| City | WESTFIELD | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 14787 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 160743222 | EIN |
| Primary Activities | HEALTH CARE | PrimaryActivitiesTxt |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Exempt Code Section | 501 (c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | 3 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NONE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (true) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| WESTFIELD MEMORIAL HOSPITAL INC | ||
| b | $13,552 | CASH GRANT |
| SAINT VINCENT HEALTH SYSTEM | ||
| c | $50,000 | CASH GRANT |
| WESTFIELD MEMORIAL HOSPITAL INC | ||
| p | $38,858 | ACTUAL COST |
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