ELIZABETHTOWN COMMUNITY HOSPITAL: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- ELIZABETHTOWN COMMUNITY HOSPITAL (EIN 14-1364513)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-11-11
- IRS object ID
- 201533159349302878
- Schema version
- 2014v5.0
- 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 H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-11-11T13:55:10-06:00 | ReturnTs |
| Tax Period End | 2014-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 161226221 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FUST CHARLES CHAMBERS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5784 WIDEWATERS PARKWAY | AddressLine1Txt |
| City | SYRACUSE | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 13214 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 141364513 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ELIZABETHTOWN COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ELIZ | BusinessNameControlTxt |
| Phone | 5188736377 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 75 PARK STREET | AddressLine1Txt |
| City | ELIZABETHTOWN | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 12932 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RODNEY BOULA | PersonNm |
| Person Title | CEO/PRESIDENT | PersonTitleTxt |
| Phone | 5188736377 | PhoneNum |
| Signature | 2015-11-04 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JOSEPH J SCHLEGEL | PreparerPersonNm |
| PTIN | P00301329 | PTIN |
| Phone | 3154463600 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | RODNEY BOULA | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 75 PARK STREET | AddressLine1Txt |
| City | ELIZABETHTOWN | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 12932 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $24,067,244 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | ECH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1926 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | MISSION: TO PROMOTE WELLNESS IN THE COMMUNITIES WE SERVE BY PROVIDING QUALITY HEALTHCARE WITH SKILL, COMPASSION AND DIGNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 263 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,959,533 | PYContributionsGrantsAmt |
| CY Contributions Grants | $323,628 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $19,757,896 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $22,190,606 | CYProgramServiceRevenueAmt |
| PY Investment Income | $53,617 | PYInvestmentIncomeAmt |
| CY Investment Income | $35,534 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,312,627 | PYOtherRevenueAmt |
| CY Other Revenue | $1,431,121 | CYOtherRevenueAmt |
| PY Total Revenue | $23,083,673 | PYTotalRevenueAmt |
| CY Total Revenue | $23,980,889 | 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 | $13,034,863 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $14,361,559 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,676,902 | PYOtherExpensesAmt |
| CY Other Expenses | $8,394,931 | CYOtherExpensesAmt |
| PY Total Expenses | $20,711,765 | PYTotalExpensesAmt |
| CY Total Expenses | $22,756,490 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,371,908 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,224,399 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $23,690,754 | TotalAssetsBOYAmt |
| Total Assets EOY | $26,462,350 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $10,343,854 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $11,905,564 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $13,346,900 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $14,556,786 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF ECH IS TO PROMOTE HEALTH AND WELLNESS IN THE COMMUNITY AND TO PROVIDE QUALITY HEALTHCARE WITH SKILL, COMPASSION AND DIGNITY. IN CREATING OUR COMMUNITY BENEFITS PLAN WE KEEP THIS MISSION IN MIND, CONTINUALLY LOOKING FOR WAYS TO MEET COMMUNITY HEALTH NEEDS AND TO BE A GOOD NEIGHBOR. ECH IS DRIVEN BY PEOPLE WHO LIVE IN THE SERVICE AREA AND WHO WANT TO SEE THEIR FRIENDS AND NEIGHBORS GET THE CARE AND SERVICES THEY NEED. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $5,982,025 | ExpenseAmt |
| Revenue | $7,092,837 | RevenueAmt |
| Desc | INPATIENT ACUTE UNIT AND SUBACUTE REHABILITATIVE (SWING BED) INPATIENT PROGRAM:A 25-BED NURSING UNIT PROVIDING ACUTE AND SUB ACUTE (SWING BED)CARE. THE SMALLER ATMOSPHERE CREATES A CLOSER BOND BETWEEN THE PATIENT AND PROFESSIONALS ENCOURAGING OPTIMAL HEALING AND COMPASSIONATE CARE. THE SUB-ACUTE PROGRAM IS VITAL TO AREA RESIDENTS BECAUSE FOLLOWING A HIP-REPLACEMENT, KNEE-SURGERY OR CARDIAC OPERATION, RECUPERATION AND THERAPY CAN BE DONE AT ELIZABETHTOWN COMMUNITY HOSPITAL, SAVING THE FAMILY THE TIME AND EXPENSE OF TRAVEL. THE PROGRAM PROVIDES ONE-ON-ONE THERAPEUTIC CARE. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $6,899,679 | ExpenseAmt |
| Revenue | $5,854,113 | RevenueAmt |
| Desc | CLINIC SERVICES:ECH OPERATES THE ELIZABETHTOWN COMMUNITY HEALTH CENTER, WESTPORT HEALTH CENTER LOCATED IN WESTPORT ,NY, THE HIGH PEAKS HEALTH CENTER LOCATED IN WILMINGTON, NY, THE SMITH HOUSE HEALTH CENTER LOCATED IN WILLSBORO, NY, AND THE AU SABLE FORKS HEALTH CENTER, LOCATED IN AU SABLE FORKS, NY. ECH OPERATES AN OUTPATIENT CHEMOTHERAPY PROGRAM, WHICH INCLUDES UPDATED INFUSION EQUIPMENT MAKING IT POSSIBLE TO PROVIDE SAFE AND EFFICIENT METHODS FOR CHEMOTHERAPY AND BLOOD-RELATED INFUSIONS. IN ADDITION, THE NEW SPECIALIZED VENTILATING HOOD ENABLES THE PREPARATION OF CHEMOTHERAPY SOLUTIONS ON-SITE. THIS IS A GREAT CONVENIENCE FOR CANCER PATIENTS, SAVING THEM THE 90-MINUTE ROUND-TRIP DRIVE TO THE CLOSEST CHEMOTHERAPY FACILITY. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $4,703,368 | ExpenseAmt |
| Revenue | $5,074,905 | RevenueAmt |
| Desc | EMERGENCY ROOM SERVICES:ECH'S PRIOR YEARS EXPANSION OF THE EMERGENCY ROOM ADDED NEW STATE OF THE ART TRAUMA ROOMS, A TELEMENTRY SYSTEM FOR PATENT MONITORING, A REGISTRATION AREA DESIGNED FOR PATIENT PRIVACY AND CONFIDENTIALITY AND NEW WAITING AREAS FOR FAMILIES AND THEIR LOVED ONES.THE HOSPITAL OPERATES AN ALL-DIGITAL RADIOLOGY DEPARTMENT, ALLOWING TECHNOLOGISTS TO OBTAIN PATIENT IMAGES ANYWHERE IN THE HOSPITAL. IN THE EVENT OF A SIGNIFICANT EMERGENCY WITH MULTIPLE TRAUMAS, THE UNIT CAN BE USED ANYWHERE IN THE BUILDING. WHEN THE HOSPITAL IS FACED WITH AN UNUSUAL SURGE IN EMERGENCY ROOM TRAUMA CASES, HOSPITAL PROCEDURES ENABLE STAFF TO TRIAGE IN NONTRADITIONAL AREAS OF THE HOSPITAL. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,608,971 | ExpenseAmt |
| Revenue | $5,599,872 | RevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $1,608,971 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $5,599,872 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $19,194,043 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | 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 | Yes (1) | 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 | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 25 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 263 | 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 | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NY | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALAN CHARDAVOYNE CFO ECH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5188733136 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 75 PARK STREET | AddressLine1Txt |
| City | ELIZABETHTOWN | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 12932 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| ALAN HIPPS | ||||||||
| BOARD TREASURER | 0.80 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| REV FRED SHAW | ||||||||
| BOARD MEMBER | 0.80 | Yes (X) | $0 | $0 | $0 | |||
| DEBRA A WHITSON | ||||||||
| BOARD MEMBER | 0.80 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JAMES FORCIER | ||||||||
| BOARD PRESIDENT | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| DOMINIC EISINGER PHD | ||||||||
| BOARD VICE PRESIDENT | 0.80 | Yes (X) | $0 | $0 | $0 | |||
| GEORGE SALG | ||||||||
| BOARD MEMBER | 0.80 | Yes (X) | $0 | $0 | $0 | |||
| PATRICIA HICKEY | ||||||||
| BOARD SECRETARY | 0.80 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MARTIN NEPHEW | ||||||||
| BOARD MEMBER | 0.80 | Yes (X) | $0 | $0 | $0 | |||
| STEPHEN J VALLEY | ||||||||
| BOARD MEMBER | 0.80 | Yes (X) | $0 | $0 | $0 | |||
| ROBERT A PERKINS | ||||||||
| BOARD MEMBER | 0.80 | Yes (X) | $0 | $0 | $0 | |||
| H NICOLAS MULLER III PHD | ||||||||
| BOARD MEMBER | 0.80 | Yes (X) | $0 | $0 | $0 | |||
| RODNEY BOULA | ||||||||
| ADMINISTRATOR/CEO | 40.00 | Yes (X) | $305,419 | $0 | $48,152 | |||
| MATTHEW NOLAN | ||||||||
| COO | 40.00 | Yes (X) | $147,685 | $0 | $9,924 | |||
| ALAN CHARDAVOYNE | ||||||||
| CFO | 40.00 | Yes (X) | $205,711 | $0 | $12,667 | |||
| ROB DEMURO MD | ||||||||
| CMO | 40.00 | $319,759 | $0 | $35,218 | Yes (X) | |||
| PASQUALINO CAPUTO | ||||||||
| PHYSICIAN | 40.00 | $282,780 | $0 | $33,815 | Yes (X) | |||
| HARRY DAVIS | ||||||||
| PHYSICIAN | 40.00 | $169,892 | $0 | $20,572 | Yes (X) | |||
| MARY HALLORAN | ||||||||
| PHYSICIAN | 40.00 | $270,201 | $0 | $27,346 | Yes (X) | |||
| PATRICK JOHNSTON | ||||||||
| PHYSICIANS ASSISTANT | 40.00 | $285,449 | $0 | $13,747 | Yes (X) | |||
| JESSICA CRANE | ||||||||
| PHYSICIANS ASSISTANT | 40.00 | $140,104 | $0 | $11,631 | Yes (X) | |||
| NICOLE CONGER | ||||||||
| PHYSICIANS ASSISTANT | 40.00 | $155,551 | $0 | $10,621 | Yes (X) | |||
| CARLY SLEEPER | ||||||||
| PHYSICIANS ASSISTANT | 40.00 | $114,599 | $0 | $10,542 | Yes (X) | |||
| JULIE ANDERSON | ||||||||
| PHYSICIANS ASSISTANT | 40.00 | $106,981 | $0 | $6,053 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,504,131 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $240,288 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 23 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $13,398 | FundraisingAmt |
| Government Grants | $235,250 | GovernmentGrantsAmt |
| All Other Contributions | $74,980 | AllOtherContributionsAmt |
| Total Contributions | $323,628 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CRITICAL ACCESS HOSPITAL | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $22,190,606 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $22,190,606 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $22,190,606 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $35,534 | TotalRevenueColumnAmt |
| Exclusion | $35,534 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $80,039 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $80,039 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $6,316 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $13,398 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $6,316 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| 340B REVENUE | 900099 | $923,747 | $923,747 |
| MEANINGFUL USE INCOME | 900099 | $350,041 | $350,041 |
| OTHER OPERATING REV. | 900099 | $157,333 | $157,333 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,431,121 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $23,980,889 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $23,621,727 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $35,534 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,763,741 | TotalAmt |
| Program Services | $1,100,461 | ProgramServicesAmt |
| Management And General | $663,280 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,979,321 | TotalAmt |
| Program Services | $8,237,256 | ProgramServicesAmt |
| Management And General | $1,742,065 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $495,728 | TotalAmt |
| Program Services | $394,704 | ProgramServicesAmt |
| Management And General | $101,024 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,273,727 | TotalAmt |
| Program Services | $1,022,411 | ProgramServicesAmt |
| Management And General | $251,316 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $849,042 | TotalAmt |
| Program Services | $665,033 | ProgramServicesAmt |
| Management And General | $184,009 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,780 | TotalAmt |
| Management And General | $38,780 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $104,686 | TotalAmt |
| Program Services | $104,686 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,605 | TotalAmt |
| Program Services | $20,605 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $222,837 | TotalAmt |
| Program Services | $137,815 | ProgramServicesAmt |
| Management And General | $85,022 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $159,221 | TotalAmt |
| Program Services | $93,106 | ProgramServicesAmt |
| Management And General | $66,115 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $77,619 | TotalAmt |
| Program Services | $47,507 | ProgramServicesAmt |
| Management And General | $30,112 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,733,139 | TotalAmt |
| Program Services | $1,733,139 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $292,256 | TotalAmt |
| Program Services | $292,256 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $183,459 | TotalAmt |
| Program Services | $183,459 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| CONTRACTED, LINEN & PUR | $1,774,184 | $1,587,537 | $186,647 |
| MAINTENANCE AND UTILITI | $1,058,091 | $1,017,576 | $40,515 |
| BAD DEBT EXPENSE | $1,035,258 | $1,035,258 | |
| DRUGS SUPPLIES, GASES & | $753,181 | $753,181 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $941,615 | TotalAmt |
| Program Services | $768,053 | ProgramServicesAmt |
| Management And General | $173,562 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,756,490 | TotalAmt |
| Program Services | $19,194,043 | ProgramServicesAmt |
| Management And General | $3,562,447 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,497,759 | BOYAmt |
| EOY | $5,035,171 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,666,697 | BOYAmt |
| EOY | $1,950,905 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $104,380 | BOYAmt |
| EOY | $151,990 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,753,565 | BOYAmt |
| EOY | $3,098,183 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $252,590 | BOYAmt |
| EOY | $268,925 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $338,316 | BOYAmt |
| EOY | $248,086 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $16,800,659 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,465,067 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,924,841 | BOYAmt |
| EOY | $13,335,592 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,006,306 | BOYAmt |
| EOY | $2,160,085 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $146,300 | BOYAmt |
| EOY | $213,413 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,690,754 | BOYAmt |
| EOY | $26,462,350 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,650,737 | BOYAmt |
| EOY | $2,677,755 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $649,726 | BOYAmt |
| EOY | $1,048,461 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,745,000 | BOYAmt |
| EOY | $5,525,000 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,284,854 | BOYAmt |
| EOY | $966,119 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,013,537 | BOYAmt |
| EOY | $1,688,229 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,343,854 | BOYAmt |
| EOY | $11,905,564 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,617,829 | BOYAmt |
| EOY | $13,814,277 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $714,331 | BOYAmt |
| EOY | $727,769 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,740 | BOYAmt |
| EOY | $14,740 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,346,900 | BOYAmt |
| EOY | $14,556,786 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,690,754 | BOYAmt |
| EOY | $26,462,350 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,224,399 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $46,758 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$61,271 | OtherChangesInNetAssetsAmt |
| 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) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | 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
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $729,071 | BeginningYearBalanceAmt |
| Contributions | $307,873 | ContributionsAmt |
| Investment Earnings Or Losses | $11 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $294,446 | OtherExpendituresAmt |
| End Year Balance | $742,509 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $743,074 | BeginningYearBalanceAmt |
| Contributions | $1,821,094 | ContributionsAmt |
| Investment Earnings Or Losses | $11 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,835,108 | OtherExpendituresAmt |
| End Year Balance | $729,071 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $771,785 | BeginningYearBalanceAmt |
| Contributions | $423,593 | ContributionsAmt |
| Investment Earnings Or Losses | $11 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $452,315 | OtherExpendituresAmt |
| End Year Balance | $743,074 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,075,485 | BeginningYearBalanceAmt |
| Contributions | $231,296 | ContributionsAmt |
| Investment Earnings Or Losses | $256 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $535,252 | OtherExpendituresAmt |
| End Year Balance | $771,785 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $982,946 | BeginningYearBalanceAmt |
| Contributions | $243,135 | ContributionsAmt |
| Investment Earnings Or Losses | $181 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $150,777 | OtherExpendituresAmt |
| End Year Balance | $1,075,485 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.01990 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.98010 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $970,000 | OtherCostOrOtherBasisAmt |
| Book Value | $970,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,537,308 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,329,949 | DepreciationAmt |
| Book Value | $8,207,359 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,597,608 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,071,137 | DepreciationAmt |
| Book Value | $2,526,471 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,695,743 | OtherCostOrOtherBasisAmt |
| Depreciation | $63,981 | DepreciationAmt |
| Book Value | $1,631,762 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $13,335,592 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (4 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| U.S. GOVERNMENT AND AGENCY OBLIGATIONS | $356,363 | F |
| MUTUAL FUNDS | $788,796 | F |
| ASSETS BACKED SECURITIES | $33,155 | F |
| MARKETABLE EQUITY SECURITIES | $981,771 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $2,160,085 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO AFFILIATES | $23,910 |
| INTEREST RATE SWAP LIABILITY | $650,228 |
| WC/MALPRACTICE LIABILITY | $138,413 |
| THIRD PARTY PAYOR SETTLEMENTS | $875,678 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,688,229 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $24,060,928 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $80,039 | OtherRevenueAmt |
| Revenue Not Reported | $80,039 | RevenueNotReportedAmt |
| Revenue Subtotal | $23,980,889 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $23,980,889 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $22,836,529 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $80,039 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $80,039 | ExpensesNotReportedAmt |
| Expenses Subtotal | $22,756,490 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $22,756,490 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE ENDOWMENT FUNDS (ASSETS WHOSE USE IS LIMITED) ARE TO BE USED FOR HOSPITAL EXPANSION AND RENOVATION AND PURCHASING HOSPITAL EQUIPMENT. |
| PART X, LINE 2: | THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS GENERALLY EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE STANDARDS FOR ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ESTABLISH A RECOGNITION THRESHOLD AND MEASUREMENT FOR INCOME TAX POSITIONS RECOGNIZED IN A HOSPITAL'S FINANCIAL STATEMENTS. THESE STANDARDS HAD NO IMPACT ON THE ACCOMPANYING FINANCIAL STATEMENTS. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES ARE 2011 THROUGH 2014. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | RENTAL EXPENSES GRANTS |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF TOURNAMENT | Event1Nm |
| Gross Receipts Event1 | $19,714 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $13,398 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $6,316 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $1,100 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $2,992 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $2,224 | FoodAndBeverageEvent1Amt |
| Gross Receipts Total | $19,714 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $13,398 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $6,316 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $1,100 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $2,992 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $2,224 | FoodAndBeverageTotalEventsAmt |
| Direct Expense Summary Events | $6,316 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $0 | NetIncomeSummaryAmt |
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 |
| Percent350 | Yes (X) | Percent350Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | 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 | $86,656 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $86,656 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00400 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,979,661 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $522,752 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,456,909 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11310 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $86,656 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $86,656 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00400 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,152,973 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $522,752 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,630,221 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12110 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,434,716 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,005,526 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,429,190 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06580 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,434,716 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,005,526 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,429,190 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06580 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,587,689 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,528,278 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,059,411 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.18690 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,035,258 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $143,850 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $11,036,696 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $10,982,372 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $54,324 | 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 | ELIZABETHTOWN COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 75 PARK STREET PO BOX 277 | AddressLine1Txt |
| City | ELIZABETHTOWN | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 12932 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | 25 BEDS (ACUTE & SWING), 5 HEALTHCENTERS, CT, LAB, PHARM. PT. AMB SURG. | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ELIZABETHTOWN COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | WWW.AHRN.ORG, WWW.CO.ESSEX.NY.US | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | 0 | StrategyPostedWebsiteInd |
| Strategy Attached | Yes (1) | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 350.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| ELIZABETHTOWN COMMUNITY HOSPITAL | PART V, SECTION B, LINE 5: EXECUTIVES FROM THE FOLLOWING INSTITUTIONS: ADIRONDACK HEALTH, INTER-LAKES HEALTH, MOSES-LUDINGTON HOSPITAL, ADIRONDACK RURAL HEALTH NETWORK AND ESSEX COUNTY PUBLIC HEALTH. |
| ELIZABETHTOWN COMMUNITY HOSPITAL | PART V, SECTION B, LINE 7D: ESSEX COUNTY PUBLIC HEALTH |
| ELIZABETHTOWN COMMUNITY HOSPITAL | PART V, SECTION B, LINE 11: PLEASE SEE ATTACHED IMPLEMENTATION PLAN AT PAGES 10 AND 11. |
| ELIZABETHTOWN COMMUNITY HOSPITAL | PART V, SECTION B, LINE 24: THE ORGANIZATION USES A GLOBAL FEE SCHEDULE. IF THE PATIENT APPLIED AND WAS DEEMED ELIGIBLE, THE APPROPRIATE DISCOUNTS WERE GRANTED. |
| PART V, SECTION B, LINE 16 | FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY |
| ELIZABETHTOWN COMMUNITY HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: | HTTP://WWW.ECH.ORG/PDFS/HELPING_HANDS.PDF |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| ELIZABETHTOWN COMMUNITY HEALTH CENTER | ||||
| 66 PARK STREET | ELIZABETHTOWN | NY | 12932 | PRIMARY CARE HEALTH CENTER |
| HIGH PEAKS HEALTH CENTER | ||||
| 7 COMMUNITY CIRCLE | WILMINGTON | NY | 12997 | PRIMARY CARE HEALTH CENTER |
| SMITH HOUSE HEALTH CENTER | ||||
| 39 FARRELL ROAD | WILLSBORO | NY | 12996 | PRIMARY CARE HEALTH CENTER |
| WESTPORT HEALTH CENTER | ||||
| 6097 NYS ROUTE 9N | WESTPORT | NY | 12993 | PRIMARY CARE HEALTH CENTER |
| AU SABLE FORKS HEALTH CENTER | ||||
| 20 N MAIN ST | AU SABLE FORKS | NY | 12912 | PRIMARY CARE HEALTH CENTER |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 $ 1,035,258. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | THE HOSPITAL STAFF PARTICIPATES IN MANY LOCAL EVENTS THAT PROVIDE COMMUNITY MEMBERS THE OPPORTUNITY TO LEARN ABOUT THE HOSPITAL AND ABOUT IMPORTANT HEALTH SCREENINGS. IN ADDITION, THE HOSPITAL HOSTS EVENTS AND OFFERS TRAINING AND SUPPORT SERVICES TO OTHER HEALTH-ORIENTED ORGANIZATIONS. ECH PARTICIPATES IN THE FOLLOWING:(1)PROVIDES ADVANCED LIFE SUPPORT TRAINING FOR REGIONAL EMERGENCY MEDICAL TECHNICIANS. (2)PROVIDES MEDICAL DIRECTORSHIP TO SEVERAL LOCAL EMS AGENCIES, PROVIDES MONTHLY COURSES AND EDUCATION FOR CME CREDITS. (3)PROVIDES MEDICAL DIRECTORSHIP TO ST. JOSEPH'S ADDICTION TREATMENT & RECOVERY CENTER (4)SPONSORS AN ANNUAL DIABETES HEALTH FAIR AT THE HOSPITAL. (5)LENDS SPACE TO THE NORTH COUNTRY REGIONAL BLOOD DONOR CENTER FOR BLOOD DRIVES. (6)MEETING SPACE IS DONATED ON A MONTHLY BASIS TO EMS SQUADS. TECHNOLOGICAL CAPABILITIES ALLOW FOR DISTANCE TRAINING / EDUCATION. (7)WORKS WITH THE CANCER SCREENING PROGRAM TO PROVIDE INFORMATION ABOUT MAMMOGRAMS AND BONE DENSITY SCREENING AT THE ANNUAL BREAST CANCER AWARENESS EVENT. (8)HOSTS THE ESSEX COUNTY DIABETES SUPPORT GROUP MEETINGS IN THE HOSPITAL BOARDROOM. (9)EMPLOYEES FROM THROUGHOUT THE HOSPITAL USE HOSPITAL PAID TIME TO LEND THEIR EXPERTISE AND INCREASE THEIR INTERESTS IN SUCH AREAS AS THE ESSEX CO. HEALTHY LIVING PARTNERSHIP, BEHAVIOR HEALTH SERVICES NORTH, RETIRED SENIOR VOLUNTEER PROGRAM, TASK FORCE AGAINST DOMESTIC VIOLENCE, KIWANIS AND NORTH COUNTRY LIFE FLIGHT. (10)ECH'S CLINICAL STAFF COMPLETES ADDITIONAL TRAINING EACH YEAR (ACLS, PALS, BLS, VARIOUS RN / NURSING TRAINING PROGRAMS, CHEMOTHERAPY EDUCATION, PHYSICIAN EDUCATION, INFECTION CONTROL TRAINING, RADIOLOGY DEPARTMENT CONTINUING EDUCATION, LAB STAFF EDUCATION, ETC.) (11) MEETING SPACE FOR AA AND NA. EACH YEAR, THE HOSPITAL ALSO HOSTS THREE EVENTS THAT OFFER FREE HEALTH SCREENINGS TO LOCAL RESIDENTS. THE COMMUNITY HEALTH SCREENINGS ARE COORDINATED BY PUBLIC RELATIONS STAFF BUT ARE DEPENDENT UPON CLINICAL STAFF TO PERFORM EXAMS AND INTERPRET THE RESULTS. EACH EVENT IS STAFFED BY 5-8 CLINICAL STAFF MEMBERS FOR APPROXIMATELY 3-4 HOURS PER EVENT. (1)HUNTERS' HEALTH SCREENING (SEPTEMBER) IS A FREE, ANNUAL EVENT SPONSORED BY THE HOSPITAL. PARTICIPANTS RECEIVE A BASIC PHYSICAL / HEALTH SCREENING (EKG, BLOOD WORK, BLOOD PRESSURE, LAB TESTING, PHYSICIAN REVIEW AND REPORTING) AT NO COST. EVENT IS ARRANGED, COORDINATED AND PROMOTED BY ECH PUBLIC RELATIONS STAFF. IN 2014, THERE WERE APPROXIMATELY 62 PARTICIPANTS. (2)HEALTHY HEART DAY (FEBRUARY) IS ANOTHER FREE HEALTH SCREENING EVENT; AND IS CO-SPONSORED BY THE HOSPITAL AUXILIARY EACH YEAR. PARTICIPANTS RECEIVE HEART HEALTH EDUCATION, HEALTH SCREENINGS, LAB TESTING, PHYSICIAN REVIEW AND REPORTING. PARTICIPANTS CAN SPEAK TO EXPERTS DURING THE EVENT. IN 2014, THERE WERE 43 PARTICIPANTS. (3) IN MAY AND OCTOBER THE HOSPITAL HOSTS AN EVENT CO-SPONSORED BY THE CANCER SERVICES SCREENING PROGRAM OF ESSEX AND FRANKLIN COUNTIES AND THE HOSPITAL'S AUXILIARY. THE EVENING FEATURES A SPEAKER, ALONG WITH THE OPPORTUNITY TO TAKE PART IN A FREE HEALTH SCREENING. WOMEN WHO QUALIFIED (UN- OR UNDER-INSURED) WERE ABLE TO RECEIVE A CLINICAL BREAST EXAM AND MAMMOGRAM AT NO COST TO THEM, THROUGH THE CANCER SERVICES SCREENING PROGRAM OF ESSEX AND FRANKLIN COUNTIES. IN 2014, 13 FREE MAMMOGRAMS AND 21 OSTEOPOROSIS SCREENING EXAMS WERE CONDUCTED AS PART OF THESE HEALTH FAIRS. |
| PART III, LINE 4: | THE BAD DEBT INCLUDED ON LINE 2 IS DETERMINED AT COST. FINANCIAL STATEMENT FOOTNOTE FOR BAD DEBT EXPENSE:THE HOSPITAL IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL BY MEDICARE AND MEDICAID. THESE THIRD-PARTY PAYORS REIMBURSE THE HOSPITAL ON A COST BASIS. THE HOSPITAL ALSO HAS AGREEMENTS WITH OTHER THIRD-PARTY PAYORS. PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, COST-BASED REIMBURSEMENT, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE AND THE RELATED PATIENT ACCOUNTS RECEIVABLE ARE REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS DUE TO FUTURE AUDITS, REVIEWS AND INVESTIGATIONS. RETROACTIVE ADJUSTMENTS ARE CONSIDERED IN THE RECOGNITION OF REVENUE ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS ADJUSTMENTS BECOME KNOWN OR AS YEARS ARE NO LONGER SUBJECT TO SUCH AUDITS, REVIEWS AND INVESTIGATIONS.AN ALLOWANCE FOR DOUBTFUL ACCOUNTS RECEIVABLE IS ESTIMATED BY MANAGEMENT BASED ON PERIODIC REVIEWS OF THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE CONSIDERING HISTORICAL EXPERIENCE AND PREVAILING ECONOMIC CONDITIONS. |
| PART III, LINE 8: | USED MEDICARE ONLY TOTAL CHARGES FROM REVENUE REPORT FOR 2013 AND APPLIED THE RATIO OF COST TO CHARGES FROM THE 2013 COST REPORT DATA. |
| PART III, LINE 9B: | THE ELIZABETHTOWN COMMUNITY HOSPITAL'S HELPING HANDS PROGRAM OFFERS FREE OR REDUCED CARE TO OUR PATIENTS WHO ARE UNINSURED OR UNDERINSURED AND MEET THE INCOME ELIGIBILITY CRITERIA SET BY THE FOLLOWING GUIDELINES. THE FREE OR REDUCED CARE APPLIES ONLY TO THE SERVICES PROVIDED BY THE ELIZABETHTOWN COMMUNITY HOSPITAL, WESTPORT HEALTH CENTER, ELIZABETHTOWN COMMUNITY HEALTH CENTER, HIGH PEAKS HEALTH CENTER, AU SABLE FORKS HEALTH CENTER, AND SMITH HOUSE HEALTH CENTER. |
| PART VI, LINE 2: | A NUMBER OF COMMUNITY PARTNERS ARE INVOLVED IN ASSESSING COMMUNITY HEALTH NEEDS WITHIN THE HOSPITAL'S SERVICE AREA.IN ADDITION TO ITS ESTABLISHED RELATIONSHIPS WITH OTHER HOSPITALS, COMMUNITY ORGANIZATIONS AND HEALTHCARE-BASED ORGANIZATIONS (EMS, PUBLIC HEALTH, MENTAL HEALTH, ETC.), ELIZABETHTOWN COMMUNITY HOSPITAL HAS PARTNERED WITH TWO REGIONAL GROUPS TO ASSESS THE REGION'S COMMUNITY HEALTH NEEDS - THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS COMMITTEE, AND THE ADIRONDACK RURAL HEALTH NETWORK.MOBILIZING FOR ACTION THROUGH PLANNING & PARTNERSHIP (MAPP): AGENCY REPRESENTATIVES FROM CLINTON, ESSEX, AND FRANKLIN COUNTIES MEET TO APPLY COMMUNITY BASED APPROACHES TO LOCAL HEALTH ISSUES. THE MAPP GROUP HAS WORKED TO CULL INFORMATION THROUGH ASSESSMENTS OF THE LOCAL PUBLIC HEALTH SYSTEMS, A CDC LOCAL PUBLIC HEALTH INDICATOR SURVEY, A QUALITY OF LIFE SURVEY OF SENIORS AND PARENTS WITH CHILDREN, AND FOCUS GROUPS. THE MAPP GROUP SHARES UPDATED INFORMATION ON A CONTINUAL BASIS TO REASSESS PRIORITIES AND GAUGE PROGRAM SUCCESS.ADIRONDACK RURAL HEALTH NETWORK (ARHN): THE ADIRONDACK RURAL HEALTH NETWORK IS A PARTNERSHIP OF PUBLIC, PRIVATE AND NON-PROFIT ORGANIZATIONS IN UPSTATE NEW YORK. ARHN MEMBERS COLLABORATE TO DEVELOP STRATEGIES ALONG WITH IMPLEMENTING, MONITORING AND EVALUATING VARIOUS INITIATIVES. THIS GROUP CONTINUES TO MEET ON A (ROUGHLY) MONTHLY BASIS IN ORDER TO SHARE INFORMATION, STATISTICS, SUCCESSES, CHALLENGES AND OUTCOMES. ELIZABETHTOWN COMMUNITY HOSPITAL (ECH): IN ADDITION TO PARTNERSHIPS WITH THE ARHN AND THE MAPP PROCESSES, ECH INDEPENDENTLY SEEKS THE VIEWS OF COMMUNITY MEMBERS TO GAIN THEIR THOUGHTS REGARDING HEALTH CARE IN THEIR COMMUNITY AND GAIN FEEDBACK REGARDING ECH SERVICES. THROUGHOUT 2010-2011 MANY DIFFERENT METHODS WERE USED TO COMMUNICATE WITH AREA RESIDENTS. EACH YEAR HOSPITAL ADMINISTRATOR ROD BOULA ATTENDS TOWN BOARD MEETINGS THROUGHOUT ESSEX COUNTY IN AN EFFORT TO UPDATE TOWN LEADERS AND COMMUNITY MEMBERS ABOUT THE HOSPITAL, ITS PLANS FOR THE FUTURE; AND TO ADDRESS ANY QUESTIONS. ANNUALLY, THE ADMINISTRATOR MEETS WITH EMS AND FIRE DEPARTMENTS WITHIN THE HOSPITAL SERVICE AREA TO ENCOURAGE OPEN COMMUNICATION AND FOSTER A GOOD WORKING RELATIONSHIP. THE ECH BOARD OF DIRECTORS IS COMPOSED OF 14 REPRESENTATIVES OF EITHER A SPECIFIC COMMUNITY AND/OR ORGANIZATION, INCLUDING THE ESSEX COUNTY OFFICE FOR THE AGING, TOWN OF ELIZABETHTOWN SUPERVISORS OFFICE, AND ESSEX COUNTY MENTAL HEALTH. A PLANNING COMMITTEE, COMPRISED OF BOARD MEMBERS, IDENTIFIES GAPS IN SERVICE AND DEVELOPS GOALS TO FILL THESE NEEDS. PATIENT SATISFACTION SURVEYS ARE CONDUCTED FOR EACH DEPARTMENT ON A CONTINUAL BASIS. |
| PART VI, LINE 4: | ELIZABETHTOWN COMMUNITY HOSPITAL'S PRIMARY SERVICE AREA HAS REMAINED UNCHANGED FOR 2014 PLANNING PURPOSES. IT IS COMPOSED OF TWENTY-TWO ZIP CODES IN NORTHEASTERN ESSEX COUNTY. THE HOSPITAL IS LOCATED 45-60 MINUTES AWAY FROM ANY OTHER HOSPITAL; THROUGH A MOUNTAINOUS REGION AND MOSTLY ALONG A SERIES OF SECONDARY ROADS.BASED ON U.S. CENSUS FOR 2010, 39,370 PEOPLE LIVE WITHIN ESSEX COUNTY OF WHICH 51.8% ARE MALE AND 48.2% ARE FEMALE. PEOPLE OVER THE AGE OF 65 CONSTITUTE 18.1% OF THE POPULATION AND CHILDREN UNDER THE AGE OF 18 MAKE UP 19.3% OF THE POPULATION.ETHNICALLY, 94.4% OF THE POPULATION IS WHITE, NON-HISPANIC. BY 2013 THE POPULATION OF THIS AREA IS EXPECTED TO DECLINE BY AN ESTIMATED 1.5%. |
| PART VI, LINE 5: | THE HOSPITAL STAFF PARTICIPATES IN MANY LOCAL EVENTS THAT PROVIDE COMMUNITY MEMBERS THE OPPORTUNITY TO LEARN ABOUT THE HOSPITAL AND ABOUT IMPORTANT HEALTH SCREENINGS. IN ADDITION, THE HOSPITAL HOSTS EVENTS AND OFFERS TRAINING AND SUPPORT SERVICES TO OTHER HEALTH-ORIENTED ORGANIZATIONS. ECH PARTICIPATES IN THE FOLLOWING:(1)PROVIDES ADVANCED LIFE SUPPORT TRAINING FOR REGIONAL EMERGENCY MEDICAL TECHNICIANS. (2)PROVIDES MEDICAL DIRECTORSHIP TO SEVERAL LOCAL EMS AGENCIES, PROVIDES MONTHLY COURSES AND EDUCATION FOR CME CREDITS. (3)PROVIDES MEDICAL DIRECTORSHIP TO ST. JOSEPH'S ADDICTION TREATMENT & RECOVERY CENTER (4)SPONSORS AN ANNUAL DIABETES HEALTH FAIR AT THE HOSPITAL. (5)LENDS SPACE TO THE NORTH COUNTRY REGIONAL BLOOD DONOR CENTER FOR BLOOD DRIVES. (6)MEETING SPACE IS DONATED ON A MONTHLY BASIS TO EMS SQUADS. TECHNOLOGICAL CAPABILITIES ALLOW FOR DISTANCE TRAINING / EDUCATION. (7)WORKS WITH THE CANCER SCREENING PROGRAM TO PROVIDE INFORMATION ABOUT MAMMOGRAMS AND BONE DENSITY SCREENING AT THE ANNUAL BREAST CANCER AWARENESS EVENT. (8)HOSTS THE ESSEX COUNTY DIABETES SUPPORT GROUP MEETINGS IN THE HOSPITAL BOARDROOM. (9)EMPLOYEES FROM THROUGHOUT THE HOSPITAL USE HOSPITAL PAID TIME TO LEND THEIR EXPERTISE AND INCREASE THEIR INTERESTS IN SUCH AREAS AS THE ESSEX CO. HEALTHY LIVING PARTNERSHIP, BEHAVIOR HEALTH SERVICES NORTH, RETIRED SENIOR VOLUNTEER PROGRAM, TASK FORCE AGAINST DOMESTIC VIOLENCE, KIWANIS AND NORTH COUNTRY LIFE FLIGHT. (10)ECH'S CLINICAL STAFF COMPLETES ADDITIONAL TRAINING EACH YEAR (ACLS, PALS, BLS, VARIOUS RN / NURSING TRAINING PROGRAMS, CHEMOTHERAPY EDUCATION, PHYSICIAN EDUCATION, INFECTION CONTROL TRAINING, RADIOLOGY DEPARTMENT CONTINUING EDUCATION, LAB STAFF EDUCATION, ETC.) (11) MEETING SPACE FOR AA AND NA. EACH YEAR, THE HOSPITAL ALSO HOSTS THREE EVENTS THAT OFFER FREE HEALTH SCREENINGS TO LOCAL RESIDENTS. THE COMMUNITY HEALTH SCREENINGS ARE COORDINATED BY PUBLIC RELATIONS STAFF BUT ARE DEPENDENT UPON CLINICAL STAFF TO PERFORM EXAMS AND INTERPRET THE RESULTS. EACH EVENT IS STAFFED BY 5-8 CLINICAL STAFF MEMBERS FOR APPROXIMATELY 3-4 HOURS PER EVENT. (1)HUNTERS' HEALTH SCREENING (SEPTEMBER) IS A FREE, ANNUAL EVENT SPONSORED BY THE HOSPITAL. PARTICIPANTS RECEIVE A BASIC PHYSICAL / HEALTH SCREENING (EKG, BLOOD WORK, BLOOD PRESSURE, LAB TESTING, PHYSICIAN REVIEW AND REPORTING) AT NO COST. EVENT IS ARRANGED, COORDINATED AND PROMOTED BY ECH PUBLIC RELATIONS STAFF. IN 2014, THERE WERE APPROXIMATELY 62 PARTICIPANTS. (2)HEALTHY HEART DAY (FEBRUARY) IS ANOTHER FREE HEALTH SCREENING EVENT; AND IS CO-SPONSORED BY THE HOSPITAL AUXILIARY EACH YEAR. PARTICIPANTS RECEIVE HEART HEALTH EDUCATION, HEALTH SCREENINGS, LAB TESTING, PHYSICIAN REVIEW AND REPORTING. PARTICIPANTS CAN SPEAK TO EXPERTS DURING THE EVENT. IN 2014, THERE WERE 43 PARTICIPANTS. (3) IN MAY AND OCTOBER THE HOSPITAL HOSTS AN EVENT CO-SPONSORED BY THE CANCER SERVICES SCREENING PROGRAM OF ESSEX AND FRANKLIN COUNTIES AND THE HOSPITAL'S AUXILIARY. THE EVENING FEATURES A SPEAKER, ALONG WITH THE OPPORTUNITY TO TAKE PART IN A FREE HEALTH SCREENING. WOMEN WHO QUALIFIED (UN- OR UNDER-INSURED) WERE ABLE TO RECEIVE A CLINICAL BREAST EXAM AND MAMMOGRAM AT NO COST TO THEM, THROUGH THE CANCER SERVICES SCREENING PROGRAM OF ESSEX AND FRANKLIN COUNTIES. IN 2014, 13 FREE MAMMOGRAMS AND 21 OSTEOPOROSIS SCREENING EXAMS WERE CONDUCTED AS PART OF THESE HEALTH FAIRS. |
| PART VI, LINE 6: | COMMUNITY PROVIDERS, INC. (CPI), A NOT-FOR-PROFIT CORPORATION, IS THE SOLE MEMBER OF THE HOSPITAL AND CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER (CVPH), LOCATED IN PLATTSBURGH, NEW YORK. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | NY |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RODNEY BOULA | ||||||||||||||
| ADMINISTRATOR/CEO | $305,419 | $0 | $0 | $0 | $0 | $0 | $12,828 | $0 | $35,324 | $0 | $353,571 | $0 | $0 | $0 |
| MATTHEW NOLAN | ||||||||||||||
| COO | $147,685 | $0 | $0 | $0 | $0 | $0 | $6,203 | $0 | $3,721 | $0 | $157,609 | $0 | $0 | $0 |
| ALAN CHARDAVOYNE | ||||||||||||||
| CFO | $205,711 | $0 | $0 | $0 | $0 | $0 | $8,640 | $0 | $4,027 | $0 | $218,378 | $0 | $0 | $0 |
| ROB DEMURO MD | ||||||||||||||
| CMO | $319,759 | $0 | $0 | $0 | $0 | $0 | $13,430 | $0 | $21,788 | $0 | $354,977 | $0 | $0 | $0 |
| PASQUALINO CAPUTO | ||||||||||||||
| PHYSICIAN | $282,780 | $0 | $0 | $0 | $0 | $0 | $11,877 | $0 | $21,938 | $0 | $316,595 | $0 | $0 | $0 |
| HARRY DAVIS | ||||||||||||||
| PHYSICIAN | $169,892 | $0 | $0 | $0 | $0 | $0 | $7,135 | $0 | $13,437 | $0 | $190,464 | $0 | $0 | $0 |
| MARY HALLORAN | ||||||||||||||
| PHYSICIAN | $270,201 | $0 | $0 | $0 | $0 | $0 | $5,168 | $0 | $22,178 | $0 | $297,547 | $0 | $0 | $0 |
| PATRICK JOHNSTON | ||||||||||||||
| PHYSICIANS ASSISTANT | $285,449 | $0 | $0 | $0 | $0 | $0 | $11,989 | $0 | $1,758 | $0 | $299,196 | $0 | $0 | $0 |
| JESSICA CRANE | ||||||||||||||
| PHYSICIANS ASSISTANT | $140,104 | $0 | $0 | $0 | $0 | $0 | $5,884 | $0 | $5,747 | $0 | $151,735 | $0 | $0 | $0 |
| NICOLE CONGER | ||||||||||||||
| PHYSICIANS ASSISTANT | $155,551 | $0 | $0 | $0 | $0 | $0 | $6,533 | $0 | $4,088 | $0 | $166,172 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ESSEX COUNTY INDUSTRIAL DEVELOPMENT AGENCY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 141630643 | BondIssuerEIN |
| Bond Issued | 2011-12-01 | BondIssuedDt |
| Issue Price | $6,160,000 | IssuePriceAmt |
| Purpose | HOSPITAL RENOVATION AND EXPANSION | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $6,160,000 | RetiredAmt |
| Total Proceeds | $6,160,000 | TotalProceedsAmt |
| Capital Expenditures | $6,160,000 | CapitalExpendituresAmt |
| Substantial Completion | 2009 | SubstantialCompletionYr |
| Current Refunding | Yes (1) | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | 0 | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE K, PART II | FormAndLineReferenceDesc |
| Explanation | ON MARCH 1, 2007, THE HOSPITAL ISSUED, THROUGH THE ESSEX COUNTY INDUSTRIAL DEVELOPMENT AGENCY, MULTI-MODE VARIABLE RATE DEMAND CIVIC FACILITY REVENUE BONDS, SERIES 2007A, IN THE AMOUNT OF $5,540,000 AND MULTI-MODE VARIABLE RATE DEMAND CIVIC FACILITY REVENUE REFUNDING BONDS, SERIES 2007B, IN THE AMOUNT OF $1,375,000. THE PROCEEDS FROM THE SERIES 2007A BONDS WERE USED FOR THE RENOVATION AND EXPANSION OF THE HOSPITAL. THE PROCEEDS FROM THE SERIES 2007B BONDS WERE USED TO REFINANCE THE MORTGAGE PAYABLE. ON DECEMBER 1, 2011, THE HOSPITAL REDEEMED THE SERIES 2007 BONDS IN THE AGGREGATE AMOUNT OF $6,160,000 (SERIES 2007A BONDS OF $5,330,000 AND SERIES 2007B BONDS OF $830,000) FUNDED BY THE PROCEEDS FROM THE ISSUANCE OF THE ESSEX COUNTY CAPITAL RESOURCE CORPORATION REVENUE BONDS, SERIES 2011 IN THE AMOUNT OF $6,160,000. THE SERIES 2011 BONDS WERE PURCHASED BY KEY BANK, N.A. UNDER A BOND PURCHASE AGREEMENT. AS PART OF THE AGREEMENT, THE SERIES 2011 BONDS ARE SUBJECT TO MANDATORY REDEMPTION IN SIMILAR AMOUNTS AS THE 2007 SERIES BONDS AND ARE SUBJECT TO OPTIONAL TENDER BY THE BANK FOR PURCHASE BY THE HOSPITAL AT A PRICE EQUAL TO THE PRINCIPAL PLUS ACCRUED AND UNPAID INTEREST BEGINNING ON JUNE 1, 2017. THE SERIES 2011 BONDS ARE SECURED BY A MORTGAGE THAT KEY BANK HOLDS WITH THE HOSPITAL. CERTAIN RESTRICTIVE COVENANTS INCLUDE REQUIREMENTS TO MAINTAIN CERTAIN FINANCIAL LEVELS AND RATIOS SUCH AS DAY'S CASH ON HAND AND FIXED CHARGE COVERAGE RATIOS. AT DECEMBER 31, 2014, THE HOSPITAL WAS IN COMPLIANCE WITH THE TERMS OF THE AGREEMENT. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | COMMUNITY PROVIDERS, INC. (CPI) IS THE SOLE MEMBER OF ELIZABETHTOWN COMMUNITY HOSPITAL. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE 990 WILL BE PROVIDED TO THE BOARD PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST POLICY AND ALL MEMBERS ARE REQUIRED TO DISCLOSE ANY CONFLICTING INTERESTS OR STATE "NONE" ON THE ANNUAL CONFLICT OF INTEREST FORM. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE GOVERNING BOARD IS PROVIDED AN INDEPENDENT REPORT OF COMPATIBLE HOSPITALS SALARY FOR THE CEO. THE GOVERNING BOARD ALSO REVIEWS VARIOUS PERFORMANCE MEASURES AND OTHER INFORMATION AND ARRIVES AT A SALARY AND BENEFIT PACKAGE FOR THE CEO. THE DIRECTOR OF HUMAN RESOURCES OBTAINS SALARY INFORMATION FROM AN INDEPENDENT SOURCE FOR LOCAL COMPATIBLE HOSPITALS FOR EACH HIGHER LEVEL POSITION AT THE HOSPITAL. THE INDEPENDENT INFORMATION CONTAINS SALARY LEVELS FOR EACH POSITION AT THE 25TH, 50TH AND 75TH PERCENTILE. THE CEO THEN CONSIDERS THIS INFORMATION AND THE PERFORMANCE FOR EACH OF THESE EMPLOYEES AND ARRIVES AT THE APPROPRIATE SALARY LEVEL. THE APPROACH AND METHODOLOGY IS ALSO PRESENTED TO THE GOVERNING BOARD. |
| FORM 990, PART VI, SECTION C, LINE 19 | THESE DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. |
| FORM 990, PART XI, LINE 9: | CHANGES IN FAIR VALUE OF INTEREST RATE SWAP -61,271. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| CVPH MEDICAL CENTER | ||||||||||
| 75 BECKMAN STREET | PLATTSBURGH | NY | 12901 | 141338471 | HOSPITAL PATIENT CARE | NY | 501(C)(3) | 3 | COMMUNITY PROVIDERS INC | 0 |
| COMMUNITY PROVIDERS INC | ||||||||||
| 75 BECKMAN STREET | PLATTSBURGH | NY | 12901 | 222544844 | HEALTH CARE SERVICES | NY | 501(C)(3) | 3 | FLETCHER ALLEN PARTNERS | 0 |
| FLETCHER ALLEN PARTNERS INC | ||||||||||
| 111 COLCHESTER AVENUE | BURLINGTON | VT | 05401 | 452880726 | HEALTH SERVICE COORDINATION | NY | 501(C)(3) | 3 | PARENT | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 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 | Yes (1) | 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 | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Comments