CLAXTON-HEPBURN MEDICAL CENTER: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- CLAXTON-HEPBURN MEDICAL CENTER (EIN 15-0559686)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-14
- IRS object ID
- 201423189349302247
- Schema version
- 2013v3.0
- 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 H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-14T10:46:13-06:00 | ReturnTs |
| Tax Period End | 2013-12-31 | 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 | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5784 WIDEWATERS PARKWAY | AddressLine1 |
| City | SYRACUSE | City |
| State | NY | State |
| ZIP Code | 13214 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 150559686 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLAXTON-HEPBURN MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CLAX | BusinessNameControlTxt |
| Phone | 3153938880 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 214 KING STREET | AddressLine1 |
| City | OGDENSBURG | City |
| State | NY | State |
| ZIP Code | 13669 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KELLEY TIERNAN | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3153938880 | PhoneNum |
| Signature | 2014-09-09 | 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 | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KELLEY TIERNAN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 214 KING STREET | AddressLine1 |
| City | OGDENSBURG | City |
| State | NY | State |
| ZIP Code | 13669 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $93,868,952 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CHMED.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1917 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | CLAXTON-HEPBURN MEDICAL CENTER (HOSPITAL) OPERATES ACUTE CARE AND PSYCHIATRIC FACILITIES IN OGDENSBURG, NEW YORK. THE HOSPITAL IS THE SOLE ACUTE CARE PROVIDER IN OGDENSBURG, NY SERVICING PATIENTS PRIMARILY FROM ST. LAWRENCE COUNTY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 20 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 20 | VotingMembersIndependentCnt |
| Total Employee | 900 | TotalEmployeeCnt |
| Total Volunteers | 44 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,924,381 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,731,949 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $90,770,714 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $89,725,606 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$1,213 | PYInvestmentIncomeAmt |
| CY Investment Income | $71,520 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,001,075 | PYOtherRevenueAmt |
| CY Other Revenue | $1,270,470 | CYOtherRevenueAmt |
| PY Total Revenue | $93,694,957 | PYTotalRevenueAmt |
| CY Total Revenue | $93,799,545 | 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 | $51,671,807 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $51,000,322 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $38,127,557 | PYOtherExpensesAmt |
| CY Other Expenses | $37,686,452 | CYOtherExpensesAmt |
| PY Total Expenses | $89,799,364 | PYTotalExpensesAmt |
| CY Total Expenses | $88,686,774 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,895,593 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,112,771 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $99,160,621 | TotalAssetsBOYAmt |
| Total Assets EOY | $102,972,855 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $62,313,831 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $48,517,478 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $36,846,790 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $54,455,377 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO MEET OUR REGION'S HEALTHCARE NEEDS WITH COMPASSION AND EXELLENCE. SIGNIFICANT ACTIVITES: INPATIENT, OUTPATIENT, AND EMERGENCY CARE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $69,718,771 | ExpenseAmt |
| Revenue | $90,861,868 | RevenueAmt |
| Desc | CLAXTON-HEPBURN MEDICAL CENTER IS LOCATED IN OGDENSBURG, NY, AND IS A NOT-FOR-PROFIT HOSPITAL. THE HOSPITAL PROVIDES ACUTE INPATIENT PRIMARY CARE, MEDICAL, SURGICAL, INTENSIVE CARE, OBSTETRICS, NURSERY, MAINTAINS AN EMERGENCY DEPT, AMBULATORY SURGERY, HOME HEMODIALYSIS AND MENTAL HEALTH CENTER ACUTE REHAB TO THE PUBLIC. ACUTE PATIENT DAYS WERE 23,230. ADMISSIONS WERE 3,841, AND ER VISITS WERE 17,953. $1,045,520 OF CHARITY HEALTHCARE WAS GIVEN TO THE COMMUNITY. | Desc |
| Total Program Service Expenses | $69,718,771 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 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 | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 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 | 74 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 900 | 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 | 20 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 20 | 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 | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | 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 | KELLEY TIERNAN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3153938880 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 214 KING STREET | AddressLine1 |
| City | OGDENSBURG | City |
| State | NY | State |
| ZIP Code | 136691191 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (33 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| REV THOMAS PATTERSON | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| RUSSELL STRAIT | ||||||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| JOSEPH TRACY | ||||||||
| CHAIRPERSON | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| CHET TRUSKOWSKI | ||||||||
| VICE-CHAIRPERSON | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| PHILIP COSMO | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| SR MARY TERESA LABRAKE GNSH | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MARY LACOMBE | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| TED LAWRENCE | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MAUREEN MISSERT | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| MICHAEL SEIDMAN MD | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $267,588 | $0 | $18,441 | |||
| MACREENA DOYLE | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| M SANDRA LYONS | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| CLIVE CHAMBERS | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MARK MASHAW | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| LAWRENCE SEARS | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| BRIAN FELITTO | ||||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| LINDA FAY | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JAMES THEW | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| CHRISTOPHER BRANDY MD | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| SR MARY ELIZABETH LOOBY GNSH | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| SR DONNA FRANKLIN DC | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ERIC PELLEGRINO EDD | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| KIRI BRANDY MD | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MARK WEBSTER | ||||||||
| PRESIDENT/EXECUTIVE OFFICE | 40.00 | $376,488 | $0 | $28,265 | Yes (X) | |||
| KELLEY TIERNAN | ||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | $203,061 | $0 | $25,500 | Yes (X) | |||
| DAVID FERRIS | ||||||||
| VP OF NURSING | 40.00 | $169,063 | $0 | $20,217 | Yes (X) | |||
| GARY HART | ||||||||
| CHIEF MEDICAL OFFICER | 40.00 | $271,877 | $0 | $28,029 | Yes (X) | |||
| VICKI PERRINE | ||||||||
| CHIEF OPERATING OFFICER | 40.00 | $190,433 | $0 | $18,522 | Yes (X) | |||
| JOHN GERBERT MD | ||||||||
| PHYSICIAN | 40.00 | $856,345 | $0 | $18,575 | Yes (X) | |||
| THOMAS HERZOG MD | ||||||||
| PHYSICIAN | 40.00 | $653,412 | $0 | $23,856 | Yes (X) | |||
| JUAN-DIEGO HARRIS MD | ||||||||
| PHYSICIAN | 40.00 | $621,386 | $0 | $28,573 | Yes (X) | |||
| GEETANJLI SANGWAN MD | ||||||||
| PHYSICIAN | 40.00 | $358,211 | $0 | $22,019 | Yes (X) | |||
| LUCILLE ALSTON MD | ||||||||
| PHYSICIAN | 40.00 | $405,339 | $0 | $8,825 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,373,203 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $240,822 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 52 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| EMERGENCY PHYSICIAN ASSOCIATES | |||||
| 307 SOUTH EVERGREEN AVE | WOODBURY | NJ | 08096 | EMERGENCY ROOM PHYSICIAN SERVICES | $910,000 |
| HEALOGICS NATIONAL WOUND | |||||
| 6400 CONGRESS AVE SUITE 2200 | BOCA RATON | FL | 33489 | WOUND SERVICES | $805,585 |
| LOCUMTENENSCOM | |||||
| 3650 MANSELL RD STE 310 | ALPHARETTA | GA | 30022 | CONTRACTED LABOR | $542,371 |
| CENTREX CLINICAL LAB | |||||
| 1656 CHAMPLAIN AVE | UTICA | NY | 13502 | LAB CONSULTING/TEST | $451,255 |
| LAB CORP OF AMERICA | |||||
| PO BOX 12140 | BURLINGTON | NC | 27216 | LAB CONSULTING/TEST | $359,076 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 26 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $1,413,880 | RelatedOrganizationsAmt |
| Government Grants | $1,318,069 | GovernmentGrantsAmt |
| Total Contributions | $2,731,949 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICES | 621990 | $88,278,713 | $88,278,713 |
| 340B RETAIL | 621990 | $1,446,893 | $1,446,893 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $89,725,606 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $275,135 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $69,407 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $205,728 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $205,728 | TotalRevenueColumnAmt |
| Exclusion | $205,728 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $71,520 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $71,520 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $71,520 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $71,520 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| OTHER | 900099 | $418,099 | $418,099 |
| CAFETERIA | 900099 | $302,275 | $302,275 |
| AUXILIARY | 900099 | $244,601 | $244,601 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $99,767 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $99,767 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,064,742 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $93,799,545 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $90,861,868 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $205,728 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,331,457 | TotalAmt |
| Program Services | $299,907 | ProgramServicesAmt |
| Management And General | $1,031,550 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,811,824 | TotalAmt |
| Program Services | $31,708,065 | ProgramServicesAmt |
| Management And General | $6,103,759 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,859,862 | TotalAmt |
| Program Services | $2,338,547 | ProgramServicesAmt |
| Management And General | $521,315 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,269,417 | TotalAmt |
| Program Services | $5,126,584 | ProgramServicesAmt |
| Management And General | $1,142,833 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,727,762 | TotalAmt |
| Program Services | $2,230,527 | ProgramServicesAmt |
| Management And General | $497,235 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $257,042 | TotalAmt |
| Program Services | $3,800 | ProgramServicesAmt |
| Management And General | $253,242 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $212,581 | TotalAmt |
| Management And General | $212,581 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $205,995 | TotalAmt |
| Program Services | $38,724 | ProgramServicesAmt |
| Management And General | $167,271 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $153,779 | TotalAmt |
| Program Services | $48,040 | ProgramServicesAmt |
| Management And General | $105,739 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $172,004 | TotalAmt |
| Program Services | $79,882 | ProgramServicesAmt |
| Management And General | $92,122 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,073,046 | TotalAmt |
| Program Services | $794,054 | ProgramServicesAmt |
| Management And General | $278,992 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,658,458 | TotalAmt |
| Program Services | $3,447,259 | ProgramServicesAmt |
| Management And General | $1,211,199 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES - MEDICAL | $12,501,678 | $12,418,498 | $83,180 |
| PURCHASED SERVICES | $6,752,744 | $4,484,004 | $2,268,740 |
| CONTRACTS & LEASES | $3,645,591 | $2,439,605 | $1,205,986 |
| BAD DEBT EXPENSE | $2,069,847 | $2,069,847 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,983,687 | TotalAmt |
| Program Services | $2,191,428 | ProgramServicesAmt |
| Management And General | $3,792,259 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $88,686,774 | TotalAmt |
| Program Services | $69,718,771 | ProgramServicesAmt |
| Management And General | $18,968,003 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,563,235 | BOYAmt |
| EOY | $1,685,959 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,275,236 | BOYAmt |
| EOY | $8,787,832 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $185,426 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,817,996 | BOYAmt |
| EOY | $15,439,396 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,222,765 | BOYAmt |
| EOY | $1,500,416 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,043,236 | BOYAmt |
| EOY | $1,089,392 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $631,830 | BOYAmt |
| EOY | $703,127 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $109,294,797 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $64,998,138 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $42,466,755 | BOYAmt |
| EOY | $44,296,659 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,954,142 | BOYAmt |
| EOY | $29,470,074 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $99,160,621 | BOYAmt |
| EOY | $102,972,855 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,402,941 | BOYAmt |
| EOY | $26,472,996 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,926,503 | BOYAmt |
| EOY | $20,659,233 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,984,387 | BOYAmt |
| EOY | $1,385,249 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $62,313,831 | BOYAmt |
| EOY | $48,517,478 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,431,410 | BOYAmt |
| EOY | $52,871,777 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $810,633 | BOYAmt |
| EOY | $893,279 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $604,747 | BOYAmt |
| EOY | $690,321 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,846,790 | BOYAmt |
| EOY | $54,455,377 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $99,160,621 | BOYAmt |
| EOY | $102,972,855 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $5,112,771 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $12,495,816 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,415,380 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $168,220 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $0 | OtherExpendituresAmt |
| End Year Balance | $1,583,600 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,489,845 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $495,268 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $569,733 | OtherExpendituresAmt |
| End Year Balance | $1,415,380 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,225,966 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$8,703 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $727,418 | OtherExpendituresAmt |
| End Year Balance | $1,489,845 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $861,939 | BeginningYearBalanceAmt |
| Contributions | $1,297,151 | ContributionsAmt |
| Investment Earnings Or Losses | $66,876 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $2,225,966 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $837,598 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $24,401 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $861,939 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.43590 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.56410 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $432,509 | OtherCostOrOtherBasisAmt |
| Book Value | $432,509 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $58,723,329 | OtherCostOrOtherBasisAmt |
| Depreciation | $27,997,443 | DepreciationAmt |
| Book Value | $30,725,886 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,028,878 | OtherCostOrOtherBasisAmt |
| Depreciation | $96,368 | DepreciationAmt |
| Book Value | $1,932,510 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $46,797,403 | OtherCostOrOtherBasisAmt |
| Depreciation | $36,640,918 | DepreciationAmt |
| Book Value | $10,156,485 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,312,678 | OtherCostOrOtherBasisAmt |
| Depreciation | $263,409 | DepreciationAmt |
| Book Value | $1,049,269 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $44,296,659 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (7 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DEBT ISSUANCE COSTS | $809,071 |
| INTEREST IN NET ASSETS OF AFFILIATE | $14,446,685 |
| AMOUNTS HELD BY HOSPITAL AND THIRD PARTIES | $402,339 |
| DUE FROM AFFILIATES | $8,598,817 |
| DEFERRED COMPENSATION | $233,395 |
| EQUITY INVESTMENTS | $402,726 |
| CORPORATE CAPITAL RESERVE ACCOUNT | $4,577,041 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $29,470,074 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INTEREST RATE SWAP LIABILITY | Desc |
| Amt | $1,385,249 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,385,249 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | TERM ENDOWMENTS ARE AVAILABLE FOR HOSPITAL RENOVATION PROJECT, HEALTH CARE SERVICES, AND CHARITABLE ANNUITY RESERVE. PERMANENT ENDOWMENTS ARE HELD IN PERPETUITY, THE INCOME FROM WHICH IS EXPENDABLE TO SUPPORT HEALTH CARE SERVICES AND THE MEDICAL LIBRARY. |
| PART X, LINE 2: | THE HOSPITAL QUALIFIES AS A TAX-EXEMPT, NOT-FOR-PROFIT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS OF DECEMBER 31, 2013 AND 2012, THE HOSPITAL DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND NEW YORK STATE TAXING AUTHORITIES ARE 2010 THROUGH 2013. THE HOSPITAL DOES NOT ANTICIPATE THAT THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 250.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | 0 | 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 | $668,883 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $668,883 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00750 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,275,369 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,245,075 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $11,030,294 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12440 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,944,252 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,245,075 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $11,699,177 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13190 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $68,500 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $68,500 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,700 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,700 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $923 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $923 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $71,123 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $71,123 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,015,375 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,245,075 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $11,770,300 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13270 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,075 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,075 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $500 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $500 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,375 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,375 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,950 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,950 | NetCommunityBenefitExpnsAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,069,847 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $34,336 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $21,722,835 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,489,743 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $13,233,092 | 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 | CLAXTON-HEPBURN MEDICAL CENTER | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 214 KING STREET | AddressLine1 |
| City | OGDENSBURG | City |
| State | NY | State |
| ZIP Code | 13669 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLAXTON-HEPBURN MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.CHMED.ORG | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Develop Community Wide Plan | Yes (X) | DevelopCommunityWidePlanInd |
| Exec Community Wide Plan | Yes (X) | ExecCommunityWidePlanInd |
| All Needs Addressed | 0 | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (1) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 300.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (1) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit Report To Credit Agency | Yes (X) | PermitReportToCreditAgencyInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| CLAXTON-HEPBURN MEDICAL CENTER | PART V, SECTION B, LINE 3: CLAXTON-HEPBURN MEDICAL CENTER WORKED WITH THE OTHER ST. LAWRENCE COUNTY HOSPITALS AS WELL AS THE ST. LAWRENCE HEALTH INITIATIVE AND THE COUNTY PUBLIC HEALTH TO CONDUCT A COMMUNITY NEEDS ASSESSMENT. THE PARTNERS DEVELOPED A COMPREHENSIVE SURVEY TOOL THAT WAS DISTRIBUTED THROUGHOUT THE COUNTY AND WAS AVAILABLE TO COMPLETE ONLINE, WITH JUST OVER 800 SURVEYS COMPLETED. FOCUS GROUPS WERE HELD IN CANTON AND MORRISTOWN TO TRY TO GATHER DATA MORE REPRESENTATIVE OF THE COUNTY. KEY COMMUNITY LEADERS WERE ALSO INTERVIEWED TO ASSIST IN IDENTIFYING THE ISSUES MOST IN NEED OF ATTENTION. THE MEDICAL CENTER ALSO LOOKS TO ITS BOARD OF DIRECTORS FOR GUIDANCE AND FOR THE IDENTIFICATION OF COMMUNITY NEEDS. |
| CLAXTON-HEPBURN MEDICAL CENTER | PART V, SECTION B, LINE 4: MASSENA MEMORIAL HOSPITALCANTON-POTSDAM HOSPITALCLIFTON-FINE HOSPITALE.J. NOBLE HOSPITALST. LAWRENCE COUNTY PUBLIC HEALTHST. LAWRENCE HEALTH INITIATIVE |
| CLAXTON-HEPBURN MEDICAL CENTER | PART V, SECTION B, LINE 7: 10 NEEDS WERE IDENTIFIED FROM THE CHNA. THE CSP WORK GROUP DECIDED ON THREE PRIORITY AREAS TO ADDRESS BASED PRIORITIZING TECHNIQUES. CHMC IS EXPECTED TO WORK COLLABORATIVELY WITH OTHER ORGANIZATIONS WITHIN THE COMMUNITY TO ADDRESS THOSE THREE PRIORITY AREAS. CHMC WORKED WITH THOSE GROUPS TO SELECT THE THREE ISSUES ON WHICH TO FOCUS FOR THE NEXT THREE YEARS. |
| CLAXTON-HEPBURN MEDICAL CENTER | PART V, SECTION B, LINE 20D: CLAXTON-HEPBURN MEDICAL CENTER USES ITS NEGOTIATED RATE FROM THEIR LARGEST COMMERCIAL PAYOR. |
| CLAXTON-HEPBURN MEDICAL CENTER | PART V, SECTION B, LINE 22: GROSS CHARGES ARE BILLED TO PATIENTS WITH A NOTICE STATING IF THEY ARE ELIGIBLE FOR A DISCOUNT. ALSO, INSTRUCTIONS TO CONTACT OUR OFFICE AS TO HOW TO APPLY ARE PROVIDED. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 7 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (7 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | FacilityFacilityTxt |
|---|---|---|---|---|
| CANTON HEALTH CENTER | ||||
| 39 WEST MAIN STREET | CANTON | NY | 13617 | CLINIC |
| CLAXTON-HEPBURN HEALTH CENTER | ||||
| 100 HORWOOD PLACE | OGDENSBURG | NY | 13669 | CLINIC |
| WOUND HEALING CENTER | ||||
| 100 HORWOOD PLACE | OGDENSBURG | NY | 13669 | CLINIC |
| MADRID HEALTH CENTER | ||||
| 16 CHURCH STREET | MADRID | NY | 13660 | CLINIC |
| HEUVELTON HEALTH CENTER | ||||
| 103 RENSSELAER ST | RENSSELAER ST | NY | 13654 | CLINIC |
| WADDINGTON HEALTH CENTER | ||||
| 4 MONTGOMERY HEIGHTS | WADDINGTON | NY | 13694 | CLINIC |
| HAMMOND HEALTH CENTER | ||||
| 225 ST LAWRENCE AVE | HAMMOND | NY | 13646 | CLINIC |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | FINANCIAL ASSISTANCE CONSIDERATION WILL BE GIVEN TO THOSE PATIENTS WHO DEMONSTRATE THAT THEY HAVE BEEN UNABLE TO SECURE HEALTH CARE COVERAGE THROUGH A PUBLICLY SPONSORED NEW YORK STATE PROGRAM AND ARE UNABLE TO OBTAIN FINANCIAL HELP THROUGH OTHER PRIVATE FUNDING RESOURCES. ELIGIBILITY IS BASED ON:-SIZE OF FAMILY-HOUSEHOLD INCOME-AVAILABLE RESOURCES-EXTENT OF EXISTING INSURANCE COVERAGE-DOLLAR AMOUNT OF HOSPITAL CHARGESCLAXTON-HEPBURN MEDICAL CENTER IS COMMITTED TO EVALUATING A PATIENT'S ELIGIBILITY ON A CASE-BY-CASE BASIS, PARTICULARLY WHEN COMPLICATED FINANCIAL SITUATIONS ARE PRESENT. IN ADDITION, THE HOSPITAL WILL ALSO CONSIDER A PATIENT'S LIVING EXPENSES, DEBTS, NET WORTH, AND HEALTH CARE NEEDS. |
| PART I, LINE 7: | THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS IN THE TABLE IS A COST-TO-CHARGE RATIO. THIS COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. |
| PART I, LN 7 COL(F): | BAD DEBT EXPENSE INCLUDED IN PART IX LINE 25A THAT IS SUBTRACTED OUT FOR THE PURPOSES OF CALCULATING LINE 7 COLUMN F IS $2,069,847. |
| PART I LINE 7: | ST. LAWRENCE COUNTY, INCIDENCES OF CANCER AND CHRONIC DISEASE RANK FAR ABOVE STATE AND NATIONAL RANKINGS.IN 2011, THE AMERICAN CANCER SOCIETY ESTIMATES THAT IN NEW YORK STATE 107,260 NEW CANCER CASES WILL BE DIAGNOSED AND 34,350 CANCER DEATHS WILL OCCUR. OVERALL, NEW YORK STATE HAS A HIGHER CANCER INCIDENCE RATE THAN THE NATION AS A WHOLE, BUT HAS A LOWER DEATH RATE.IN ST. LAWRENCE COUNTY, 12 INDIVIDUALS ARE DIAGNOSED WITH CANCER EACH WEEK AND FIVE INDIVIDUALS DIE FROM CANCER EACH WEEK. THE BURDEN IN ST. LAWRENCE COUNTY REFLECTS THAT ANNUAL INCIDENCE RATES HAVE INCREASED. THERE WAS AN AVERAGE OF 492.8 CASES PER 100,000 PEOPLE PER YEAR IN 1994-1998. THIS RATE WAS 534.5 FOR 2004-2008, WHICH IS AN INCREASED RATE OF 8.5%. ANNUAL MORTALITY RATES HAVE DECREASED. THERE WAS AN AVERAGE OF 223.9 DEATHS PER 100,000 PEOPLE PER YEAR IN 1994-1998. THIS RATE WAS 216.3 FOR 2004-2008. THE ANNUAL MORTALITY RATE HAS DECREASED 3.4%. FOUR CANCER SITES REPRESENT 54.8% OF ALL NEW CANCER CASES AND 52.7% OF ALL NEW CANCER DEATHS IN ST. LAWRENCE COUNTY. THEY ARE LUNG AND BRONCHUS, PROSTATE, FEMALE BREAST, AND COLORECTAL CANCERS. CANCER TAKES A TOLL ON NEW YORK STATE. ONE IN TWO MEN AND ONE IN THREE WOMEN WILL GET A CANCER DIAGNOSIS IN THEIR LIFETIME. CANCER IS THE SECOND MOST COMMON CAUSE DEATH AFTER HEART DISEASE. IT IS WELL DOCUMENTED THAT THE BEST CANCER SURVIVAL RATES OCCUR FOR THOSE WHO ARE DIAGNOSED WITH EARLY STAGE DISEASE. ACCESS TO ADEQUATE HEALTH CARE HAS A SIGNIFICANT IMPACT ON AN INDIVIDUAL'S CHANCE OF SURVIVING CANCER. THERE IS A CLEAR NEED FOR POLICIES THAT REDUCE THE OCCURRENCE OF CANCER, HELP IDENTIFY THE DISEASE AT ITS EARLIEST (AND MOST TREATABLE) PHASE, AND TO HELP ALLEVIATE THE ECONOMIC TOLL AND IMPROVE QUALITY OF LIFE FOR THOSE DIAGNOSED WITH CANCER. CLAXTON-HEPBURN TAKES THE LEAD IN OUR COUNTY BY PROVIDING MANY VARIOUS CANCER SCREENINGS THROUGHOUT THE YEAR TO MAKE IT EASIER FOR PEOPLE TO GET SCREENED. IN 2012, THE MEDICAL CENTER SPONSORED ONE FREE COUNTY-WIDE SKIN CANCER SCREENINGS AND TWO FREE BREAST CANCER SCREENINGS AND 20 FREE COLONOSCOPIES. 36 PEOPLE PARTICIPATED IN THE SKIN CANCER SCREENINGS AND 11 WOMEN PARTICIPATED IN THE BREAST CANCER SCREENINGS. THE COST INCURRED TO THE MEDICAL CENTER FOR THESE SCREENINGS INCLUDE STAFF TIME, AND FEES ASSOCIATED WITH THE SCREENINGS SUCH AS XRAY COSTS. MAJOR CAUSES OF MORBIDITY AND MORTALITY IN THE UNITED STATES ARE RELATED TO POOR DIET AND PHYSICAL INACTIVITY. BY MAINTAINING A HEALTHY DIET AND BEING PHYSICALLY ACTIVE, INDIVIDUALS CAN ACHIEVE A HEALTHY WEIGHT AND REDUCE THEIR RISK OF CHRONIC DISEASES SUCH AS DIABETES, HEART DISEASE AND SOME FORMS OF CANCER, AND STRENGTHEN BONES TO REDUCE THE RISK OF OSTEOPOROSIS.OBESITY, WHICH MAY BE ADDRESSED THROUGH PROPER NUTRITION AND PHYSICAL ACTIVITY, IS A MAJOR RISK FACTOR FOR MANY CHRONIC DISEASES, AND HAS REACHED EPIDEMIC PROPORTIONS BOTH IN NEW YORK AND ACROSS THE NATION. THE PERCENTAGE OF OBESE ADULTS IN NEW YORK MORE THAN DOUBLED FROM 10% IN 1997 TO 24.2% IN 2009 AND, NATIONALLY, OBESITY AMONG CHILDREN AND ADOLESCENTS HAS TRIPLED OVER THE PAST THREE DECADES. ACCORDING TO A REPORT BY THE NEW YORK STATE COMPTROLLER'S OFFICE, NEW YORK RANKS SECOND AMONG STATES IN ADULT OBESITY-RELATED MEDICAL EXPENDITURES, WITH TOTAL SPENDING ESTIMATED AT NEARLY $7.6 BILLION (81% OF WHICH IS PAID BY MEDICAID AND MEDICARE), AND FAR EXCEEDING THE NATIONAL AVERAGE OF 52%. PHYSICAL INACTIVITY, POOR NUTRITION, CONSUMPTION OF SUGAR-SWEETENED BEVERAGES AND TELEVISION VIEWING CAN CONTRIBUTE TO EXCESS WEIGHT GAIN IN CHILDREN AND ADULTS. IN 2009, 26.4% OF ADULT NEW YORKERS REPORTED NO PHYSICAL ACTIVITY IN THE PAST 30 DAYS.IN A RECENT NEEDS ASSESSMENT COMPLETED IN COORDINATION WITH THE ST. LAWRENCE COUNTY PUBLIC HEALTH, ST. LAWRENCE HEALTH INITIATIVE AND ST. LAWRENCE COUNTY HOSPITALS, HIGHEST RANKED PROBLEMS:-ACCESS TO CARE-DRUG ABUSE -ALCOHOL ABUSE/UNDERAGE DRINKING-CANCER-POOR NUTRITION-LACK OF PHYSICAL ACTIVITY-DEPRESSION/MENTAL ILLNESS -SMOKING/TOBACCO USE -LUNG DISEASE/COPD (CLRD)-DIABETES -BEHAVIORAL PROBLEMS IN CHILDRENTYPES 1 AND 2 DIABETES AFFECTS A LARGE PERCENTAGE OF THE POPULATION BECAUSE THEY AFFECT SUCH A WIDE AGE RANGE. DATA GATHERED IN ST. LAWRENCE COUNTY SHOWS THAT DIABETES TRENDS ARE SIMILAR FOR ST. LAWRENCE COUNTY; A LARGE PERCENTAGE OF INDIVIDUALS ARE DIAGNOSED WITH DIABETES BETWEEN THE AGES OF 41 AND 60. IT WAS NOTED THAT 6372 PEOPLE OR 5.69% OF ST. LAWRENCE COUNTY INDIVIDUALS HAVE DIABETES AND THAT 7.5% OF THE POPULATION WITH DIABETES IN ST. LAWRENCE COUNTY DOES NOT RECEIVE MEDICATION FOR THEIR CONDITION DUE TO LACK OF ACCESS TO CARE. STUDIES SHOW THAT EARLY RECOGNITION OF DIABETES AS WELL AS PERSISTENT MANAGEMENT OF THE DISEASE IS NECESSARY TO FIGHT THE NEGATIVE EFFECTS THAT DIABETES CAN HAVE ON AN INDIVIDUAL. WITH IMPROVED EDUCATION, SCREENING AND PREVENTIVE CARE, DIABETES RATES IN ST. LAWRENCE COUNTY MAY BE REDUCED TO MINIMAL LEVELS. CLAXTON-HEPBURN PLAYS A VITAL ROLE IN CHRONIC DISEASE SELF-MANAGEMENT AND A PROACTIVE APPROACH TO SLOW PROGRESSION OF CHRONIC DISEASE IN OUR COMMUNITY BY OFFERING NUMEROUS FREE PROGRAMS AND EVENTS TO THE COMMUNITY. IN 2011, THE MEDICAL CENTER SCREENED 970 PEOPLE FOR CANCER, PERIPHERAL VASCULAR DISEASE, HYPERTENSION, HYPERLIPIDEMIA, DIABETES AND BODY MASS INDEX. THE MEDICAL CENTER ALSO PARTICIPATED IN 16 COMMUNITY HEALTH FAIRS PROVIDING FREE EDUCATIONAL MATERIALS, INTERACTIVE WORKSHOPS, FREE SCREENINGS AND HEALTH RELATED GIVEAWAYS. ON AN AVERAGE, FIVE OR MORE SERVICE LINES ATTEND THE EVENTS.CLAXTON-HEPBURN PROVIDED TWO CHRONIC DISEASE MANAGEMENT COURSES THAT COVERED A SIX-WEEK TIME PERIOD WITH TWO INSTRUCTORS. ALL MATERIALS, SPACE AND REFRESHMENTS AND SNACKS WERE PROVIDED TO THE PARTICIPANTS FOR FREE BY CLAXTON-HEPBURN. THE MEDICAL CENTER ALSO PROVIDED SEVERAL FREE SUPPORT GROUPS THAT MEET ONCE A MONTH ON THE HOSPITAL CAMPUS. THEY ARE THE TOBACCO CESSATION, DIABETES AND OSTOMY SUPPORT, THE LOOK GOOD, FEEL BETTER PROGRAM THAT MEETS MONTHLY FOR 2 HOURS IN CRM CONFERENCE ROOM AND THE FREE DIABETES EDUCATION DAY. |
| PART I LINE 6A: | ANNUALLY, CHMC PRODUCES A COMMUNITY SERVICE PLAN THAT IS SHARED WITH THE PUBLIC VIA THE MEDICAL CENTER'S WEBSITE, A BROCHURE THAT IS HANDED OUT AT COMMUNITY EVENTS AND IN A PAPER FORM WHEN REQUESTED. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | CLAXTON-HEPBURN PARTNERS WITH 5 LOCAL SCHOOLS PROVIDING FREE INTERACTIVE HEALTH ORIENTED WORKSHOPS AND EDUCATIONAL LECTURES ON A MONTHLY BASIS. STAFF CONSISTS OF A VARIETY OF EMPLOYEES THROUGHOUT THE MEDICAL CENTER FROM NURSING TO CLERICAL STAFF. GENERALLY THE VISITS LAST ABOUT ONE AND ONE-HALF HOURS AND ARE OFFERED TEN TIMES A YEAR. CLAXTON-HEPBURN ALSO PARTNERS WITH LOCAL BUSINESSES AND ORGANIZATIONS SUCH AS COLLEGES PROVIDING FREE HEALTH SCREENINGS, EDUCATIONAL WORKSHOPS AND EMPLOYEE/STUDENT WELLNESS PROGRAMMING. THE MEDICAL CENTER DOES NOT CHARGE FOR THESE SERVICES AND DOES INCUR THE EXPENSE OF EMPLOYEE TIME (WHICH INCLUDES PLANNING AND PRESENTING, TRAVEL TIME AND MATERIALS AND SUPPLIES USED FOR THE EVENTS.)ALSO CPR, ACLS, PALS, NALS, SAFE SITTER COURSE, LET'S NOT MEET BY ACCIDENT DRILL, YEARLY 5K AND FAMILY WELLNESS DAY. THE LET'S NOT MEET BY ACCIDENT DRILL HAD ABOUT 50 ATTENDEES. THERE WAS NO REVENUE FOR THIS. THE EXPENSES INCURRED WERE STAFF TIME, SPACE AND FOOD AND BEVERAGES. THE STAFF INCLUDED CHERY'L O'BRIEN, STEVE KARLBERG, DON BURLINGAME, AMY ROBINSON AND MICHELE CATLIN. THE FAMILY WELLNESS DAY GARNERED NO REVENUE. ABOUT 250 PEOPLE ATTENDED THE EVENT. EXPENSES FOR THE EVENT WERE $2500. STAFF VOLUNTEERED THEIR TIME. |
| PART III, LINE 4: | PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL AND CORPORATION ANALYZE PAST PAYMENT HISTORY AND IDENTIFY TRENDS FOR EACH MAJOR PAYOR SOURCE OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL AND CORPORATION ANALYZE CONTRACTUALLY DUE AMOUNTS AND PROVIDE AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS AND FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE HOSPITAL AND CORPORATION ALSO ANALYZE AMOUNTS DUE AND PROVIDE AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE BASED ON PAST EXPERIENCE, INCLUDING CONSIDERATION OF CURRENT BUSINESS AND ECONOMIC CONDITIONS. WHEN THE HOSPITAL AND CORPORATION ESTABLISH THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BOTH TAKE INTO CONSIDERATION THE FACT THAT MANY SELF-PAY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.THE HOSPITAL'S AND CORPORATION'S ALLOWANCE FOR DOUBTFUL ACCOUNTS WAS 13.4% AND 11.8% OF THE RELATED PATIENT ACCOUNTS RECEIVABLE, NET OF CONTRACTUAL ALLOWANCES AT DECEMBER 31, 2013 AND 2012, RESPECTIVELY. THIS INCREASE RELATES TO NEGATIVE TRENDS EXPERIENCED IN THE COLLECTION OF AMOUNTS FROM SELF-PAY PATIENTS IN RECENT YEARS AS A RESULT OF UNSTABLE ECONOMIC CONDITIONS. |
| PART III, LINE 8: | THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNT OF MEDICARE ALLOWABLE COSTS IS A COST-TO- CHARGE RATIO. |
| PART III, LINE 9B: | CLAXTON- HEPBURN MEDICAL CENTER WILL PROVIDE CHARITY CARE TO PATIENTS WHO HAVE BEEN ESTABLISHED AS HAVING INADEQUATE MEANS TO PAY FOR MEDICAL SERVICES. THE IDENTIFICATION OF INADEQUATE MEANS WILL BE BASED ON CRITERIA ESTABLISHED BY PATIENT FINANCIAL SERVICES AND APPROVED BY ADMINISTRATION. |
| PART VI, LINE 2: | CLAXTON-HEPBURN USES A VARIETY OF RESOURCES TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. WE USE LOCAL PUBLIC HEALTH DATA, NATIONAL RANKINGS DATA, AS WELL AS DATA FROM THE NEW YORK STATE DEPARTMENT OF HEALTH AND THE NEW YORK STATE HOSPITAL ASSOCIATION AND A RECENT COMMUNITY NEEDS ASSESSMENT. WE ALSO GATHER DATA ON OUR OWN THROUGH SURVEYS AND QUESTIONNAIRES UTILIZED AT COMMUNITY EVENTS THAT WE ATTEND. WE WORK WITH THE LOCAL HEALTH INITIATIVE AND COUNTY PUBLIC HEALTH TO ASSESS COMMUNITY HEALTH NEEDS. |
| PART VI, LINE 3: | ALL PATIENTS WITH SELF PAY BALANCES OVER $500.00 RECEIVE A LETTER FROM THE PATIENT FINANCIAL SERVICES DEPARTMENT. THE LETTER INCLUDES INFORMATION REGARDING THE CHARITY CARE PROGRAM. PATIENT FINANCIAL SERVICES STAFF VERBALLY COMMUNICATE WITH PATIENTS ABOUT CHARITY CARE AS THEY WORK ACCOUNTS. HEALTH CENTERS AND OTHER INTAKE AREAS HAVE CHARITY CARE INFORMATIONAL SHEETS TO HANDOUT TO PATIENTS IN NEED. ALL SELF PAY INPATIENTS ARE REFERRED TO AHC TO BE SCREENED FOR MEDICAID. SOCIAL WORKERS IN RENAL AND CANCER CARE SERVICES WORK CLOSELY WITH THE PATIENT FINANCIAL SERVICES STAFF WHEN SELF PAY PATIENTS ARE IN NEED OF SERVICES. |
| PART VI, LINE 4: | CLAXTON-HEPBURN MEDICAL CENTER IS A PRIVATE, NOT-FOR-PROFIT, 130-BED COMMUNITY HOSPITAL AND REGIONAL REFERRAL CENTER. CLAXTON-HEPBURN INCLUDES 67 ACUTE CARE BEDS, A 10-BED INTENSIVE CARE UNIT, A 10-BED BIRTHING CENTER, A 28-BED MENTAL HEALTH CENTER, AND A 15-BED ACUTE REHABILITATION UNIT. THE MEDICAL CENTER PROVIDES PRIMARY CARE TO NEARLY 40,000 RESIDENTS OF OGDENSBURG AND SURROUNDING COMMUNITIES, AND REGIONAL SERVICES TO THE 110,000 PEOPLE OF ST. LAWRENCE COUNTY. CHMC HAS AN ACTIVE MEDICAL STAFF OF MORE THAN 50 PHYSICIANS REPRESENTING MOST SPECIALTIES. REGIONAL AND COUNTY-WIDE SERVICES INCLUDE SIX AREA HEALTH CENTERS, RADIATION AND MEDICAL ONCOLOGY PROVIDED BY THE RICHARD E. WINTER CANCER CENTER, DIALYSIS TREATMENT PROVIDED BY THE DR. RAVINDER N. AGARWAL RENAL CENTER, THE REV. THOMAS T. PATTERSON WOUND HEALING CENTER, AND A STATE-OFTHE-ART DIAGNOSTIC IMAGING DEPARTMENT.OVERALL, THE PERCENT CHANGE IN POPULATION IN ST. LAWRENCE COUNTY HAS REMAINED FAIRLY STATIC AS COMPARED TO PERCENT POPULATION CHANGE IN NEW YORK STATE AS A WHOLE. THE VERY LARGE PERCENT OF POPULATION CHANGE IN 2010 SHOWS A DECREASE IN POPULATION WITHIN ST. LAWRENCE COUNTY FROM 1990 TO 2000. POPULATIONS IN MOST OF THE VILLAGES AND CITIES DECREASED BETWEEN 1990 AND 2000, WITH ONLY THE VILLAGES OF HAMMOND, HEUVELTON, AND RENSSELAER FALLS INCREASING IN POPULATION. THE TOWNS, WITH THEIR MORE RURAL AREAS HOWEVER, HAVE MOSTLY GROWN SINCE THE TIME OF THE LAST CENSUS. ONLY THE TOWNS OF CANTON, CLIFTON, FINE, MASSENA, AND POTSDAM HAVE DECREASED IN SIZE.THE COMMUNITY NEEDS ASSESSMENT SHOWED THAT POVERTY IS PREVALENT IN ST. LAWRENCE COUNTY. THE COUNTY'S POVERTY RATE IS 17.8% MAKING IT 3.6% HIGHER THAN THE STATE RATE AND 2.5% HIGHER THAN THE FEDERAL RATE. THE POVERTY RATE FOR CHILDREN IS 22.9% WHICH IS 2.7% ABOVE THE STATE RATE AND 1.3% ABOVE THE FEDERAL RATE. STUDIES HAVE SHOWN THAT POVERTY IS THE SINGLE MOST POWERFUL PREDICTOR OF POOR HEALTH AMONG CHILDREN AND THAT POVERTY IS ASSOCIATED WITH POOR NUTRITION, SUBSTANDARD HOUSING, DISRUPTIVE SOCIAL ENVIRONMENT AND LACK OF HEALTH INFORMATION. POOR CHILDREN ARE MORE APT TO BECOME ILL, SUFFER ADVERSE CONSEQUENCES FROM ILLNESS AND DIE THAN CHILDREN WITH GREATER ECONOMIC RESOURCES. |
| PART VI, LINE 5: | WE HAVE AN OPEN MEDICAL STAFF, AN ACTIVE VOLUNTEER BOARD OF DIRECTORS, AND PROVIDE A VARIETY OF FREE HEALTH SCREENINGS AT HEALTH FAIRS, IN THE COMMUNITY AND AT THE MEDICAL CENTER. THEY ARE PROMOTED IN PRINT ADVERTISING AND NEW RELEASES. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | NY |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| 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 (11 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MICHAEL SEIDMAN MD | ||||||||||||||
| DIRECTOR | $267,588 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $18,441 | $0 | $286,029 | $0 | $0 | $0 |
| MARK WEBSTER | ||||||||||||||
| PRESIDENT/EXECUTIVE OFFICE | $340,396 | $0 | $36,092 | $0 | $0 | $0 | $12,750 | $0 | $15,515 | $0 | $404,753 | $0 | $0 | $0 |
| KELLEY TIERNAN | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $196,621 | $0 | $6,440 | $0 | $0 | $0 | $10,402 | $0 | $15,098 | $0 | $228,561 | $0 | $0 | $0 |
| DAVID FERRIS | ||||||||||||||
| VP OF NURSING | $162,791 | $0 | $6,272 | $0 | $0 | $0 | $5,217 | $0 | $15,000 | $0 | $189,280 | $0 | $0 | $0 |
| GARY HART | ||||||||||||||
| CHIEF MEDICAL OFFICER | $259,002 | $0 | $12,875 | $0 | $0 | $0 | $12,750 | $0 | $15,279 | $0 | $299,906 | $0 | $0 | $0 |
| VICKI PERRINE | ||||||||||||||
| CHIEF OPERATING OFFICER | $182,670 | $0 | $7,763 | $0 | $0 | $0 | $9,550 | $0 | $8,972 | $0 | $208,955 | $0 | $0 | $0 |
| JOHN GERBERT MD | ||||||||||||||
| PHYSICIAN | $856,345 | $0 | $0 | $0 | $0 | $0 | $7,650 | $0 | $10,925 | $0 | $874,920 | $0 | $0 | $0 |
| THOMAS HERZOG MD | ||||||||||||||
| PHYSICIAN | $578,412 | $0 | $75,000 | $0 | $0 | $0 | $7,650 | $0 | $16,206 | $0 | $677,268 | $0 | $0 | $0 |
| JUAN-DIEGO HARRIS MD | ||||||||||||||
| PHYSICIAN | $446,386 | $0 | $175,000 | $0 | $0 | $0 | $12,750 | $0 | $15,823 | $0 | $649,959 | $0 | $0 | $0 |
| GEETANJLI SANGWAN MD | ||||||||||||||
| PHYSICIAN | $285,334 | $0 | $72,877 | $0 | $0 | $0 | $12,750 | $0 | $9,269 | $0 | $380,230 | $0 | $0 | $0 |
| LUCILLE ALSTON MD | ||||||||||||||
| PHYSICIAN | $405,339 | $0 | $0 | $0 | $0 | $0 | $7,650 | $0 | $1,175 | $0 | $414,164 | $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 | ST LAWRENCE COUNTY INDUSTRIAL DEVELOPMENT AGENCY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 222757318 | BondIssuerEIN |
| CUSIP | 791097EJ3 | CUSIPNum |
| Bond Issued | 2006-10-11 | BondIssuedDt |
| Issue Price | $20,000,000 | IssuePriceAmt |
| Purpose | REFINANCE 1999 BONDS AND FUND HOSPITAL IMPROVEMENTS AND EQUIPMENT | 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 | $10,908,009 | RetiredAmt |
| Total Proceeds | $20,180,750 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $272,741 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $9,000,000 | CapitalExpendituresAmt |
| Substantial Completion | 2006 | SubstantialCompletionYr |
| Current Refunding | 0 | 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 | 0 | 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 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LINDA FAY | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | BOARD MEMBER | RelationshipDescriptionTxt |
| Transaction | $173,152 | TransactionAmt |
| Transaction | LINDA FAY IS A BOARD MEMBER AND THE HOSPITAL RENTS A CLINIC FROM HER HUSBAND IN CANTON, NY. | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | CLAXTON-HEPBURN HEALTH SYSTEMS, INC., A NOT-FOR-PROFIT HOLDING COMPANY, IS THE SOLE CORPORATE MEMBER OF THE HOSPITAL. |
| FORM 990, PART VI, SECTION A, LINE 7A | CLAXTON-HEPBURN HEALTH SYSTEM ELECTS THE MEMBERS OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION A, LINE 7B | DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO THE APPROVAL OF CLAXTON-HEPBURN HEALTH SYSTEM. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 WAS PROVIDED TO CLAXTON-HEPBURN MEDICAL CENTER'S BOARD FOR REVIEW BEFORE FILING THE FORM. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD OF DIRECTORS CONTRACTS WITH YAFFE AND COMPANY TO WORK WITH THE EXECUTIVE COMMITTEE TO ENSURE COMPLIANCE WITH IRC 4958 AND CONFLICT OF INTEREST DISCLOSURE, AND MAINTAINS MINUTES OF MEETINGS. BOARD MEMBERS DISCLOSE CONFLICTS OF INTEREST ANNUALLY IN WRITING, AFTER REVIEWING THE CORPORATE POLICY. THESE CONFLICTS ARE REVIEWED BY THE FULL BOARD ANNUALLY AND KEPT ON FILE. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CHMC BOARD CONTRACTS WITH YAFFE AND COMPANY, AN INDEPENDENT SALARY COMPENSATION SPECIALIST TO ADVISE ON THE EXECUTIVE SALARY PROCESS AND PHILOSOPHY. YAFFE WORKS WITH THE EXECUTIVE COMMITTEE TO ASSIST THE COMMITTEE IN SETTING ANNUAL SALARIES AND BENEFITS FOR SENIOR LEADERSHIP. |
| FORM 990, PART VI, SECTION C, LINE 18 | CLAXTON-HEPBURN MEDICAL CENTER'S 990 IS AVAILABLE UPON WRITTEN REQUEST. |
| FORM 990, PART VI, SECTION C, LINE 19 | CLAXTON-HEPBURN MEDICAL CENTER'S GOVERNING DOCUMENTS, FINANCIAL STATEMENT AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | EQUITY IN CHANGE IN FOUNDATION - UNRESTRICTED ASSETS 350,323. PENSION AND POSTRETIREMENT RELATED CHANGES 11,601,294. EQUITY IN CHANGE IN FOUNDATION - TEMPORARILY RESTRICTED ASSETS 82,646. EQUITY IN CHANGE IN FOUNDATION - PERMANENTLY RESTRICTED ASSETS 85,574. EQUITY TRANSFER TO THE FOUNDATION -119,300. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 599,138. CHANGE IN UNREALIZED GAINS/LOSSES 74,378. EQUITY IN CHANGE IN NORTHERN LIGHTS - PERMANENTLY RESTRICTED ASSETS -178,237. |
| FORM 990, PART XII, LINE 2C | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| CLAXTON-HEPBURN HEALTH SYSTEMS INC | |||||||||||
| 214 KING STREET | OGDENSBURG | NY | 13669 | 161449491 | PARENT HOLDING COMPANY FOR CLAXTON-HEPBURN MEDICAL CENTER | NY | 501(C)(3) | 509(A)(3) | N/A | 0 | |
| CLAXTON-HEPBURN MEDICAL CENTER FOUNDATION INC | |||||||||||
| 503 MANSION AVENUE | OGDENSBURG | NY | 13669 | 222488389 | TO CONDUCT FUND RAISING ACTIVITIES TO SUPPORT CLAXTON-HEPBURN MEDICAL CENTER | NY | 501(C)(3) | 509(A)(3) | 0 | CLAXTON-HEPBURN HEALTH SYSTEMS INC | |
| CLAXTON MEDICAL PC | |||||||||||
| 214 KING STREET | OGDENSBURG | NY | 13669 | 264009395 | ATTRACTING AND RETAINING SPECIALIZED MEDICAL PRACTITIONERS | NY | 501(C)(3) | 509(A)(3) | 0 | CLAXTON-HEPBURN MEDICAL CENTER | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST LAWRENCE HEALTH ALLIANCE INC | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3 LYON PLACE | AddressLine1 |
| City | OGDENSBURG | City |
| State | NY | State |
| ZIP Code | 13669 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 161489843 | EIN |
| Primary Activities | MANAGEMENT SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | NY | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLAXTON-HEPBURN HEALTH SYSTEMS INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | -$5,577 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $1,452,634 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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