LITTLE FALLS HOSPITAL: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- LITTLE FALLS HOSPITAL (EIN 15-0533578)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-15
- IRS object ID
- 201313199349306926
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-15T13:42:55-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 161226221 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FUST CHARLES CHAMBERS LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| 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 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 150533578 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LITTLE FALLS HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | LITT | NameControl |
| Phone | 3158231000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 140 BURWELL STREET | AddressLine1 |
| City | LITTLE FALLS | City |
| State | NY | State |
| ZIP Code | 13365 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JAMES VIELKIND | Name |
| Title | CFO | Title |
| Phone | 3158231000 | Phone |
| Date Signed | 2013-11-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOSEPH J SCHLEGEL | Name |
| PTIN | P00301329 | PTIN |
| Phone | 3154463600 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JAMES VIELKIND | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 140 BURWELL STREET | AddressLine1 |
| City | LITTLE FALLS | City |
| State | NY | State |
| ZIP Code | 13365 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 33524695 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | LFHNY.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1893 | YearFormation |
| State Legal Domicile | NY | StateLegalDomicile |
| Activity Or Mission Description | LITTLE FALLS HOSPITAL IS A CRITICAL ACCESS HOSPITAL PROVIDING ACCESS TO HEALTH CARE SERVCIES TO RESIDENTS OF HERKIMER COUNTY, AND WESTERN PORTIONS OF MONTGOMERY AND FULTON COUNTIES. LITTLE FALLS HOSPITAL EMERGENCY DEPARTMENT IS STAFFED WITH PHYSICIANS ON A 24/7 BASIS. TWENTY FIVE BEDS ARE USED FOR INPATIENT AND SKILLED NURSING CARE. AMBULATORY SURGERY SERVCIES ARE PROVIDED FOR A VARIETY OF SPECIALTIES, PERFORMANCE IMPROVEMENT AND HIGH QUALITY OF CARE IS DEMOSTRATED WITHIN THE HOSPITAL CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (HCAHPS) AS REPORTED IN HOSPITAL COMPARE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 16 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 13 | NbrIndependentVotingMembers |
| Total Nbr Employees | 347 | TotalNbrEmployees |
| Total Nbr Volunteers | 17 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 856607 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 589094 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 26972536 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 28142900 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 196800 | InvestmentIncomePriorYear |
| Investment Income Current Year | 61421 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 28025943 | TotalRevenuePriorYear |
| Total Revenue Current Year | 28793415 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 13528783 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 14326208 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 9250 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 9250 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 76723 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 13425422 | OtherExpensePriorYear |
| Other Expenses Current Year | 14047264 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 26963455 | TotalExpensesPriorYear |
| Total Expenses Current Year | 28382722 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1062488 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 410693 | RevenuesLessExpensesCY |
| Total Assets BOY | 30895128 | TotalAssetsBOY |
| Total Assets EOY | 34802499 | TotalAssetsEOY |
| Total Liabilities BOY | 13134431 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 15228007 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 17760697 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 19574492 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | LITTLE FALLS HOSPITAL IS A VOLUNTARY, NOT-FOR-PROFIT COMMUNITY HEALTHCARE SYSTEM WHOSE MISSION IS TO OFFER QUALITY CARE WITH COMPASSION, TO ALL WHO NEED OUR SERVICES. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 7634171 | Expense |
| Revenue | 8546300 | Revenue |
| Description | INPATIENT SERVICESLITTLE FALLS HOSPITAL INPATIENT SERVICES WERE ACTIVE IN PLANNING FOR THE FEBRAURY 2013 "GO LIVE" OF PROVIDER ORDER ENTRY ALONG WITH A COMPLETE INTEGRATED ELECTRONIC MEDICAL RECORD. A NEW PHARMACY DISPENSING PROCEDURE WAS IMPLEMENTED TO REDUCE POTENTIAL FOR MEDICATION ERRORS. THE HOSPITAL IMPROVED ITS PATIENT HOSPITAL CONSUMER ASSESSMENT RATING TO 75 FROM 62 FOR A PEER GROUP PERCENTILE RANKING OF 95. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 7066656 | Expense |
| Revenue | 8254568 | Revenue |
| Description | LITTLE FALLS HOSPITAL OPERATES AN EMERGENCY DEPARTMENT WITH TWENTY FOUR HOURS OF PHYSICIAN COVERAGE SEVEN DAYS PER WEEK. THE EMERGENCY DEPARTMENT PROVIDED ACCESS TO CARE FOR APPROXIMATELY 16,000 PATIENTS IN 2012. THESE SERVCIES ARE PROVIDED TO ALL PATIENTS REGARDLESS OF ABILITY TO PAY. PLANNING FOR THE ELECTRONIC MEDICAL RECORD AND PROVIDER ELECTRONIC ORDER ENTRY WAS A LARGE PROJECT AHEAD OF THE FEBRUARY 2013 SYSTEM "GO LIVE" DATE. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 8707080 | Expense |
| Revenue | 10776927 | Revenue |
| Description | TOTAL AMBULATORY OUTPATIENT VISITS WERE APPROXIMATELY 34,000 VISITS IN 2012. AN AMBULATORY FACILITY PROJECT WAS INITIATED TO IMPROVE PATIENT PRIVACY, UPDATE INFRASTRUCTURE, AND LOCATE SERVICES IN MORE EFFICIENT AREAS OF THE HOSPITAL. THIS PROJECT WILL BE COMPLETED IN 2013 WITH A TOTAL COST OF APPROXIMATELY $12M. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 736780 | Expense |
| Revenue | 1215620 | Revenue |
| Description | THE HOSPITAL RECEIVED NYS MEDICAID "MEANINGFUL USE" FUNDS OF $186,000. THESE FUNDS WERE USED TO ASSIST IN FUNDING FOR THE IMPLEMENTATION OF THE ELECTRONIC MEDICAL REORD. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 736780 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Rev | 1215620 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 24144687 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 1 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 33 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 347 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 16 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 13 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NY | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JAMES G VIELKIND | NamePerson |
| Telephone Number | 3158235281 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 140 BURWELL STREET | AddressLine1 |
| City | LITTLE FALLS | City |
| State | NY | State |
| ZIP Code | 13365 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| JOHN BULLIS | ||||||||
| CHAIRMAN | 2.00 | 1.50 | X | 0 | 0 | 0 | ||
| JOAN S CONBOY | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| TIMOTHY DALY | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| ANTHONY DELUCA | ||||||||
| FIRST VICE CHAIRMAN | 2.00 | X | 0 | 0 | 0 | X | ||
| JOY MALONE | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| MARSHA MASON | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| GERARD J SNYDER | ||||||||
| SECRETARY | 2.00 | X | 0 | 0 | 0 | X | ||
| JENNIFER VANWAGONER | ||||||||
| SECOND VICE CHAIRMAN | 2.00 | X | 0 | 0 | 0 | X | ||
| RANBIR SODHI MD | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| AUGUST LEINHART MD | ||||||||
| TRUSTEE | 2.00 | 40.00 | X | 0 | 473320 | 24803 | ||
| NICHOLAS J NICOLETTA | ||||||||
| TREASURER | 2.00 | 51.50 | X | 0 | 483575 | 26532 | X | |
| JEFFREY WOEPPEL | ||||||||
| THIRD VICE CHAIRMAN | 2.00 | 48.00 | X | 0 | 197600 | 22077 | X | |
| KEVIN CROSLEY | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| JUSTIN HUMMEL | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| DALE ADAMSON MD | ||||||||
| PRESIDENT OF MEDICAL STAFF | 2.00 | 40.00 | X | 0 | 168059 | 14060 | ||
| ROBERT CASULLO | ||||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | |||
| MICHAEL OGDEN | ||||||||
| PRESIDENT & CEO | 40.00 | 0 | 153288 | 8331 | X | |||
| JAMES G VIELKIND | ||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | 130598 | 0 | 4136 | X | |||
| RICHARD NOCELLA | ||||||||
| PRIMARY CARE PHYSICIAN | 40.00 | 157236 | 0 | 13968 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 287834 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1475842 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 113907 | TotalOtherCompensation |
| Number Individuals GT100 K | 6 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| BIVENS & ASSOCIATES ARCHITECTS | |||||
| 528 PLUM STREET SUITE 200 | SYRACUSE | NY | 132041473 | ARCHITECT SERVICES | 385731 |
| TWO BROTHERS CONTRACTING | |||||
| 185 MOHAWK STREET | WHITESBORO | NY | 13501 | CONTRACTOR SERVICES | 225092 |
| MEDSPAR LLC | |||||
| PO BOX 830 | BINGHAMTON | NY | 139020830 | BILLING SERVICES | 136533 |
| FUST CHARLES CHAMBERS | |||||
| 5784 WIDEWATER PARKWAY | SYRACUSE | NY | 13214 | AUDITING, TAX AND CONSULTING SERVICES | 133892 |
| DM CONSULTING | |||||
| PO BOX 4715 | UTICA | NY | 13504 | INFORMATION TECHNOLOGY | 114400 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| Related Organizations | 342293 | RelatedOrganizations |
| Government Grants | 246801 | GovernmentGrants |
| Total Contributions | 589094 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| OUTPATIENT SERVICES | 623000 | 19031495 | 19031495 |
| INPATIENT HOSPITAL | 621930 | 8546300 | 8546300 |
| PROGRAM SERVICE LEASE | 532000 | 433377 | 433377 |
| HOSPITAL CAFETERIA | 900099 | 124344 | 124344 |
| OTHER OPERATING REVENUE | 900099 | 7384 | 7384 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 28142900 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 66754 | TotalRevenueColumn |
| Related Or Exempt Function Income | 66754 | RelatedOrExemptFunctionIncome |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 4725947 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 4731280 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -5333 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -5333 | TotalRevenueColumn |
| Related Or Exempt Function Income | -5333 | RelatedOrExemptFunctionIncome |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 28793415 | TotalRevenueColumn |
| Related Or Exempt Function Income | 28204321 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 305938 | Total |
| Program Services | 171204 | ProgramServices |
| Management And General | 134734 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10873332 | Total |
| Program Services | 9336805 | ProgramServices |
| Management And General | 1488718 | ManagementAndGeneral |
| Fundraising | 47809 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 805378 | Total |
| Program Services | 688104 | ProgramServices |
| Management And General | 113799 | ManagementAndGeneral |
| Fundraising | 3475 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1521774 | Total |
| Program Services | 1292625 | ProgramServices |
| Management And General | 222571 | ManagementAndGeneral |
| Fundraising | 6578 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 819786 | Total |
| Program Services | 697143 | ProgramServices |
| Management And General | 119126 | ManagementAndGeneral |
| Fundraising | 3517 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 70798 | Total |
| Management And General | 70798 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 43250 | Total |
| Program Services | 12145 | ProgramServices |
| Management And General | 31105 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 56272 | Total |
| Management And General | 56272 | ManagementAndGeneral |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9250 | Total |
| Fundraising | 9250 | Fundraising |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 687329 | Total |
| Program Services | 459988 | ProgramServices |
| Management And General | 227341 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2229070 | Total |
| Program Services | 2174173 | ProgramServices |
| Management And General | 53178 | ManagementAndGeneral |
| Fundraising | 1719 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 795538 | Total |
| Program Services | 638333 | ProgramServices |
| Management And General | 157205 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 648192 | Total |
| Program Services | 563576 | ProgramServices |
| Management And General | 83988 | ManagementAndGeneral |
| Fundraising | 628 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 31072 | Total |
| Program Services | 20333 | ProgramServices |
| Management And General | 10173 | ManagementAndGeneral |
| Fundraising | 566 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 32678 | Total |
| Program Services | 15756 | ProgramServices |
| Management And General | 16189 | ManagementAndGeneral |
| Fundraising | 733 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 152296 | Total |
| Program Services | 133426 | ProgramServices |
| Management And General | 18850 | ManagementAndGeneral |
| Fundraising | 20 | Fundraising |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1374845 | Total |
| Program Services | 1204502 | ProgramServices |
| Management And General | 170161 | ManagementAndGeneral |
| Fundraising | 182 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 240104 | Total |
| Program Services | 197290 | ProgramServices |
| Management And General | 42814 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| PURCHASED MEDICAL SERVI | 3730570 | 3730570 | |
| PROVISION FOR BAD DEBT | 2277927 | 2277927 | |
| ADMINISTRATIVE SERVICES | 915028 | 915028 | |
| NEW YORK STATE ASSESSME | 76843 | 76843 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 685452 | Total |
| Program Services | 453944 | ProgramServices |
| Management And General | 229262 | ManagementAndGeneral |
| Fundraising | 2246 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28382722 | Total |
| Program Services | 24144687 | ProgramServices |
| Management And General | 4161312 | ManagementAndGeneral |
| Fundraising | 76723 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 348968 | BOY |
| EOY | 1265667 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1039532 | BOY |
| EOY | 1146049 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5437347 | BOY |
| EOY | 4009271 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3484074 | BOY |
| EOY | 3044932 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 382900 | BOY |
| EOY | 394976 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1215888 | BOY |
| EOY | 1607890 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 30562757 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 17302903 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8962981 | BOY |
| EOY | 13259854 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1915088 | BOY |
| EOY | 4883639 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5478882 | BOY |
| EOY | 2429906 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2455626 | BOY |
| EOY | 2299567 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 173842 | BOY |
| EOY | 460748 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30895128 | BOY |
| EOY | 34802499 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3217283 | BOY |
| EOY | 4192044 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 39912 | BOY |
| EOY | 31431 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3937377 | BOY |
| EOY | 5119529 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5939859 | BOY |
| EOY | 5885003 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13134431 | BOY |
| EOY | 15228007 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5007384 | BOY |
| EOY | 9475082 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12028938 | BOY |
| EOY | 9327867 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 724375 | BOY |
| EOY | 771543 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17760697 | BOY |
| EOY | 19574492 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30895128 | BOY |
| EOY | 34802499 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 410693 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 268663 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 1134439 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 12753313 | BeginningOfYearBalance |
| Contributions | 12870 | Contributions |
| Investment Earnings Or Losses | 1085526 | InvestmentEarningsOrLosses |
| Other Expenditures | 3752299 | OtherExpenditures |
| End Of Year Balance | 10099410 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 12156996 | BeginningOfYearBalance |
| Contributions | 623347 | Contributions |
| Investment Earnings Or Losses | -27030 | InvestmentEarningsOrLosses |
| End Of Year Balance | 12753313 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 5547082 | BeginningOfYearBalance |
| Contributions | 5230555 | Contributions |
| Investment Earnings Or Losses | 1782439 | InvestmentEarningsOrLosses |
| Other Expenditures | 403080 | OtherExpenditures |
| End Of Year Balance | 12156996 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 2664349 | BeginningOfYearBalance |
| Contributions | 174329 | Contributions |
| Investment Earnings Or Losses | 3874661 | InvestmentEarningsOrLosses |
| Other Expenditures | 1166257 | OtherExpenditures |
| End Of Year Balance | 5547082 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 4951188 | BeginningOfYearBalance |
| Contributions | 327877 | Contributions |
| Investment Earnings Or Losses | -202282 | InvestmentEarningsOrLosses |
| Other Expenditures | 2412434 | OtherExpenditures |
| End Of Year Balance | 2664349 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 0.07640 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.92360 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 1 | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | 1 | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 339702 | InvestmentCostOrOtherBasis |
| Book Value | 339702 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 20429734 | InvestmentCostOrOtherBasis |
| Depreciation | 10075440 | Depreciation |
| Book Value | 10354294 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 9793321 | InvestmentCostOrOtherBasis |
| Depreciation | 7227463 | Depreciation |
| Book Value | 2565858 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 13259854 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (2 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| MARY LEARY CHARITABLE REMAINDER TR | 1003779 | F |
| ELSA O'BRIEN CHARITABLE REMAINER TR | 1426127 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 2429906 | TotalOfBookValueSecurities |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DIRECT FINANCE LEASE | Description |
| Book Value | 2299567 | BookValue |
| Method Of Valuation | C | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Program Related | 2299567 | TotalOfBookValueProgramRelated |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ACCRUED PENSION LIABILITY | $4,906,176 |
| ACCRUED SALARIES, PAYROLL TAXES AND FRINGE BENEFITS | $903,827 |
| OTHER LIABILITIES | $75,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 5885003 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 30196517 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 268663 | NetUnrealizedGainsInvestments |
| Other Revenues | 1134439 | OtherRevenues |
| Revenue Not Rptd F990 | 1403102 | RevenueNotRptdF990 |
| Revenue Subtotal | 28793415 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 28793415 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 26104795 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 26104795 | ExpensesSubtotal |
| Other Expenses Not Included | 2277927 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 2277927 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 28382722 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | ENDOWMENT FUNDS DISTRIBUTE INCOME FOR PURPOSES OF CAPITAL INVESTMENT. TEMPORARY ENDOWMENTS ARE USED BASED ON THE INTENT OF THE DONATION. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X, LINE 2: | THE HOSPITAL QUALIFIES AS AN ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. AS OF DECEMBER 31, 2012 AND 2011, 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 2009 THROUGH 2012. THE HOSPITAL DOES NOT ANTICIPATE THAT THE TOTAL UNRECOGNIZED TAX BENEFITS WILL CHANGE IN THE NEXT TWELVE MONTHS. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | PENSION RELATED CHANGES OTHER THAN NET PERIODIC BENEFIT COST 111,805. CHANGES IN VALUE OF BENEFICIAL REMAINDER TRUST 464,163. CHANGE IN INTEREST IN NET ASSETS OF FRIENDS OF BASSETT 558,471. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBTS 2,277,927. | |
| BUILDINGS INCLUDES CONSTRUCTION IN PROGRESS OF $5,696,846 FOR 2012 AND $1,115,093 FOR 2011 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 300.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCare |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 252 | PersonsServed |
| Total Community Benefit Expense | 149983 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 121248 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 28735 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1622 | PersonsServed |
| Total Community Benefit Expense | 888572 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 850535 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 38037 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00150 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 10990 | PersonsServed |
| Total Community Benefit Expense | 3994820 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3018815 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 976005 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03740 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 12864 | PersonsServed |
| Total Community Benefit Expense | 5033375 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3990598 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1042777 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04000 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Total Community Benefit Expense | 78284 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2883 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 75401 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00290 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Total Community Benefit Expense | 78284 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2883 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 75401 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00290 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 12864 | PersonsServed |
| Total Community Benefit Expense | 5111659 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3993481 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1118178 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04290 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $838,868 | BadDebtExpenseAmount |
| Amount Attributable To | 35883 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 9288741 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 9196773 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 91968 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LITTLE FALLS HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 140 BURWELL STREET | AddressLine1 |
| City | LITTLE FALLS | City |
| State | NY | State |
| ZIP Code | 13365 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
| Other | INCLUDES 25 INPATIENT BEDS, | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LITTLE FALLS HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 300.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 0 | UsesFPGDiscounted |
| Explains Basis | 1 | ExplainsBasis |
| Other Factors | X | OtherFactors |
| Explains Application Method | 0 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 3C: LITTLE FALLS HOSPITAL DID NOT PROVIDE CHARITY CARE OR DISCOUNTED CARE TO PATIENTS WITH INSURANCE BENEFITS. | ||
| PART I, LINE 7: COST FOR CHARITY CARE PATIENTS WAS CALCULATED USING RATIO OF COST TO CHARGES. COST ASSOCIATED WITH MEDICAID AND MEDICAID HMO PROGRAMS REPRESENTS AGGREGATE ALLOWABLE COST AND TOTAL GROSS CHARGES USED TO CALCULATE A FACILITY LEVEL COST TO CHARGE RATIO. THIS FACILITY LEVEL COST TO CHARGE RATIO WAS APPLIED TO TOTAL MEDICAID AND MEDICAID HMO CHARGES TO ARRIVE AT TOTAL MEDICAID COST. COST OF OTHER MEANS TESTED PROGRAMS IS COMPRISED OF MEDICAID HMO AND NYS FAMILY HEALTH PLUS INSURANCE PROGRAMS. | ||
| PART I, LINE 7G: LITTLE FALLS HOSPITAL DOES NOT PROVIDE DISCOUNTED CARE FOR PATIENTS WITH INSURANCE. HARDSHIP CASES ARE REVIEWED ON AN INDIVIDUAL BASIS. | ||
| PART I, L7 COL(F): LITTLE FALLS HOSPITAL REMOVED $2,277,927 OF BAD DEBT EXPENSE TO CALCULATE COST OF PATIENT CARE. | ||
| PART III, LINE 4: 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 THAT PROVIDE FOR PAYMENTS AT AMOUNTS DIFFERENT FROM THEIR ESTABLISHED RATES. PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, COST-BASED REIMBURSEMENT, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. THE HOSPITAL RECOGNIZES PATIENT SERVICE REVENUE ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE ON THE BASIS OF CONTRACTUAL RATES FOR THE 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.FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE HOSPITAL RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES PROVIDED OR ON THE BASIS OF NEGOTIATED DISCOUNTED RATES. ON A BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE HOSPITAL'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. REVENUE FROM THE MEDICARE AND MEDICAID PROGRAMS, INCLUDING THE HMO PROGRAMS OFFERED BY THESE PAYORS, ACCOUNTED FOR APPROXIMATELY 55% AND 59% OF THE HOSPITAL'S NET PATIENT SERVICE REVENUE FOR THE YEARS 2012 AND 2011, RESPECTIVELY. LAWS AND REGULATIONS GOVERNING THE MEDICARE AND MEDICAID PROGRAMS ARE EXTREMELY COMPLEX AND SUBJECT TO INTERPRETATION. AS A RESULT, THERE IS AT LEAST A REASONABLE POSSIBILITY THAT RECORDED ESTIMATES WILL CHANGE BY A MATERIAL AMOUNT IN THE NEAR TERM. IN 2012 AND 2011, NET PATIENT SERVICE REVENUE INCREASED (DECREASED) BY APPROXIMATELY $101,000 AND $(150,000), RESPECTIVELY, RELATED TO EITHER SETTLEMENT OF PRIOR YEAR ISSUES OR CHANGES IN ESTIMATES ASSOCIATED WITH THIRD-PARTY ISSUES. THE HOSPITAL GRANTS UNSECURED CREDIT TO ITS PATIENTS, MOST OF WHOM ARE LOCAL RESIDENTS AND ARE INSURED UNDER THIRD-PARTY PAYOR AGREEMENTS. THE MIX OF RECEIVABLES FROM PATIENTS AND THIRD-PARTY PAYORS AT DECEMBER 31 WAS AS FOLLOWS: 2012 2011MEDICARE 45% 43%MEDICAID 10% 13%PRIVATE PAYORS 16% 11%INSURANCE AND ALL OTHERS 29% 33% 100% 100%PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS WAS 31% AND 25% OF THE RELATED PATIENT ACCOUNTS RECEIVABLE, NET OF CONTRACTUAL ALLOWANCES AT DECEMBER 31, 2012 AND 2011, RESPECTIVELY. THIS INCREASE PRIMARILY RELATES TO NEGATIVE TRENDS EXPERIENCED IN THE COLLECTION OF AMOUNTS FROM SELF-PAY RESIDENTS IN RECENT YEARS AS A RESULT OF UNSTABLE ECONOMIC CONDITIONS.LITTLE FALLS HOSPITAL INCURRED BAD DEBT EXPENSE OF $2,277,927 IN 2012 CONSISTING OF SERVICES UNPAID BY UNISURED AND UNDERINSURED PATIENTS. THE COSTING OF BAD DEBT EXPENSE REPRESENTS USING RCC PERCENTAGES BY PATIENT SERVICE TYPE AGAINST THE SAME SERVICE TYPES INCURRING BAD DEBTS. IN 2012 THE RCC PERCENTAGE WAS 37.57%. | ||
| PART III, LINE 8: LITTLE FALLS HOSPITAL COSTING METHODOLOGY CONSISTS OF INFORMATION FROM MEDICARE COST REPORT. AS A CRITICAL ACCESS HOSPITAL PAYMENT IS BASED ON 101 % OF MEDICARE ALLOWABLE COST. | ||
| PART III, LINE 9B: COLLECTION AND CHARITY CARE POLICY SPECIFY ACCOUNTS WITH ACTIVE CARE APPLICATIONS WILL NOT GO TO COLLECTION AGENCIES WHILE IN REVIEW. | ||
| PART V, SECTION A: LITTLE FALLS HOSPITAL HAS PRIMARY CARE CLINICS IN DOLGEVILLE, NY AND NEWPORT,NY. EXTENDED EVENING HOURS ARE PROVIDED ONE NIGHT PER WEEK IN THE DOLGEVILLE, NY PRIMARY CARE CENTER. | ||
| PART V, SECTION B, LINE 12H: LITTLE FALLS HOSPITAL CHARGES FOR SERVICES BASED ON RELATIONSHIPS OF COST OF SERVICES, AND AGGREGATE MARGINS REQUIRED FOR HEALTHCARE SERVICES. | LITTLE FALLS HOSPITAL | |
| PART V, SECTION B, LINE 14G: LITTLE FALLS HOSPITAL BILLING FORMS INCLUDE A STATEMENT TO INQUIRE ABOUT FINANCIAL ASSISTANCE WITH A PHONE NUMBER TO CALL. UNINSURED PATIENTS ARE MAILED AN APPLICATION FOR THEIR COMPLETION. | LITTLE FALLS HOSPITAL | |
| PART V, SECTION B, LINE 20D: LITTLE FALLS HOSPITAL CHARGES UNIFORM CHARGES TO ALL PAYERS REGARDLESS OF RESPONSIBLE PARTY FOR THE BILL. | LITTLE FALLS HOSPITAL | |
| PART VI, LINE 2: HEALTH CARE SERVICE NEEDS ARE ASSESSED ON A COLLABORATIVE BASIS BY BASSETT HEALTHCARE NETWORK AND LITTLE FALLS HOSPITAL TO ENSURE ACCESS TO SERVICES IN AN EFFICIENT DELIVERY OF CARE MODEL. IN 2012 BASSETT HEALTHCARE NETWORK UNDERTOOK A LOCALIZED DATA ANALYSIS OF SERVICE DEMAND MEASURED AGAINST THE RESOURCES AVAILABLE TO MEET THE DEMAND. THIS STUDY WILL SERVE AS ONE OF THE REPORTS FOR DEVELOPMENT OF THE COMMUNITY HEALTH NEEDS ASSESSMENT IN 2013, AND CONTINUAL REGIONAL PLANNING. WITH THIS COLLABORATIVE PROCESS, STAKEHOLDERS HAVE BEEN IDENTIFIED TO PROVIDE INTO FOR THE COMMUNITY HEALTH ASSESSMENT, AND RELATED PLANS FOR IMPLEMENTATION. PARTICIPANTS INCLUDED REPRESENTATIVES OF LOCAL HOSPITALS, HEALTH DEPARTMENTS, HUMAN SERVICE AGENCIES AND COMMUNITY ORGANIZATIONS. | ||
| PART VI, LINE 3: LITTLE FALLS HOSPITAL PROVIDES ACCESS AND EDUCATION ON THE COMMUNITY SERVICE PROGRAM WITH CONTACT INFORMATION FOR PATIENTS TO CALL TO HAVE ASSISTANCE IN COMPLETING THE APPLICATIONS. AT ALL PATIENT ACCESS POINTS WHERE SERVICES ARE PROVIDED APPLICATIONS ARE PROVIDED. IN ADDITION THE WEBSITE FOR LITTLE FALLS HOSPITAL INCLUDES INFORMATION ON THE COMMUNITY ASSISTANCE PROGRAM. IN 2012 THE NUMBER OF APPROVED VISITS FROM THE COMMUNITY SERVICE PROGRAM INCREASED BY 82 OR APPROXIMATELY A 50% INCREASE. | ||
| PART VI, LINE 4: LITTLE FALLS HOSPITAL SERVES AN ESTIMATED POPULATION OF OVER 54,000 PEOPLE IN 10 COMMUNITIES THROUGHOUT HERKIMER COUNTY AND SECTIONS OF FULTON AND MONTGOMERY COUNTIES. THE SERVICE AREA POPULATION IS COMPRISED OF INDIVIDUALS AND FAMILIES FROM ALL SOCIO-ECONOMIC AND EDUCATIONAL LEVELS. THE POPULATION IS 97 PERCENT WHITE, 51 PERCENT FEMALE AND 49 PERCENT MALE. THE AGE DISTRIBUTION OF THE POPULATION IS SIMILAR TO OTHER UPSTATE NEW YORK AREAS WITH 5.4 PERCENT OF THE POPULATION UNDER 5 YEARS OF AGE, 21 PERCENT UNDER THE AGE OF 18 AND 16.2PERCENT AGED 65 AND OLDER. NEARLY 80 PERCENT OF THE POPULATION OVER 25 HAS GRADUATED FROM HIGH SCHOOL. PER CAPITA INCOME LEVELS ARE $16,141, LOWER THAN NEW YORK STATE'S AVERAGE OF $23,389 AND MEDIAN HOUSEHOLD INCOME AT $40,106 ARE ALSO BELOW THE STATE MEDIAN OF $55,980. IT ESTIMATED THAT 14 PERCENT OF THE POPULATION IS BELOW THE FEDERAL POVERTY LEVEL, HIGHER THAN BOTH THE STATE (13.7) AND U.S. (13.3) AVERAGES AND AN ESTIMATED 14.4 PERCENT OF THE COUNTY'S POPULATION IS UNINSURED. IN ADDITION, THERE ARE NUMEROUS HEALTH STATUS INDICATORS THAT SHOW THAT MANY PRIMARY CARE NEEDS OF THE POPULATION RESIDING IN AREA REMAIN UNMET. THESE INCLUDE COMPARATIVELY: LOWER PERCENTAGES OF PREGNANT WOMEN WITH EARLY PRENATAL CARE, ANEMIA AND OBESITY; HIGHER PERCENTAGES OF CHILDREN WITH ANEMIA; HIGHER PERCENTAGES OF ADULTS WHO ARE OVERWEIGHT, SMOKE AND DRINK EXCESSIVELY; HIGHER RATES OF DEATH AND HOSPITALIZATION FROM CARDIOVASCULAR AND HEART DISEASES; A HIGHER INCIDENCE OF CANCER OF THE LUNGS; HIGHER DEATH RATES DUE TO CIRRHOSIS AND DIABETES; HIGHER HOSPITALIZATIONS DUE TO PNEUMONIA AND FLU; AND HIGHER RATES OF DEATH AND HOSPITALIZATION FROM SUICIDE, SELF INFLICTED AND UNINTENTIONAL INJURIES. | ||
| PART VI, LINE 5: LITTLE FALLS HOSPITAL ACTIVELY PLANS AND IMPLEMENTS COORDINATED HEALTH CARE RESOURCES WITH BASSETT HEALTHCARE NETWORK. THIS SYNERGY ALLOWS FOR GREATER ACCESS, MINIMIZES DUPLICATION OF SERVICES, AND RESULTS WITH HIGH QUALITY CARE. LITTLE FALLS HOSPITAL SERVES ALL PATIENTS WITHOUT CONSIDERATION OF PAYMENT SOURCES. IN 2012 THE AGGREGATE OUTPATIENT GOVERNMENT AND UNINSURED SPONSORED PAYMENT PERCENTAGE WAS 72%. THIS MEANS 72% OF PATIENTS ARE COVERED BY MEDICAID, MEDICARE, GOVERNMENT SPONSORED HMO PROGRAMS OR ARE UNINSURED (NOTE PERCENTAGE IS BASED UPON GOVERNMENT PROGRAMS TO TOTAL FACILITY CHARGES). TO MANAGE CARE MORE APPROPRIATELY EMPHASIS HAS BEEN PREVALENT IN QUALITY OF CARE MEASUREMENTS. THIS HAS RESULTED IN IMPROVING FEWER PATIENTS REQUIRING RE-ADMISSION TO THE HOSPITAL AFTER 30 DAYS. IN ADDITION THE NUMBER OF PATIENTS CONNECTED WITH FOLLOW-UP COMMUNICATIONS HAS SHOWN IMPROVED SHORT AND LONG-TERM HEALTH STATUS BENEFITS. CONTINUED EFFORTS TO EXPAND THE PRIMARY CARE PROVIDER BASE WILL FURTHER IMPROVE ACCESS TO PRIMARY CARE RESULTING IN A MORE PATIENT CENTERED DELIVERY OF CARE MODEL.IN 2013 THE IMPLEMENTATION OF THE "ELECTRONIC HEALTH RECORD" WILL RESULT IN A MORE SIGNIFICANT ADOPTION OF CARE DOCUMENTATION PROTOCOLS TO FURTHER IMPROVE THE HEALTH STATUS OF OUR PATIENTS. | ||
| PART VI, LINE 6: LITTLE FALLS HOSPITAL IS A MEMBER OF THURSTON CORPORATION (DBA BASSETT HEALTHCARE NETWORK) THAT PROVIDES HEALTH SERVICES IN MORE THAN 20 COMMUNITIES SPANNING 5,600 SQUARE MILES AND SEVEN COUNTIES. THE NETWORK FOCUSES ITS COMMUNITY SERVICES PROGRAMS IN THE COUNTIES WHERE THE SIX AFFILIATED HOSPITALS AND GREATEST PATIENT POPULATIONS ARE LOCATED. OTSEGO COUNTY - POPULATION 61,709; DELAWARE COUNTY - POPULATION 47,276; HERKIMER COUNTY - POPULATION 64,508; SCHOHARIE COUNTY - POPULATION 32,099 (ACCORDING TO THE 2012 U.S. CENSUS ESTIMATES). THE MARY IMOGENE BASSETT HOSPITAL, AN ACUTE CARE INPATIENT TEACHING FACILITY IN COOPERSTOWN, OTSEGO COUNTY, O'CONNOR HOSPITAL, A CRITICAL ACCESS HOSPITAL IN DELHI, DELAWARE COUNTY, COBLESKILL REGIONAL HOSPITAL, AN ACUTE CARE FACILITY IN COBLESKILL, SCHOHARIE COUNTY, LITTLE FALLS HOSPITAL, A CRITICAL ACCESS HOSPITAL IN LITTLE FALLS, HERKIMER COUNTY, TRI TOWN REGIONAL HOSPITAL A 24/7 EMERGENCY CARE FACILITY IN SIDNEY, DELAWARE COUNTY, AUREILA OSBORN FOX MEMORIAL HOSPITAL, AN ACUTE CARE FACILITY IN ONEONTA, OTSEGO COUNTY, THE BASSETT CLINIC, AN OUTPATIENT PRIMARY AND SPECIALTY CARE CENTER IN COOPERSTOWN, A REGIONAL NETWORK OF 26 COMMUNITY BASED HEALTH CENTERS, 19 SCHOOL BASED HEALTH CENTERS, TWO AMBULATORY SURGERY CENTERS, VALLEY HEALTH SERVICES A RESIDENTIAL HEALTH CARE AND REHABILITATION FACILITY, AT HOME CARE, A CERTIFIED HOME CARE AGENCY AND FIRST COMMUNITY CARE OF BASSETT, A MEDICAL SUPPLY COMPANY, ALL OF WHICH MAKE UP THE BASSETT HEALTHCARE NETWORK AND PROVIDE HEALTH SERVICES TO THIS NINE COUNTY REGION IN CENTRAL NEW YORK. | ||
| NY | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AUGUST LEINHART MD | ||||||||||||||
| TRUSTEE | 0 | 472027 | 0 | 0 | 0 | 1293 | 0 | 23096 | 0 | 1707 | 0 | 498123 | 0 | 0 |
| NICHOLAS J NICOLETTA | ||||||||||||||
| TREASURER | 0 | 376575 | 0 | 107000 | 0 | 0 | 0 | 23096 | 0 | 3436 | 0 | 510107 | 0 | 0 |
| JEFFREY WOEPPEL | ||||||||||||||
| THIRD VICE CHAIRMAN | 0 | 197600 | 0 | 0 | 0 | 0 | 0 | 17596 | 0 | 4481 | 0 | 219677 | 0 | 0 |
| DALE ADAMSON MD | ||||||||||||||
| PRESIDENT OF MEDICAL STAFF | 0 | 167000 | 0 | 0 | 0 | 1059 | 0 | 10626 | 0 | 3434 | 0 | 182119 | 0 | 0 |
| MICHAEL OGDEN | ||||||||||||||
| PRESIDENT & CEO | 0 | 152440 | 0 | 0 | 0 | 848 | 0 | 7436 | 0 | 895 | 0 | 161619 | 0 | 0 |
| RICHARD NOCELLA | ||||||||||||||
| PRIMARY CARE PHYSICIAN | 157236 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 13968 | 0 | 171204 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 3 | ReturnReference |
| Explanation | THE COMPENSATION PROCESS FOR TOP OFFICIAL THE CHIEF EXECUTIVE OFFICER'S SALARY IS PAID BY A RELATED ORGANIZATION UNDER A MANAGEMENT SERVICES AGREEMENT. THE LITTLE FALLS HOSPITAL BOARD OF TRUSTEE'S REVIEWS THE FORMAL PROCESS THAT IS USED TO DETERMINE THE BASE COMPENSATION OF THE CEO. THE CEO WORK PLAN AND ACCOMPLISHMENTS FOR THE YEAR ARE REVIEWED. SALARY CHANGES ARE BASED ON MARKET, WORK PLAN, AND ACCOMPLISHMENTS. THE CEO'S SALARY IS SUBMITTED AS PART OF THE MANAGEMENT SERVICES AGREEMENT WHICH IS APPROVED BY THE BOARD OF TRUSTEES. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | LITTLE FALLS HOSPITAL PRESENTS THE DRAFT 990 TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS PRIOR TO FILING. ANY QUESTIONS ARE RAISED AND ONCE APPROVED, THE 990 CAN BE FILED. A COMPLETE COPY OF THE ORGANIZATION'S FINAL FORM 990, INCLUDING ALL REQUIRED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, IS AVAILABLE TO EACH MEMBER OF THE BOARD BEFORE ITS FILING WITH THE IRS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | CONFLICT OF INTEREST STATEMENTS ARE MADE ANNUALLY. NEW BOARD MEMEBERS ARE REQUIRED TO DISCLOSE ON THEIR RESUME ALL AFFILIATED ORGANIZATIONS. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CHIEF EXECUTIVE OFFICER'S SALARY IS PAID BY A RELATED ORGANIZATION UNDER A MANAGEMENT SERVICES AGREEMENT. THE LITTLE FALLS HOSPITAL BOARD OF TRUSTEES REVIEWS THE FORMAL PROCESS THAT IS USED TO DETERMINE THE BASE COMPENSATION OF THE CEO. THE CEO'S WORK PLAN AND ACCOMPLISHMENTS FOR THE YEAR ARE REVIEWED. SALARY CHANGES ARE BASED ON MARKET, WORKPLAN, AND ACCOMPLISHMENTS. THE CEO'S SALARY IS SUBMITTED AS PART OF THE MANAGEMENT SERVICES AGREEMENT WHICH IS APPROVED BY THE BOARD. | |
| FORM 990, PART VI, SECTION C, LINE 19 | LITTLE FALLS HOSPITAL MAKES AVAILABLE THE IRS FROM 990 UPON REQUEST ALONG WITH INFORMATION INCLUDED WITHIN THE 990 SUCH AS FINANCIAL REPORTS, CONFLICT OF INTEREST POLICY,AND CODE OF CONDUCT. THE HOSPITAL ALSO PROVIDES THE ANNUAL OPERATING PLAN, CORPORATE VLAUES, IN PUBLIC AREAS OF THE FACILITY. | |
| FORM 990, PART XI, LINE 9: | PENSION RELATED CHANGES OTHER THAN NET PERIODIC BENEFIT COST 111,805. CHANGE IN VALUE OF BENEFICIAL INTEREST IN CHARITABLE REMAINDER TRUST 464,163. CHANGE IN INTEREST IN NET ASSETS OF FRIENDS OF BASSETT, INC. 558,471. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (10 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| THURSTON CORPORATION | |||||||||||
| ONE ROCKEFELLER PLAZA 31ST FLOOR | NEW YORK | NY | 10020 | 133218680 | SUPPORTING ORGANIZATION | NY | 501 (C) 3 | 11 C | N/A | 0 | |
| FRIENDS OF BASSETT | |||||||||||
| ONE ATWELL ROAD | COOPERSTOWN | NY | 13326 | 237041610 | FUND RAISING ORGANIZATION | NY | 501 (C) 3 | 7 | 0 | THURSTON CORPORATION | |
| MARY IMOGENE BASSETT HOSPITAL | |||||||||||
| ONE ATWELL ROAD | COOPERSTOWN | NY | 13326 | 135596796 | HEALTH CARE ORGANIZATION OFFERING INPATIENT AND OUTPATIENT SERVICES | NY | 501 (C) 3 | 3 | 0 | THURSTON CORPORATION | |
| AURELIA OSBORN FOX MEMORIAL HOSPITAL SOCIETY | |||||||||||
| ONE NORTON AVENUE | ONEONTA | NY | 13820 | 150539039 | HEALTH CARE ORGANIZATION OFFERING INPATIENT AND OUTPATIENT SERVICES | NY | 501 (C) 3 | 3 | 0 | THURSTON CORPORATION | |
| TEMPLETON FOUNDATION | |||||||||||
| ONE ATWELL ROAD | COOPERSTOWN | NY | 13326 | 133317084 | FACILITIES / OFFICE SPACE | NY | 501 (C) 3 | 9 | 0 | THURSTON CORPORATION | |
| BASSETT REGIONAL CORPORATION | |||||||||||
| ONE ATWELL ROAD | COOPERSTOWN | NY | 13326 | 133522783 | PROVIDES EXCELLENCE IN THE COORDINATION PLANNING AND POLICY DIRECTION FOR | NY | 501 (C) 3 | 11 (B) | 0 | THURSTON CORPORATION | |
| COBLESKILL REGIONAL HOSPITAL | |||||||||||
| 178 GRANDVIEW DRIVE | COBLESKILL | NY | 12043 | 141772971 | HEALTHCARE SERVICES OFFERING INPATEINT AND OUTPATIENT SERVICES | NY | 501 (C) 3 | 3 | 0 | BASSETT REGIONAL CORPORATION | |
| O'CONNOR HOSPITAL | |||||||||||
| 460 ANDES ROAD | DELHI | NY | 13753 | 161540394 | HEALTH CARE ORGANIZATION OFFERING INPATIENT AND OUTPATIENT SERVICES | NY | 501 (C) 3 | 3 | 0 | BASSETT REGIONAL CORPORATION | |
| TRI TOWN REGIONAL HEALTHCARE | |||||||||||
| 43 PEARL STREET | SYNDEY | NY | 13838 | 260169584 | HEALTHCARE SERVICES OFFERING OUTPATIENT SERVICES | NY | 501 (C) 3 | 3 | 0 | BASSETT REGIONAL CORPORATION | |
| VALLEY HEALTH SERVICES | |||||||||||
| 690 GERMAN STREET | HERKIMER | NY | 13350 | 222511614 | NURSING HOME | NY | 501 (C) 3 | 3 | 0 | BASSETT REGIONAL CORPORATION | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
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