LAKESIDE MEMORIAL HOSPITAL INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- LAKESIDE MEMORIAL HOSPITAL INC (EIN 16-0743068)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-10-23
- IRS object ID
- 201322969349300912
- 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
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-10-23T11:47:13-05:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 264298079 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EFP ROTENBERG LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 280 KENNETH DRIVE | AddressLine1 |
| City | ROCHESTER | City |
| State | NY | State |
| ZIP Code | 14623 | 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 | 160743068 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKESIDE MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | LAKE | NameControl |
| Phone | 5853956095 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 156 WEST AVENUE | AddressLine1 |
| City | BROCKPORT | City |
| State | NY | State |
| ZIP Code | 14420 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JAMES CUMMINGS | Name |
| Title | INTERIM CEO | Title |
| Phone | 5853956095 | Phone |
| Date Signed | 2013-10-23 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | WILLIAM MCDONALD | Name |
| PTIN | P01600766 | PTIN |
| Phone | 5854278900 | Phone |
| Date Prepared | 2013-10-21 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JAMES CUMMINGS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 156 WEST AVENUE | AddressLine1 |
| City | BROCKPORT | City |
| State | NY | State |
| ZIP Code | 14420 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 40943025 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.LAKESIDEHEALTH.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1939 | YearFormation |
| State Legal Domicile | NY | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE A FULL RANGE OF HOSPITAL/MEDICAL SERVICES TO THE GENERAL PUBLIC. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 542 | TotalNbrEmployees |
| Total Nbr Volunteers | 138 | TotalNbrVolunteers |
| Total Gross UBI | -166611 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -460805 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 2485 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 35126804 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 32425950 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 60617 | InvestmentIncomePriorYear |
| Investment Income Current Year | 73097 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 5546752 | OtherRevenuePriorYear |
| Other Revenue Current Year | 6085638 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 40734173 | TotalRevenuePriorYear |
| Total Revenue Current Year | 38587170 | 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 | 23912327 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 21232491 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 20694344 | OtherExpensePriorYear |
| Other Expenses Current Year | 20932294 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 44606671 | TotalExpensesPriorYear |
| Total Expenses Current Year | 42164785 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -3872498 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -3577615 | RevenuesLessExpensesCY |
| Total Assets BOY | 22578748 | TotalAssetsBOY |
| Total Assets EOY | 19178983 | TotalAssetsEOY |
| Total Liabilities BOY | 23019321 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 22360813 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -440573 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -3181830 | NetAssetsOrFundBalancesEOY |
| Mission Description | LAKESIDE HEALTH SYSTEM IS TO BE THE CENTER OF OUR HEALTHCARE COMMUNITY AND TO PROVIDE THE HIGHEST LEVEL OF QUALITY, COMPASSIONATE, COST-EFFECTIVE CARE. THE SERVICES WE PROVIDE TO OUR CUSTOMERS ARE ROOTED IN AN INTEGRATED DELIVERY SYSTEM. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 24748339 | Expense |
| Revenue | 23037257 | Revenue |
| Description | PATIENT HEALTH CARE INCLUDES SERVICES SUCH AS MEDICAL AND SURGICAL PROCEDURES, OBSTETRICS, INTENSIVE CARE, NEWBORN NURSERY, DELIVERY ROOM, RECOVERY ROOM, EMERGENCY ROOM, AND URGENT CARE CENTER. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 12227788 | Expense |
| Revenue | 10808650 | Revenue |
| Description | OTHER PROFESSIONAL SERVICES INCLUDED LABORATORY COSTS, RADIOLOGY, INTRAVENOUS THERAPY, RESPIRATORY THERAPY, PHYSICAL THERAPY, AND ELECTROCARDIOLOGY COST INCURRED FOR PATIENT SERVICE | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 36976127 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | 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 | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | 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 | 1 | 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 | 230 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 542 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| 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 |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | 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 | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NY | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LEON GOSSIN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5853956095 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 156 WEST AVENUE | AddressLine1 |
| City | BROCKPORT | City |
| State | NY | State |
| ZIP Code | 14420 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (21 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| PATRICIA HAYLES | ||||||||
| SECRETARY | 8.00 | X | X | 0 | 0 | 0 | ||
| NANCY PLEWS | ||||||||
| CHAIRPERSON | 8.00 | X | X | 0 | 0 | 0 | ||
| GERARD WENZKE | ||||||||
| VICE CHAIRPERSON | 8.00 | X | X | 0 | 0 | 0 | ||
| KATHLEEN PETERSON | ||||||||
| DIRECTOR | 8.00 | X | 0 | 0 | 0 | |||
| NORMAN KNIGHT | ||||||||
| DIRECTOR | 8.00 | X | 0 | 0 | 0 | |||
| MARK MAXIM | ||||||||
| TREASURER | 8.00 | X | X | 0 | 0 | 0 | ||
| DAVID NEWMAN MD | ||||||||
| DIRECTOR | 8.00 | X | 0 | 0 | 0 | |||
| MICHAEL RAFF OD | ||||||||
| DIRECTOR | 8.00 | X | 0 | 0 | 0 | |||
| DANIEL RICHARDSON | ||||||||
| DIRECTOR | 8.00 | X | 0 | 0 | 0 | |||
| THOMAS RICHARDSON | ||||||||
| DIRECTOR | 8.00 | X | 0 | 0 | 0 | |||
| JOHN RISOLO MD | ||||||||
| DIRECTOR | 8.00 | X | 0 | 0 | 0 | |||
| DR JAMES SZALADOS | ||||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| HUGH COLLINS | ||||||||
| CEO & CFO | 40.00 | X | 117382 | 0 | 23456 | |||
| JIM CUMMINGS | ||||||||
| COO | 40.00 | X | 123127 | 0 | 15595 | |||
| HARRIS SILVERMD | ||||||||
| PHYSICIAN | 40.00 | 504055 | 0 | 100811 | X | |||
| TIMOTHY HAGY | ||||||||
| PHYSICIAN | 40.00 | 249673 | 0 | 49935 | X | |||
| ERIK PETERSON | ||||||||
| PHYSICIAN | 40.00 | 438977 | 0 | 87795 | X | |||
| JASON MCCLUNG MD | ||||||||
| PHYSICIAN | 40.00 | 397745 | 0 | 79549 | X | |||
| JACK DAVIDOFF | ||||||||
| PHYSICIAN | 40.00 | 247541 | 0 | 49508 | X | |||
| BRIDGETT REED | ||||||||
| FORMER CFO | 40.00 | 57482 | 0 | 11497 | X | |||
| JAMES WISSLER | ||||||||
| FORMER CEO | 40.00 | 72045 | 0 | 14409 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2208027 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 432555 | TotalOtherCompensation |
| Number Individuals GT100 K | 7 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (4 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| URMC - ORTHO | |||||
| 4901 LAC DE VILLE BLVD | ROCHESTER | NY | 14618 | MEDICAL | 620769 |
| LAKESIDE ANESTHESIA PLLC | |||||
| 3205 MT READ BLVD | ROCHESTER | NY | 14616 | ANESTHESIOLOGY | 490563 |
| PRONEXUS | |||||
| 171 SULLYS TRAIL SUITE 201 | PITTSFORD | NY | 14534 | ACCOUNTING | 229692 |
| BETH PLATT & ASSOC | |||||
| 2100 PENFIELD RD | WALWORTH | NY | 14568 | MEDICAL BILLING/COLLECTION | 189895 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 4 | NumberOfContractorsGT100K |
| All Other Contributions | 2485 | AllOtherContributions |
| Total Contributions | 2485 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE RE | Description |
| Business Code | 621990 | BusinessCode |
| Total Revenue Column | 32425950 | TotalRevenueColumn |
| Related Or Exempt Function Income | 32425950 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 32425950 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 7605 | TotalRevenueColumn |
| Exclusion | $7,605 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 791710 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 499397 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 292313 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 292313 | TotalRevenueColumn |
| Exclusion | $292,313 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 866329 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 800837 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 65492 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 65492 | TotalRevenueColumn |
| Exclusion | $65,492 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 889010 | GrossSalesOfInventory |
| Cost Of Goods Sold | 1055621 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -166611 | TotalRevenueColumn |
| Unrelated Business Revenue | -166611 | UnrelatedBusinessRevenue |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| PHYSICIAN PRACTICE | 621110 | 3106233 | $3,106,233 | |
| MEANINGFUL USE INCOME | 900099 | 1419957 | 1419957 | |
| SHARED SERVICES | 900099 | 1061526 | $1,061,526 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 372220 | TotalRevenueColumn |
| Exclusion | $372,220 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 5959936 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 38587170 | TotalRevenueColumn |
| Related Or Exempt Function Income | 33845907 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | -166611 | UnrelatedBusinessRevenue |
| Exclusion | $4,905,389 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 279561 | Total |
| Management And General | 279561 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16970950 | Total |
| Program Services | 14670748 | ProgramServices |
| Management And General | 2300202 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 524720 | Total |
| Program Services | 444963 | ProgramServices |
| Management And General | 79757 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2271811 | Total |
| Program Services | 1926495 | ProgramServices |
| Management And General | 345316 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1185449 | Total |
| Program Services | 1005261 | ProgramServices |
| Management And General | 180188 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 165355 | Total |
| Management And General | 165355 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 80250 | Total |
| Management And General | 80250 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7167 | Total |
| Program Services | 6137 | ProgramServices |
| Management And General | 1030 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 282441 | Total |
| Management And General | 282441 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 90556 | Total |
| Program Services | 82600 | ProgramServices |
| Management And General | 7956 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 320790 | Total |
| Program Services | 274683 | ProgramServices |
| Management And General | 46107 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1887516 | Total |
| Program Services | 1646167 | ProgramServices |
| Management And General | 241349 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 398856 | Total |
| Program Services | 358486 | ProgramServices |
| Management And General | 40370 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| CONTRACTED SERVICES | 8622167 | 8021101 | 601066 |
| SUPPLIES | 4863325 | 4590415 | 272910 |
| BAD DEBT | 2252028 | 2252028 | |
| LOSS ON IMPAIRMENT | 1134956 | 987412 | 147544 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 826887 | Total |
| Program Services | 709631 | ProgramServices |
| Management And General | 117256 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42164785 | Total |
| Program Services | 36976127 | ProgramServices |
| Management And General | 5188658 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 626739 | BOY |
| EOY | 696025 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1048795 | BOY |
| EOY | 104018 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4385332 | BOY |
| EOY | 4068879 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 947642 | BOY |
| EOY | 872243 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 669458 | BOY |
| EOY | 1507922 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 37383372 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 27843294 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11664600 | BOY |
| EOY | 9540078 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 802654 | BOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2433528 | BOY |
| EOY | 2389818 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22578748 | BOY |
| EOY | 19178983 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6441922 | BOY |
| EOY | 6861373 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7496373 | BOY |
| EOY | 6682678 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9081026 | BOY |
| EOY | 8816762 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23019321 | BOY |
| EOY | 22360813 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -1110248 | BOY |
| EOY | -3866919 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 367253 | BOY |
| EOY | 382943 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 302422 | BOY |
| EOY | 302146 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -440573 | BOY |
| EOY | -3181830 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22578748 | BOY |
| EOY | 19178983 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -3577615 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | -136 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 836494 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| 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 Both | X | FinancialStatementBoth |
| 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $9,747 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 9747 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | AS MEMBERS OF 3 ASSOCIATIONS (AHA - AMERICAN HOSPITAL ASSOCIATION, HANYS-THE HEALTHCARE ASSOCIATION OF NEW YORK STATE & RRHA/SEAGATE ALLIANCE) A PORTION OF THE DUES (TOTAL REFLECTED ABOVE) ARE PAID AS PART OF MEMBERSHIP AND REPRESENT AMOUNTS DESIGNATED FOR LOBBYING ACTIVITIES. THESE ASSOCIATE ORGANIZATIONS OF WHICH WE ARE MEMBERS HANDLE THE DIRECT LOBBYING/ADVOCACY ACTIVITIES ON BEHALF OF THEIR MEMBERS. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 51707 | OtherCostOrOtherBasis |
| Book Value | 51707 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 19672339 | OtherCostOrOtherBasis |
| Depreciation | 14760056 | Depreciation |
| Book Value | 4912283 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 17659326 | OtherCostOrOtherBasis |
| Depreciation | 13083238 | Depreciation |
| Book Value | 4576088 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 9540078 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| BENEFICIAL INTEREST IN NET ASSETS OF LAKESIDE FOUNDATION, INC. | 685089 |
| DUE FROM RELATED PARTIES | 1441521 |
| OTHER ASSETS | 263208 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 2389818 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ACCRUED PENSION COSTS | $7,150,939 |
| ACCRUED POSTRETIREMENT BENEFITS | $706,337 |
| DUE TO THIRD PARTY PAYERS | $959,486 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 8816762 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 37098450 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -1488720 | OtherRevenues |
| Revenue Not Rptd F990 | -1488720 | RevenueNotRptdF990 |
| Revenue Subtotal | 38587170 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 38587170 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 39912757 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 39912757 | ExpensesSubtotal |
| Other Expenses Not Included | 2252028 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 2252028 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 42164785 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X, LINE 2: | THE HOSPITAL IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. HOWEVER, INCOME FROM CERTAIN ACTIVITIES NOT DIRECTLY RELATED TO THE HOSPITAL'S TAX-EXEMPT PURPOSES IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. IN ACCORDANCE WITH ASC 740-10-50, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, THE HOSPITAL RECOGNIZES THE TAX BENEFITS FROM UNCERTAIN TAX POSITIONS ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES. MANAGEMENT BELIEVES THAT THE HOSPITAL IS CURRENTLY OPERATING IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE INTERNAL REVENUE CODE. THEREFORE, NO LIABILITY FOR UNRECOGNIZED TAX BENEFITS HAS BEEN INCLUDED ON THE HOSPITALS FINANCIAL STATEMENTS. THE EXEMPT HOSPITAL'S INFORMATIONAL RETURNS ARE SUBJECT TO AUDIT BY VARIOUS TAXING AUTHORITIES AND ITS OPEN AUDIT PERIODS ARE 2009 THROUGH 2011. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | GROSS RENTS -791,710. RENTAL EXPENSE 499,397. COST OF GOODS SOLD 1,055,621. BAD DEBT EXPENSE -2,252,028. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 2,252,028. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 190317 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 190317 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00450 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5468286 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4617739 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 850547 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02020 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5658603 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4617739 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1040864 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02470 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5658603 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4617739 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1040864 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02470 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,118,435 | BadDebtExpenseAmount |
| Amount Attributable To | 653629 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 3455360 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 4371838 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -916478 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| 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 | LAKESIDE MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 156 WEST AVE | AddressLine1 |
| City | BROCKPORT | City |
| State | NY | State |
| ZIP Code | 14420 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKESIDE MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Lawsuit | X | Lawsuit |
| 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 (11 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART III, LINE 4: COST TO CHARGE RATIO FROM COST REPORT APPLIED BY PATIENT TYPE. BAD DEBT INCLUDED IN COMMUNITY BENEFIT BECAUSE MANY MORE PEOPLE WOULD QUALIFY IF THEY APPLIED, BUT THEY DID NOT GO THROUGH THE PROCESS. THIS IS LIKELY THE CASE WITH MOST OF BAD DEBT. | ||
| PART III, LINE 8: COST PER CMS 2552-96 PER WKST D SERIES. | ||
| PART III, LINE 9B: LAKESIDE MEMORIAL HOSPITAL WORKS WITH PATIENTS TO ESTABLISH A REASONABLE PAYMENT PLAN PRIOR TO ANY COLLECTION REFERRALS. PATIENTS WHO DO NOT FULFILL THEIR PAYMENT OBLIGATIONS WITHIN SPECIFIED TIME PERIODS WILL BE REFERRED TO A COLLECTION AGENCY FOR FURTHER COLLECTION ACTIVITY. | ||
| PART V, SECTION B, LINE 10: FAMILY SIZE AND EARNINGS BROKEN OUT MONTHLY AND YEARLY DETERMINES WHETHER FREE CARE WILL BE GIVEN. | LAKESIDE MEMORIAL HOSPITAL, INC. | |
| PART V, SECTION B, LINE 11: FAMILY SIZE AND EARNINGS BROKEN OUT MONTHLY AND YEARLY DETERMINES THE PERCENTAGE OF CHARITY CARE TO BE PROVIDED. | LAKESIDE MEMORIAL HOSPITAL, INC. | |
| PART V, SECTION B, LINE 20D: CHARITY CARE ASSISTANCE IS DETERMINED BY ASSESSING ANNUAL HOUSEHOLD INCOME AND THE NUMBER OF PEOPLE IN THE HOME AND COMPARING IT TO THE FEDERAL POVERTY GUIDELINES FOR THE SAME SIZE HOUSEHOLD. THOSE PATIENTS WHO DO NOT FALL WITHIN THE POVERTY GUIDELINE WILL BE REQUIRED TO SUBMIT ADDITIONAL INFORMATION REDARGING INCOME, LIQUID ASSETS, AND EXPENSES. THE PROGRAM IS GENERALLY DESIGNED SO THAT PATIENTS ARE NOT EXPECTED TO EXPEND MORE THAN 20% OF THEIR INCOME OR 10% OF ASSETS FOR QUALIFYING HEALTHCARE OBLIGATIONS. PATIENTS WHO HAVE EXHAUSTED THEIR INSURANCE BENEFITS AND/OR EXCEED FINANCIAL ELIGIBILITY CRITERIA BUT FACE EXTRAORDINARY MEDICAL COSTS WILL BE TREATED ON A CASE-BY-CASE BASIS. | LAKESIDE MEMORIAL HOSPITAL, INC. | |
| PART VI, LINE 2: COMMUNITY PERCEPTION SURVEY, INTERVIEW LOCAL PHYSICIANS TO DETERMINE PATIENT SPECIALTY NEEDS. | ||
| PART VI, LINE 3: GIVEN BROCHURE, SIGNS IN PATIENT REGISTRATION AREA, MEDICAID LIAISON USED BY CASE MANAGEMENT/SOCIAL WORK STAFF. | ||
| PART VI, LINE 4: RURAL, COLLEGE STUDENTS, MIDDLE CLASS AND UNINSURED POPULATION. | ||
| PART VI, LINE 6: LAKESIDE MEMORIAL HOSPITAL SERVES AS A HOSPITAL, LAKESIDE BEIKIRCH CARE CENTER IS A NURSING HOME WITH REHABILITATION SERVICES, LAKESIDE FOUNDATION RAISES MONEY FOR THE ENTITIES OF THE HEALTH SYSTEM, AND LAKESIDE CHILD CARE PROVIDES DAY CARE SERVICES. | ||
| NY | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HARRIS SILVERMD | ||||||||||||||
| PHYSICIAN | 504055 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 100811 | 0 | 604866 | 0 | 0 | 0 |
| TIMOTHY HAGY | ||||||||||||||
| PHYSICIAN | 249673 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 49935 | 0 | 299608 | 0 | 0 | 0 |
| ERIK PETERSON | ||||||||||||||
| PHYSICIAN | 399977 | 0 | 0 | 0 | 39000 | 0 | 0 | 0 | 87795 | 0 | 526772 | 0 | 0 | 0 |
| JASON MCCLUNG MD | ||||||||||||||
| PHYSICIAN | 378129 | 0 | 0 | 0 | 19616 | 0 | 0 | 0 | 79549 | 0 | 477294 | 0 | 0 | 0 |
| JACK DAVIDOFF | ||||||||||||||
| PHYSICIAN | 247541 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 49508 | 0 | 297049 | 0 | 0 | 0 |
| BRIDGETT REED | ||||||||||||||
| FORMER CFO | 57482 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 11497 | 0 | 68979 | 0 | 0 | 0 |
| JAMES WISSLER | ||||||||||||||
| FORMER CEO | 72045 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 14409 | 0 | 86454 | 0 | 0 | 0 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| JOHN RISOLO MD | |||
| DIRECTOR | 21604 | RENTS SPACE FROM ORGANIZATION | 0 |
| DAVID NEWMAN MD | |||
| DIRECTOR | 8580 | PROVIDES BILLING SERVICES FOR ONE OF THE PHYSICIAN PRACTICES, ON CALL COVERAGE THROUGH CONTRACT, AND ED-PHYSICIAN SALARY | 0 |
| JAMES SZALADOS MD | |||
| DIRECTOR | 27450 | MEDICAL DIRECTOR SALARY | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | A COPY OF THE 990 IS PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING. THE FORM 990 IS PREPARED IN CONJUNCTION WITH ACCOUNTING FIRM AND MANAGEMENT. | |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH MEMBER SIGNS A STATEMENT THAT LISTS CONFLICTS AND THAT THEY HAVE REVIEWED CONFLICT OF INTEREST POLICY. AT ANNUAL BOARD MEETING ALL CONFLICTS ARE DISCUSSED WITH THE GROUP. | |
| FORM 990, PART VI, SECTION B, LINE 15A | MARKET SURVEYS ARE UTILIZED TO ASSESS COMPETITIVE SALARY LEVELS FOR EXECUTIVE LEADERSHIP POSITIONS. WITH THIS SURVEY INFORMATION FOR THE ROCHESTER REGION AS A BASIS, IT IS LAKESIDE'S POLICY TO PAY SALARIES FOR ALL EXECUTIVE POSITIONS WHICH ARE COMPETITIVE FOR THE POSITION, WHICH ARE CONSISTENT WITH OUR ORGANIZATION'S SIZE AND WHICH ACCOUNT FOR THE OCCUPANT'S EXPERIENCE AND PERFORMANCE. COMPENSATION IS REVIEWED BY THE BOARD ANNUALLY. | |
| FORM 990, PART VI, SECTION C, LINE 19 | AVAILABLE UPON REQUEST | |
| FORM 990, PART XI, LINE 9: | CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF LAKESIDE FOUNDATION 97,912. PENSION & POSTRETIREMENT CHANGES OTHER THAN NET PERIODIC BENEFIT COST -24,726. RENTAL EXPENSES 499,397. COST OF GOOD SOLD 1,055,621. GROSS RENTS -791,710. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XI, LINE 2C | NO CHANGE FROM PRIOR YEAR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|
| LAKESIDE HEALTH SYSTEM INC | |||||||||
| 156 WEST AVENUE | BROCKPORT | NY | 14420 | 161396374 | TO PROVIDE MANAGEMENT SERVICES TO RELATED ENTITIES | NY | 501(C)(3) | SECTION 509(A)(3) | 1 |
| LAKESIDEBEIKIRCH CARE CENTER INC | |||||||||
| 170 WEST AVENUE | BROCKPORT | NY | 14420 | 222998029 | OPERATION OF NURSING HOME | NY | 501(C)(3) | SECTION 509(A)(2) | 1 |
| LAKESIDE FOUNDATION INC | |||||||||
| 156 WEST AVENUE | BROCKPORT | NY | 14420 | 161374547 | TO PROVIDE FINANCIAL SUPPORT TO RELATED ENTITIES | NY | 501(C)(3) | 170(B)(1)(A) (VI) | 1 |
| 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 | 0 | 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 | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | 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 |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| LAKESIDEBEIKIRCH CARE CENTER INC | ||
| Q | 1323476 | ACTUAL AMOUNTS INCURRED |
| LAKESIDE FOUNDATION INC | ||
| Q | 116410 | ACTUAL AMOUNTS INCURRED |
Comments