CUBA MEMORIAL HOSPITAL INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CUBA MEMORIAL HOSPITAL INC (EIN 16-0755761)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-14
- IRS object ID
- 201333189349303338
- 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 B
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-14T12:25:56-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 160755761 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CUBA MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CUBA | NameControl |
| Phone | 5859682000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 140 WEST MAIN ST | AddressLine1 |
| City | CUBA | City |
| State | NY | State |
| ZIP Code | 147271398 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ANDREW H BOSER III CEO | Name |
| Title | CEO | Title |
| Phone | 5859682000 | Phone |
| Date Signed | 2013-11-13 | DateSigned |
| 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 | ANDREW H BOSER III | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 140 WEST MAIN ST | AddressLine1 |
| City | CUBA | City |
| State | NY | State |
| ZIP Code | 147271398 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 9514519 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CUBAMEMORIALHOSPITAL.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1925 | YearFormation |
| State Legal Domicile | NY | StateLegalDomicile |
| Activity Or Mission Description | ACUTE AND LONG TERM PATIENT CARE | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 287 | TotalNbrEmployees |
| Total Nbr Volunteers | 3 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 524988 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 227327 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 8957568 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 8861762 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 137 | InvestmentIncomePriorYear |
| Investment Income Current Year | 18 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 524788 | OtherRevenuePriorYear |
| Other Revenue Current Year | 414796 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 10007481 | TotalRevenuePriorYear |
| Total Revenue Current Year | 9503903 | 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 | 7257510 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 6990710 | 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 | 5239673 | OtherExpensePriorYear |
| Other Expenses Current Year | 4144149 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 12497183 | TotalExpensesPriorYear |
| Total Expenses Current Year | 11134859 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -2489702 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1630956 | RevenuesLessExpensesCY |
| Total Assets BOY | 10111133 | TotalAssetsBOY |
| Total Assets EOY | 9633646 | TotalAssetsEOY |
| Total Liabilities BOY | 7819325 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 8972794 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 2291808 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 660852 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO PROVIDE A CONTINUUM OF APPROPRIATE HEALTH RELATED SERVICES TO ENHANCE THE QUALITY OF LIFE IN OUR COMMUNITY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 8189570 | Expense |
| Revenue | 9236896 | Revenue |
| Description | CUBA MEMORIAL HOSPITAL IS A NOT FOR PROFIT PUBLIC BENEFIT CORPORATION. ACUTE AND SKILLED NURSING HOME CARE IS PROVIDED IN ADDITION TO A 24 HOUR URGENT CARE CENTER AND TWO DENTAL CLINICS. THE HOSPITAL PROVIDED $448,199 IN CHARITY CARE AND FREE CARE ASSESSMENTS TO THE STATE OF NEW YORK. | Description |
| Total Program Service Expense | 8189570 | 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 | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | 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 | 1 | 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 | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| 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 | 17 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 287 | 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 |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | 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 | JOHN T ORMOND | NamePerson |
| Telephone Number | 5859682000 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 140 W MAIN ST | AddressLine1 |
| City | CUBA | City |
| State | NY | State |
| ZIP Code | 14727 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (16 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 |
|---|---|---|---|---|---|---|---|
| TOM BROWN | |||||||
| CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 | |
| JODY SPEARS | |||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| RALPH FOX | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| JOHN FOELS | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| AMY BLACK | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| LARRY POELMA | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| DR JAMES MOOR | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| JEAN SWITALSKI | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| JOHN HASPER | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| ANDREW H BOSER III | |||||||
| CEO | 37.50 | X | 135813 | 0 | 12559 | ||
| JOHN T ORMOND | |||||||
| CFO | 37.50 | X | 135720 | 0 | 5276 | ||
| DAVID HANRAHAN | |||||||
| PHYSICIAN ASSISTANT | 48.00 | 141683 | 0 | 288 | X | ||
| MARK STANCOMBE | |||||||
| PHYSICIAN ASSISTANT | 48.00 | 140303 | 0 | 12559 | X | ||
| KEVIN J BRICELAND | |||||||
| PHYSICIAN ASSISTANT | 48.00 | 127651 | 0 | 4864 | X | ||
| CHRISTOPHER L YOUNG | |||||||
| DENTIST | 37.50 | 134310 | 0 | 12350 | X | ||
| MICHAEL WILT | |||||||
| PHYSICIAN ASSISTANT | 48.00 | 133477 | 0 | 12860 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 948957 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 60756 | TotalOtherCompensation |
| Number Individuals GT100 K | 7 | 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 |
|---|---|---|---|---|---|
| MCKESSON TECHNOLOGIES | |||||
| PO BOX 403421 | ATLANTA | GA | 30384 | COMPUTER MAINTENANCE | 336874 |
| HEALTHCARE SERVICES GROUP | |||||
| 3220 TILLMAN DRIVE | BENSALEM | PA | 19020 | HOUSEKEEPING SERVICE | 257249 |
| SYNERGY GLOBAL SOLUTIONS | |||||
| PO BOX 8000 | BUFFALO | NY | 14267 | COMPUTER SUPPORT | 198491 |
| ANGELICA-BATAVIA | |||||
| PO BOX 823283 | PHILADELPHIA | PA | 19182 | LAUNDRY SERVICES | 135925 |
| ACM MEDICAL LABORATORY | |||||
| 160 ELMGROVE PARK | ROCHESTER | NY | 14624 | LABORATORY SERVICES | 123551 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| Fundraising Events | 1890 | FundraisingEvents |
| Government Grants | 215385 | GovernmentGrants |
| All Other Contributions | 10052 | AllOtherContributions |
| Total Contributions | 227327 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT REVENUE | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 8861762 | TotalRevenueColumn |
| Related Or Exempt Function Income | 8861762 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 8861762 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 18 | TotalRevenueColumn |
| Exclusion | $18 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 27850 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 27850 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 27850 | TotalRevenueColumn |
| Exclusion | $27,850 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 22428 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 1890 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 10616 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 11812 | TotalRevenueColumn |
| Exclusion | $11,812 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| OTHER REVENUE | 621110 | 289470 | 289470 |
| MEANINGFUL USE INCENTI | 900099 | 85664 | 85664 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 375134 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 9503903 | TotalRevenueColumn |
| Related Or Exempt Function Income | 9236896 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $39,680 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 289368 | Total |
| Program Services | 217402 | ProgramServices |
| Management And General | 71966 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5699199 | Total |
| Program Services | 4281808 | ProgramServices |
| Management And General | 1417391 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 567887 | Total |
| Program Services | 426654 | ProgramServices |
| Management And General | 141233 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 434256 | Total |
| Program Services | 326257 | ProgramServices |
| Management And General | 107999 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15894 | Total |
| Management And General | 15894 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15867 | Total |
| Management And General | 15867 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 811060 | Total |
| Program Services | 676287 | ProgramServices |
| Management And General | 134773 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30402 | Total |
| Program Services | 30402 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1370523 | Total |
| Program Services | 1295462 | ProgramServices |
| Management And General | 75061 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 296894 | Total |
| Program Services | 223056 | ProgramServices |
| Management And General | 73838 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 381783 | Total |
| Program Services | 225896 | ProgramServices |
| Management And General | 155887 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7083 | Total |
| Program Services | 5509 | ProgramServices |
| Management And General | 1574 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11243 | Total |
| Program Services | 10236 | ProgramServices |
| Management And General | 1007 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 947460 | Total |
| Program Services | 214661 | ProgramServices |
| Management And General | 732799 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 77277 | Total |
| Program Services | 77277 | ProgramServices |
Other Expenses OtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | BAD DEBT EXPENSE | Description |
| Total | 178663 | Total |
| Program Services | 178663 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11134859 | Total |
| Program Services | 8189570 | ProgramServices |
| Management And General | 2945289 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 336546 | BOY |
| EOY | 441194 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 228670 | BOY |
| EOY | 267262 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1358490 | BOY |
| EOY | 1259738 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 75102 | BOY |
| EOY | 80402 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 49737 | BOY |
| EOY | 60727 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 18847856 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 11365661 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7998476 | BOY |
| EOY | 7482195 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 64112 | BOY |
| EOY | 42128 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10111133 | BOY |
| EOY | 9633646 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3118421 | BOY |
| EOY | 2617716 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4700904 | BOY |
| EOY | 6355078 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7819325 | BOY |
| EOY | 8972794 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -264571 | BOY |
| EOY | -1854645 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 743446 | BOY |
| EOY | 702564 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1812933 | BOY |
| EOY | 1812933 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2291808 | BOY |
| EOY | 660852 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10111133 | BOY |
| EOY | 9633646 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -1630956 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | 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 Consolidated | X | FinancialStatementConsolidated |
| 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
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 200274 | OtherCostOrOtherBasis |
| Book Value | 200274 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 9528358 | OtherCostOrOtherBasis |
| Depreciation | 4807295 | Depreciation |
| Book Value | 4721063 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 195631 | OtherCostOrOtherBasis |
| Depreciation | 139998 | Depreciation |
| Book Value | 55633 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 8923593 | OtherCostOrOtherBasis |
| Depreciation | 6418368 | Depreciation |
| Book Value | 2505225 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 7482195 | TotalOfBookValueLandBuildings |
| Tot Revenue Etc Audited Fincl Stmt | 9325240 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -178663 | OtherRevenues |
| Revenue Not Rptd F990 | -178663 | RevenueNotRptdF990 |
| Revenue Subtotal | 9503903 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 9503903 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 10956196 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 10956196 | ExpensesSubtotal |
| Other Expenses Not Included | 178663 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 178663 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 11134859 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS -178,663. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS 178,663. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF TOURNAMENT | NameOfEvent1 |
| Gross Receipts Event1 | 24318 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 1890 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 22428 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 1500 | CashPrizesEvent1 |
| Non Cash Prizes Event1 | 1570 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 1750 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 4117 | FoodAndBeverageEvent1 |
| Entertainment Event1 | 150 | EntertainmentEvent1 |
| Other Direct Expenses Event1 | 1529 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 24318 | GrossReceiptsTotal |
| Charitable Contributions Total | 1890 | CharitableContributionsTotal |
| Gross Revenue Total Events | 22428 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 1500 | CashPrizesTotalEvents |
| Non Cash Prizes Total Events | 1570 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 1750 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 4117 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 150 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 1529 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 10616 | DirectExpenseSummaryEvents |
| Net Income Summary | 11812 | NetIncomeSummary |
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 | 250.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 0 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 678000 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 363033 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 314967 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02880 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5969034 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4132863 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1836171 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.16770 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6647034 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4495896 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2151138 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.19650 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7054 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4972 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2082 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7054 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4972 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2082 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6654088 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4500868 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2153220 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.19670 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $178,663 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 3017276 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 2282306 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 734970 | 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 | CUBA MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 140 W MAIN ST | AddressLine1 |
| City | CUBA | City |
| State | NY | State |
| ZIP Code | 14727 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Critical Access Hospital | X | CriticalAccessHospital |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CUBA MEMORIAL HOSPITAL INC | 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 | 250.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lawsuit | X | PermitLawsuit |
| Permit Lien On Residence | X | PermitLienOnResidence |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Lawsuit | X | Lawsuit |
| Lien On Residence | X | LienOnResidence |
| 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 |
| Medicare Rate | X | MedicareRate |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (7 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 6A: A COMMUNITY BENEFIT REPORT WAS PREPARED IN ACCORD WITH NYS DEPARTMENT OF HEALTH REQUIREMENTS AND WAS FILED WITH THIS AGENCY. | |
| PART I, LINE 7: SPECIFIED WORKSHEETS WERE UTILIZED TO DETERMINE APPROPRIATE REVENUES AND COSTS TO BE REPORTED USING A RATIO OF COST TO CHARGES AS DEFINED IN THE WORKSHEETS. | |
| PART III, LINE 4: 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 A SIGNIFICANT 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 ACUTALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. | |
| PART III, LINE 9B: IF A PATIENT IS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE, THE ACCOUNT IS MOVED TO A PRESUMED CHARITY CATEGORY AND COLLECTION EFFORTS ARE TERMINATED. | |
| PART V, SECTION B, LINE 19D: WHERE A MEDICARE FEE SCHEDULE IS NOT AVAILABLE, SUCH AS FOR DENTAL SERVICES, THE LARGEST COMMERCIAL INSURER FEE SCHEDULE IS UTILIZED TO DETERMINE MAXIMUM CHARGES FOR THE SERVICES. | CUBA MEMORIAL HOSPITAL, INC. |
| PART V, SECTION B, LINE 20D: ESTABLISHED HOSPITAL CHARGES ARE BILLED. | CUBA MEMORIAL HOSPITAL, INC. |
| PART V, SECTION B, LINE 22: HOSPITAL GROSS CHARGES ARE BILLED TO ALL PATIENTS OR THEIR INSURANCE COVERAGE. PAYMENT ADJUSTMENTS ARE MADE AS SEPARATE ALLOWANCE ON INDIVIDUAL ACCOUNTS.2. NEEDS ASSESSMENTS - DUE TO THE NATURE OF THE HOSPITAL AS A CRITICAL ACCESS HOSPITAL, THE NEEDS OF THE COMMUNITY THAT CAN BE MET THROUGH THE LIMITED SERVICES PROVIDED BY THE FACILTY ARE IDENTIFIED THROUGH PARTICIPATION IN REGIONAL AND COUNTY HEALTH PLANNING GROUPS WHICH FOCUS ON THE HEALTH NEEDS OF OUR SERVICE AREA.3. PATIENT EDUCATION - EACH PATIENT SEEKING SERVICES AT THE FACILITY WHO DOES NOT PROVIDE VERIFIABLE INSURANCE COVERAGE IS PROVIDED WITH THE FINANCIAL ASSISTANCE POLICY AND APPLICATION AT THE TIME OF REGISTRATION FOR THE SERVICES PROVIDED. IN ADDITION, THE AVAILABILITY OF FINANCIAL ASSISTANCE IS NOTED ON BILLINGS SENT TO THE PATIENT AFTER INSURANCE. CALLS ARE ALSO MADE TO ALL SELF PAY PATIENTS THAT FIRST BUSINESS DAY AFTER SERVICE TO EITHER IDENTIFY ALTERNATIVE INSURANCE COVERAGE OR TO REMIND THE PATIENT OF THE AVAILABILITY OF THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY.4. THE FACILITY SERVES A REGION COVERED PRIMARILY BY ALLEGANY AND CATTARAUGUS COUNTIES IN SOUTH WESTERN NEW YORK STATE. THE HOSPITAL WAS DESIGNATED AS A CRITICAL ACCESS HOSPITAL BY THE NEW YORK STATE DEPARTMENT OF HEALTH IN FEBRUARY 1997 AND HAS FUNCTIONED PRIMARILY FOCUSING ON GERIATRIC ACUTE AND REHAB MEDICINE IN ADDITION TO SKILLED NURSING CARE AND AN URGENT CARE CENTER.5. CUBA MEMORIAL HOSPITAL PARTICIPATES IN COMMUNITY WIDE CANCER SCREENING PROGRAMS AND PARTICIPATES IN REGIONAL RURAL HEALTH PLANNING ACTIVITIES. THE BOARD OF TRUSTEES IS MADE UP OF COMMUNITY BASED REPRESENTATIVES WHO PROVIDE DIRECTION AND OVERSIGHT OF ALL FACILITY SERVICES AND ACTIVITIES.6. THE CUBA MEMORIAL HOSPITAL IS NOT CURRENTLY AFFILIATED WITH ANY OTHER HEALTH CARE SYSTEM.7. CUBA MEMORIAL HOSPITAL ANNUALLY FILES A COMMUNITY BENEFIT REPORT WITH THE NEW YORK STATE DEPARTMENT OF HEALTH. | CUBA MEMORIAL HOSPITAL, INC. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | MARK STANCOMBE | NamePerson |
| Title | PHYSICIAN ASSISTANT | Title |
| Base Compensation Filing Org | 140303 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 0 | CompBasedOnRelatedOrgs |
| Bonus Filing Org | 0 | BonusFilingOrg |
| Bonus Related Orgs | 0 | BonusRelatedOrgs |
| Other Compensation Filing Org | 0 | OtherCompensationFilingOrg |
| Other Compensation Related Orgs | 0 | OtherCompensationRelatedOrgs |
| Deferred Comp Filing Org | 0 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 0 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 12559 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 0 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 152862 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 0 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 0 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 0 | CompReportPrior990RelatedOrgs |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALLEGANY COUNTY INDUSTRIAL DEVELOPMENT AGENCY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 470942108 | IssuerEIN |
| Date Issued | 2004-11-12 | DateIssued |
| Issue Price | 3000000 | IssuePrice |
| Description Of Purpose | REFINANCING OF HOSPITAL MORTGAGE | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 1 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Year Of Subst Completion | 2004 | YearOfSubstCompletion |
| Current Refunding | 1 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Bond Iss Meet Prvt Security Pay Test | 0 | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedProp |
| Non Qualified Bond Remed Procdrs | 0 | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiled |
| Rebate Not Due Yet | 1 | RebateNotDueYet |
| Exception To Rebate | 0 | ExceptionToRebate |
| No Rebate Due | 0 | NoRebateDue |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqs |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (4 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE BOARD OF TRUSTEE FINANCE COMMITTEE WAS PROVIDED A COPY OF THE DRAFT 990 FOR REVIEW. A MEETING WAS THEN HELD TO REVIEW ANY QUESTIONS OR ISSUES RELATED TO THE SUBMISSION. QUESTIONS WERE DISCUSSED AND RESOLVED AND THE REVISED SUBMISSION WAS SENT TO OUR INDEPENDENT AUDITORS FOR REVIEW. THE FINALIZED VERSION OF THE 990 IS THEN PROVIDED TO ALL BOARD MEMBERS. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANNUALLY, ALL TRUSTEES AND OFFICERS COMPLETE AND SIGN AN ATTESTATION FORM IDENTIFYING ANY PERSONAL AND/OR FAMILY POTENTIAL CONFLICT SITUATIONS. |
| FORM 990, PART VI, SECTION B, LINE 15 | ANNUALLY, THE BOARD OF TRUSTEES EXECUTIVE COMMITTEE REVIEWS CEO AND CFO PERFORMANCE AND COMPENSATION. KEY EMPLOYEE COMPENSATION IS REVIEWED AND ESTABLISHED BY EXECUTIVE OFFICER CONSISTENT WITH THE BOARD APPROVED OPERATING BUDGET. |
| FORM 990, PART VI, SECTION C, LINE 19 | MONTHLY AND ANNUAL FINANCIAL STATEMENTS ARE FILED WITH ALL FINANCIAL INSTITUTIONS WITH RELATIONSHIPS WITH THE HOSPITAL. ANNUAL COST REPORTS ARE FILED WITH MEDICARE AND MEDICAID. THE 990 IS ELECTRONICALLY FILED AND IS AVAILABLE FROM THE ORGANIZATION UPON REQUEST. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| CMHR CORPORATION | ||||||||||
| 140 WEST MAIN ST | CUBA | NY | 14727 | 562495396 | PROPERTY MANAGEMENT | NY | SECTION 501(C)3 | 9 | CUBA MEMORIAL HOSPITAL INC | 0 |
| CUBA MEMORIAL RETIREMENT COMMUNITY INC | ||||||||||
| 140 WEST MAIN ST | CUBA | NY | 14727 | 271463624 | ASSISTED LIVING | NY | SECTION 501(C)3 | 9 | CUBA MEMORIAL HOSPITAL INC | 0 |
| 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 | 0 | 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 | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Form990 Schedule R Part VII Form990ScheduleRPartVII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART V, SECTION 2 | ReturnReference |
| Explanation | PAID OFFICERS OF CUBA MEMORIAL HOSPITAL, INC ARE FUNCTIONING AS THE OFFICERS OF BOTH SUBSIDIARY CORPORATION UNTIL THERE IS ACTIVITY WHICH JUSTIFIES ADDITIONAL STAFF. DURING THE YEAR, ONLY PLANNING ACTIVITIES WERE INVOLVED IN IDENTIFYING POTENTIAL FINANCING FOR THE PLANNED ASSISTED LIVING CAMPUS TO BE DEVELOPED WHEN FINANCING CAN BE IDENTIFIED. | Explanation |