FURP.ORG / PUBLIC DATA EXPLORER

COLUMBIA MEMORIAL HOSPITAL: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
COLUMBIA MEMORIAL HOSPITAL (EIN 14-1338373)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-14
IRS object ID
201343189349306434
Schema version
2012v2.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-11-14T05:13:34-00:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Columbia Memorial HospitalBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line171 Prospect AvenueAddressLine1
CityHudsonCity
StateNYState
ZIP Code12534ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN141338373EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Columbia Memorial HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOLUNameControl
Phone5188287601Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line171 Prospect AvenueAddressLine1
CityHudsonCity
StateNYState
ZIP Code12534ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJay P CahalanName
TitlePresident CEOTitle
Date Signed2013-11-14DateSigned
Authorize Third PartyfalseAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJohn M GallagherName
Phone5188288181Phone
Date Prepared2013-11-14DatePrepared
Self EmployedXSelfEmployed
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJane EhrlichNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line171 Prospect AvenueAddressLine1
CityHudsonCity
StateNYState
ZIP Code12534ZIPCode
FieldValueIRS element (for citing)
Gross Receipts160879462GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.columbiamemorial.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionThe mission of Columbia Memorial Hospital is to provide our communities with safe, high quality, comprehensive health care services in a dignified and compassionate environment.ActivityOrMissionDescription
Nbr Voting Members Governing Body17NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees1605TotalNbrEmployees
Total Nbr Volunteers45TotalNbrVolunteers
Total Gross UBI119857TotalGrossUBI
Net Unrelated Business Txbl Income23879NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year2090556ContributionsGrantsPriorYear
Contributions Grants Current Year4085085ContributionsGrantsCurrentYear
Program Service Revenue Prior Year137810264ProgramServiceRevenuePriorYear
Program Service Revenue CY150008281ProgramServiceRevenueCY
Investment Income Prior Year347167InvestmentIncomePriorYear
Investment Income Current Year288320InvestmentIncomeCurrentYear
Other Revenue Prior Year-1974625OtherRevenuePriorYear
Other Revenue Current Year262655OtherRevenueCurrentYear
Total Revenue Prior Year138273362TotalRevenuePriorYear
Total Revenue Current Year154644341TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year81772622SalariesEtcPriorYear
Salaries Etc Current Year89731756SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year56838502OtherExpensePriorYear
Other Expenses Current Year61807810OtherExpensesCurrentYear
Total Expenses Prior Year138611124TotalExpensesPriorYear
Total Expenses Current Year151539566TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-337762RevenuesLessExpensesPriorYear
Revenues Less Expenses CY3104775RevenuesLessExpensesCY
Total Assets BOY84080999TotalAssetsBOY
Total Assets EOY92451460TotalAssetsEOY
Total Liabilities BOY65443019TotalLiabilitiesBOY
Total Liabilities EOY71274731TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY18637980NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY21176729NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionThe mission of Columbia Memorial Hospital is to provide our communities with safe, high quality, comprehensive health care services in a dignified and compassionate environment.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense42430400Expense
Revenue49429254Revenue
DescriptionAcute Inpatient Hospital services 32,537 patient days. Hospital Emergency Medical Care available to all 32,727 visits.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense75158725Expense
Revenue87426115Revenue
DescriptionOutpatient Surgery Outreach Clinics spanning 3 Counties. 373,496 visitsDescription

Activity3 Activity3

FieldValueIRS element (for citing)
Expense7891020Expense
Revenue9134027Revenue
DescriptionOur Nursing Home provides skilled care resident rehabilitative services. 40,709 patient daysDescription
FieldValueIRS element (for citing)
Total Of Other Program Service Exp3880829TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev4018885TotalOfOtherProgramServiceRev
Total Program Service Expense129360974TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundstrueDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionstrueDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgtrueTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096100NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees1605NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionstrueTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members17NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturetrueInvestmentInJointVenture
Written Policy Or ProceduretrueWrittenPolicyOrProcedure
States Where Copy Of Return Is FiledNYStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Columbia Memorial HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5188287601TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line171 Prospect AvenueAddressLine1
CityHudsonCity
StateNYState
ZIP Code12534ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (28 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
James Warren
Chair008.00XX000
Mary Gail Biebel
Vice-Chair008.00XX000
Donald Gibson
Treasurer008.00XX000
Winnie Thorn
Secretary008.00XX000
VRichard Back MD
Trustee008.00X3000
HLouis Clinton MD
Trustee008.00X40316700
Stephen Dunn
Trustee008.00X000
David Ginsberg
Trustee008.00X000
Clara Kellner
Trustee008.00X000
Aven Kerr
Trustee008.00X000
James M Kingsbury
Trustee008.00X000
James Lapenn
Trustee008.00X000
James Reynolds
Trustee008.00X000
William Van Slyke
Trustee008.00X000
Marie Ostoyich RN
Trustee008.00X000
Ananthakrishnan Ramani MD
Trustee040.00X37797400
John Mathews MD
Trustee008.00X39507000
Patti Matheney
Trustee008.00X000
Jane Ehrlich
Pres. CEO040.00XX46314700
Jay Cahalan
COO040.00X36425600
Vincent J Dingman III
CFO040.00X25620100
Norm Chapin MD
Medical Director040.0032036300X
Leitha Pierro
VP-Patient Clin. Oper.040.0019289600X
Christopher Gorczynski MD
Physician040.0065224900X
Ersno Eromo MD
Physician040.0056249000X
Andrew Packard MD
Physician040.0052622300X
Monoj Subudhi MD
Physician040.0049268000X
Karuvath Enu MD
Physician040.0048331600X
FieldValueIRS element (for citing)
Total Reportable Comp From Org5490062TotalReportableCompFromOrg
Number Individuals GT100 K99NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
AOW Associates Inc
30 Essex StreetAlbanyNY12206Contractor2601614
LabCorp
PO Box 12140BurlingtonNC27216Laboratory1446207
Dennis Marcus MD PC
PO Box 797ValatieNY12184Psychiatric Services1134901
Atlas
60 Grider StreetBuffaloNY14215Laundry Service605371
Sodexho Clinical
113 Seaboard Lane - Suite B201FranklinTN37067BioMed Services440550
FieldValueIRS element (for citing)
Number Of Contractors GT100 K36NumberOfContractorsGT100K
Related Organizations1328785RelatedOrganizations
Government Grants2635604GovernmentGrants
All Other Contributions120696AllOtherContributions
Noncash Contributions314481NoncashContributions
Total Contributions4085085TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
I/P O/P Svcs.- Medicare/Medicaid Paymts9000998466525684665256
I/P O/P Services - Other Direct Payments9000995888986358889863
Other Government Payments90009964531626453162
FieldValueIRS element (for citing)
Total Program Service Revenue150008281TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column259592TotalRevenueColumn
Exclusion$259,592ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities6240473Securities
Other23376Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities6235121Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities5352Securities
Other23376Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column28728TotalRevenueColumn
Exclusion$28,728ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
Unrealized Gain on Investments900099462283462283
Unrelated Business Income531190119857119857
FieldValueIRS element (for citing)
Total Other Revenue262655TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column154644341TotalRevenueColumn
Related Or Exempt Function Income150151079RelatedOrExemptFunctionIncome
Unrelated Business Revenue119857UnrelatedBusinessRevenue
Exclusion$288,320ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total5490062Total
Program Services3893199ProgramServices
Management And General1596863ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total68746943Total
Program Services60043992ProgramServices
Management And General8702951ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1824247Total
Program Services1719497ProgramServices
Management And General104750ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total8862489Total
Program Services8046423ProgramServices
Management And General816066ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total4808015Total
Program Services4226730ProgramServices
Management And General581285ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total318196Total
Program Services75889ProgramServices
Management And General242307ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total149835Total
Management And General149835ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Fees For Services Prof FundraisingFeesForServicesProfFundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total12854914Total
Program Services11281377ProgramServices
Management And General1573537ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total553541Total
Program Services559ProgramServices
Management And General552982ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total19305248Total
Program Services18083351ProgramServices
Management And General1221897ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total931305Total
Program Services514087ProgramServices
Management And General417218ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total4075185Total
Program Services3177556ProgramServices
Management And General897629ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total172568Total
Program Services50399ProgramServices
Management And General122169ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total154503Total
Program Services39556ProgramServices
Management And General114947ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1590943Total
Management And General1590943ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total37241Total
Program Services7742ProgramServices
Management And General29499ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total7083838Total
Program Services4622605ProgramServices
Management And General2461233ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total2781125Total
Program Services2555574ProgramServices
Management And General225551ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Maintenance22270681703324523744
Miscellaneous379382126196253186
Provision for Bad Debt85440808544080
Assessment648838648838

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total0Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total151539566Total
Program Services129360974ProgramServices
Management And General22178592ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY6467684BOY
EOY4614404EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY10872613BOY
EOY11588400EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1465692BOY
EOY1741737EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1472291BOY
EOY1316555EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis115040243LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec65686178LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY40944184BOY
EOY49354065EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY12056292BOY
EOY12822061EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY2149638BOY
EOY1490606EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY4966145BOY
EOY5530164EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3686460BOY
EOY3993468EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY84080999BOY
EOY92451460EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY9861731BOY
EOY12422953EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY32298995BOY
EOY32702094EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY137329BOY
EOY68329EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY23144964BOY
EOY26081355EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY65443019BOY
EOY71274731EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY16170358BOY
EOY18306946EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1481957BOY
EOY1883118EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY985665BOY
EOY986665EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY18637980BOY
EOY21176729EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY84080999BOY
EOY92451460EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses3104775ReconcilationRevenueExpenses
Reconciliation Unrealized Invest5501ReconciliationUnrealizedInvest
Reconcilation Other Changes-571527ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview

Accountant Compile Or Review Basis AccountantCompileOrReviewBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii
Public Support Pertcentage1700.00000PublicSupportPertcentage170
Public Support Percentage5090.00000PublicSupportPercentage509
Investment Income Percentage0.00000InvestmentIncomePercentage

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Number DA Fs Held1NumberDAFsHeld
Donor Advised Contributions7920DonorAdvisedContributions
Aggregate DAF Value27688AggregateDAFValue
Disclosed Orgs Legal ControltrueDisclosedOrgsLegalControl
Disclosed For Charitable PurposestrueDisclosedForCharitablePurposes
Included On FSfalseIncludedOnFS

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance6367304BeginningOfYearBalance
Contributions4449006Contributions
Investment Earnings Or Losses535580InvestmentEarningsOrLosses
Other Expenditures4305681OtherExpenditures
End Of Year Balance7046209EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance6708314BeginningOfYearBalance
Contributions1929661Contributions
Investment Earnings Or Losses-298828InvestmentEarningsOrLosses
Other Expenditures1971843OtherExpenditures
End Of Year Balance6367304EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance6309608BeginningOfYearBalance
Contributions1082856Contributions
Investment Earnings Or Losses515830InvestmentEarningsOrLosses
Other Expenditures1199980OtherExpenditures
End Of Year Balance6708314EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance6110594BeginningOfYearBalance
Contributions749034Contributions
Investment Earnings Or Losses592695InvestmentEarningsOrLosses
Other Expenditures1142715OtherExpenditures
End Of Year Balance6309608EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance7632997BeginningOfYearBalance
Contributions3220130Contributions
Investment Earnings Or Losses-1514973InvestmentEarningsOrLosses
Other Expenditures3227560OtherExpenditures
End Of Year Balance6110594EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.24000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.14000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.62000TermEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgstrueEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RtrueAreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis782850OtherCostOrOtherBasis
Book Value782850BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis64797685OtherCostOrOtherBasis
Depreciation28962960Depreciation
Book Value35834725BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis48583690OtherCostOrOtherBasis
Depreciation36148278Depreciation
Book Value12435412BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis876018OtherCostOrOtherBasis
Depreciation574940Depreciation
Book Value301078BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings49354065TotalOfBookValueLandBuildings

Other Securities OtherSecurities (2 entries)

DescriptionDescription
Financial derivatives and other financial products
Closely-held equity interests

Other Liabilities OtherLiabilities (10 entries)

DescriptionDescriptionAmountAmount
Federal income taxes
Accrued Vacation PTO$3,570,646
Estimated Payables to 3rd Party Reimbursement Agencies$3,239,000
Accrued Pension$7,369,118
Obligations Under Capital Leases$3,264,270
Interest Rate Swaps$2,739,983
Asset Retirement Obligation$1,229,640
Deferred Liability - Exec. Life Insurance Policies$2,744,698
Professional Liability Insurance Reserve$1,828,000
Kaaterskill Commons - Ground Lease$96,000
FieldValueIRS element (for citing)
Total Of Amounts26081355TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt151389727TotRevenueEtcAuditedFinclStmt
Revenue Subtotal151389727RevenueSubtotal
Other Revenues Not Included3254614OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt3254614RevenueNotRptdOnFinStmt
Total Revenue Per Form990154644341TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt151763261TotExpensesEtcAuditedFinclStmt
Expenses Subtotal151763261ExpensesSubtotal
Other Expenses Not Included-223695OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt-223695ExpensesNotRptdOnFinStmt
Total Expenses Per Form990151539566TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
X2Audited Statement Footnote 1t, Income Taxes The hospital and KCI are Internal Revenue Code Section 501c3 organizations and , as such, are exempt from Federal Income Taxes on related income pursuant to Section 501a. The Hospital recognizes effect, if any, of income tax positions only if they are more likely than not, sustainable under current income tax regulations. Recoginzed income tax positions are measured at the largest amount that is greater than 50 likely of being realized. Changes in recognition or measurement are reflected in the period in which the change in judgment occurs. The Hospital has no uncertain tax positions at December 2012 or 2011.
XI4bNot included in revenue on Part XII, Line 1, but included as revenue on the Hospitals consolidated financials are restricted Gifts Grants 3,365,249 which are adjustments to temporary Permanently Restricted Net Assets Revenue from Kaaterskill commons, Inc. 110,971 Net Worth of a related organization which is not recorded on the Hospitals books 336.
XII4bNot included in Expenses on Part XII, Line 3, but included as expense on the Hospitals consolidated financials are the expenses for Kaaterskill Commons, Inc. 223,695.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense512745TotalCommunityBenefitExpense
Net Community Benefit Expense512745NetCommunityBenefitExpense
Percent Of Total Expense0.00340PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense32217486TotalCommunityBenefitExpense
Direct Offsetting Revenue24164047DirectOffsettingRevenue
Net Community Benefit Expense8053439NetCommunityBenefitExpense
Percent Of Total Expense0.05310PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense32730231TotalCommunityBenefitExpense
Direct Offsetting Revenue24164047DirectOffsettingRevenue
Net Community Benefit Expense8566184NetCommunityBenefitExpense
Percent Of Total Expense0.05650PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense498765TotalCommunityBenefitExpense
Direct Offsetting Revenue76563DirectOffsettingRevenue
Net Community Benefit Expense422202NetCommunityBenefitExpense
Percent Of Total Expense0.00280PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense76752TotalCommunityBenefitExpense
Direct Offsetting Revenue7285DirectOffsettingRevenue
Net Community Benefit Expense69467NetCommunityBenefitExpense
Percent Of Total Expense0.00050PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense66374381TotalCommunityBenefitExpense
Direct Offsetting Revenue51961867DirectOffsettingRevenue
Net Community Benefit Expense14412514NetCommunityBenefitExpense
Percent Of Total Expense0.09510PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense66949898TotalCommunityBenefitExpense
Direct Offsetting Revenue52045715DirectOffsettingRevenue
Net Community Benefit Expense14904183NetCommunityBenefitExpense
Percent Of Total Expense0.09840PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense99680129TotalCommunityBenefitExpense
Direct Offsetting Revenue76209762DirectOffsettingRevenue
Net Community Benefit Expense23470367NetCommunityBenefitExpense
Percent Of Total Expense0.15490PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense230255TotalCommunityBuildingExpense
Net Community Building Expense230255NetCommunityBuildingExpense
Percent Of Total Expense0.00150PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense230255TotalCommunityBuildingExpense
Net Community Building Expense230255NetCommunityBuildingExpense
Percent Of Total Expense0.00150PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense$8,544,080BadDebtExpenseAmount
Amount Attributable To205496AmountAttributableTo
Amount Reimbursed By Medicare60550709AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare59418529CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall1132180MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

FieldValueIRS element (for citing)
Business Name Line1Tri-Way InterventionalBusinessNameLine1
FieldValueIRS element (for citing)
Description Ent Primary ActivityOwnership/Rental of Vascular EquipmentDescriptionEntPrimaryActivity
Organization Profit Or Ownership0.33000OrganizationProfitOrOwnership
Physicans Profit Or Ownership0.33000PhysicansProfitOrOwnership
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Columbia Memorial HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line171 Prospect AvenueAddressLine1
CityHudsonCity
StateNYState
ZIP Code12534ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours
Facility Reporting GroupCMHFacilityReportingGroup

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1CMHBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA ConductedtrueCHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
Community Health NeedsXCommunityHealthNeeds
Other Health IssuesXOtherHealthIssues
Identifying ProcessXIdentifyingProcess
Needs Assessment Conducted12NeedsAssessmentConducted
Take Into AccounttrueTakeIntoAccount
Other FacilitiestrueOtherFacilities
CHNA Widely AvailabletrueCHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Adopt Implement StrategyXAdoptImplementStrategy
Develop Community PlanXDevelopCommunityPlan
Prioritize ServicesXPrioritizeServices
All Needs AddressedtrueAllNeedsAddressed
Organization Incur Excise TaxfalseOrganizationIncurExciseTax
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent0000000001.000000000000FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent0000000004.000000000000FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Permit Report To Credit AgencyXPermitReportToCreditAgency
Permit LawsuitXPermitLawsuit
Permit Lien On ResidenceXPermitLienOnResidence
Collection ActivitiestrueCollectionActivities
Report To Credit AgencyXReportToCreditAgency
LawsuitXLawsuit
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care PolicyfalseNondiscrimEmergencyCarePolicy
Lowest Negotiated RatesXLowestNegotiatedRates
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargestrueGrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities1NumberOfOtherFacilities

Other Facilities OtherFacilities

Name Name

FieldValueIRS element (for citing)
Business Name Line1Kaaterskill Care Skilled Nursing & RehabBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1161 Jefferson HeightsAddressLine1
CityCatskillCity
StateNYState
ZIP Code12414ZIPCode
FieldValueIRS element (for citing)
Facility TypeSkilled Nursing RehabFacilityType

Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)

IdentifierIdentifierExplanationExplanation
Part I Line 7For the purposes of calculating the Hospitals total community benefits expense at cost, the Hospital used a cost-to-charge ratio, consistent with the calculation derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges.
Part IIThe hospitals community building activities consist of ongoing workforce development and community training sessions, for which the Hospital receives a very nominal fee, if any. These free or low-cost programs increase community awareness of health issues, provide an opportunity for ongoing education of community providers and caregivers, and support improved health habits for the community the Hospital serves.
Part III Line 4The Hospital used the Bad Debt Expense derived from the audited Statement of Operations for the period-ended December 31, 2012. Bad Debts are estimated at cost on an ongoing basis, and charged to expense when management deems it probable that the revenue will not be collected. Discounts provided to patients are considered an adjustment in calculating Net Patient Service Revenue, and are not included as a component of Bad Debt Expense.
Part III Line 4The Hospitals discusses the availability of charity care with patients during the registration process, and enrolls all eligible patients based on the information provided by the patient.
Part III Line 4The Hospitals audited financial statements contain the following information regarding bad debt expense The amount of the provision for bad debts is based on managements assessment of historical and expected net collections, based on business and economic conditions, trends in federal and state governmental health care coverage and other collection indicators.
Part III Line 8The Hospitals costing methodology used to determine the Medicare allowable costs reported in the organizations Medicare Cost Report is based upon the ratio of patient care cost to charges.
Part III Line 9bThe Hospital follows a consistent collections policy for all patients.
Part VLine 19d The Hospital determines the maximum amounts charged to Financial Assistance Policy FAP individuals based upon the payment rates negotiated with the commercial insurer with the highest volume of services performed at our facility and outpatient locations.
Part VI Line 2The Hospital continuously monitors changes in the demographics of the 2 counties it serves, through community outreach, discussions with local political and business leader, and working with a variety of state and local agencies to assess the needs of the community. The Community Service plan is continuously updated and available on the Hospitals public website. The Hospital serves the people of Columbia and Greene Counties and part of Northern Dutchess County, with a combined population of approximately 115,000, which, is distributed between one small city and 32 towns. The two counties combined, cover an area of nearly 1,300 square miles, most of which is agricultural or rural. Columbia County is located in the northeastern region of the Mid-Hudson Valley of New York State. It is bordered on the north by Rensselaer County, on the south by Dutchess County, on the east by the Berkshire County of the Commonwealth of Massachsetts and on the west by the Hudson River, opposite Greene County. Columbia County is rural in nature and includes the City of Hudson and 18 towns. Greene County is situated between the Hudson River on the east and the Catskill Mountains at the Southern Western ends. It is bordered by Albany County to the north, Rensselaer County to the northeast, Columbia County to the east, Ulster County to the south, Delaware County to the west and Schoharie County to the northwest. Greene County is two hours north of the major metropolitan areas of New York City, and a half-hour south of Albany, New York States Capital District.
Part VI Line 3The Hospitals written Bad Debt Charity Care policy broadly applies to the outstanding balance for patient or insurer. The Hopital advertises throughout the facility, discusses directly with patients during the registration process, and again during collections process re availability for charity care. As patients enroll in Charity Care, adjustment to their o/s balance is charged against net patient service revenue, and not considered a component of bad debt expense.
Part VI Line 6The Hospital is not part of an affiliated health care system, and files a community benefit report only in New York State.
Part VI, Line 7NY

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (13 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgBonus Filing OrgBonusFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg
HLouis Clinton MD
Trustee403167750403917
Ananthakrishnan Ramani MD
Trustee2577161575042072412000025827000
John Mathews MD
Trustee395070395070
Jane Ehrlich
Pres. CEO3968394044542941529171339175750
Jay Cahalan
COO282667513844163607050011089720
Vincent J Dingman III
CFO206237383752977614750024643185
Norm Chapin MD
Medical Director305146750324966150002163854
Leitha Pierro
VP-Patient Clin. Oper.17434019289617500396660
Christopher Gorczynski MD
Physician65219565224954
Ersno Eromo MD
Physician562490562490
Andrew Packard MD
Physician526223526619396
Monoj Subudhi MD
Physician492422750493430258
Karuvath Enu MD
Physician4820804833161236

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Identifier1Identifier
Return Reference3ReturnReference
ExplanationThe compensation of the Hospitals CEO is determined by the Compensation Committee of the Board of Trustees. This Committee bases their decision on CEO compensation surveys from healthcare industry organizations, Form 990 for comparable organizations and general industry knowledge. The CEO compensation package is formalized in a written employment contract and approved by that Committee.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Bond ReferenceBondReferenceCdIssuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeased
Columbia County Industrial Development Agency
A141636496197511AR92008-01-3011730000Refinancingfalse
Columbia County Capital Resource Corp
B271072117197505AA82010-03-0112945000Refinancing New Constructionfalse

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Bond ReferenceBondReferenceCdTotal ProceedsTotalProceedsIssuance Costs From ProceedsIssuanceCostsFromProceedsWorking Capital ExpendituresWorkingCapitalExpendituresCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindAmount UnspentAmountUnspent
A11730000603669385291072734212010falsefalsetruetrue
B1294500076295895745232012falsefalsefalsetrue2607519

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsTerm Of HedgeTermOfHedgeSuperintegrated HedgeSuperintegratedHedgeHedge TerminatedHedgeTerminatedGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvested
HSBC
Afalsetruetrue0000000010.000000000000falsefalsefalsefalse
HSBC
Bfalsetruetrue0000000010.000000000000falsefalsefalsefalse

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
James Reynolds
CMH Board Trustee61969Refer to Schedule L, Part Vfalse
David Ginsberg
CMH Board Trustee695218Refer to Schedule L. Part Vfalse

Form990 Schedule L Part V Form990ScheduleLPartV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
IV1James Reynolds, a Columbia Memorial Hospital Board Trustee, is President of Mid-Hudson Cablevision, Inc. 52,667, and Mid-Hudson Media 9,302. Those companies provide cable internet service to various locations belonging to the Hospital.
IV1David Ginsberg, a Columbia Memorial Hospital Board Trustee, is also the Owner, President and CEO of Ginsbergs Institutional Foods, Inc. His company provided 695,218 in food, paper products, etc. during 2012.

Schedule M IRS990ScheduleM

Real Estate Residential RealEstateResidential

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F990300000NoncashContribsRptdF990
Method Of Determining RevenuesSale of Comparable PropertiesMethodOfDeterminingRevenues

Real Estate Other RealEstateOther

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F99014481NoncashContribsRptdF990
Method Of Determining RevenuesPaving Mat.Labor-Pkg.LotMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Number Of8283 Received1NumberOf8283Received
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftstrueReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

ExplanationExplanation
Form 990, Part III, Line 4d Program Service Expenses 3,880,829, Grants and allocations 0, Revenue 4,018,885 Miscellaneous Ancillary services
Form 990 Part VI Section B Line 11b - GOVERNING BODYS REVIEW OF FORM 990 Form 990 and its supporting schedules are mailed to the Executive and/or Finance Committees for their review, in advance of a meeting to be held whereby feedback is obtained from members of those committees. As result of that meetings, changes agreed upon, if any, are made to said documents prior to the presentation made by the Chief Financial Officer of Columbia Memorial Hospital at the General Board of Trustees Meeting.
Form 990 Part VI Section B Line 12c CONFLICT OF INTEREST All members of the Board of Trustees are required to complete and execute the Hospital policy on Organizational Ethics as well as a Conflict of Interest Questionaire for Trustees and Confidentiality Agreement for Board Members. In addition to these forms being completed by new members, they are also required from all encumbent trustees on an annual basis. The Governance Committee reviews, monitors enforces conflicts of interest issues, and reports the same to all members at General Board Meetings.
Form 990 Part VI Section B Line 15a COMPENSATION OF CEO OTHER KEY EMPLOYEES Performance review and recommendations pertaining to salary are undertaken by the Compensation Committee on an annual basis. The Compensation Committee is comprised of select member of the Board of Trustees who may employ outside consultants, use data industry standards, etc. to formulate conclusions.
Form 990 Part VI Section B Line 19 DISCLOSURE Columbia Memorial Hospital makes its governing documents, conflict of interest policy and financial statements available to the public upon request.
Form 990 Part XI Line 9 RECONCILIATION OF NET ASSETS Combined total of -571,527 adjustment doe to the following Pension valuation -35,169, Net assests released from restriction -236,022, change in net assets of Auxiliary not booked by CMH -336.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
Columbia-Greene Hospital Foundation
71 Prospect AvenueHudsonNY12534141761112Fund RaisingNY501c3170b1AivN/Afalse
The Second Show Inc
519 Warren StreetHudsonNY12534141796715Thrift ShopNY501c3170b1AivN/Afalse

Form990 Schedule R Part III Form990ScheduleRPartIII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAPredominant Income TypePredominantIncomeTypeDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartnerShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnership
Columbia Medical Complex LLC
839 North Jefferson StreetMilwaukeeWI53202201017545HealthcareWIN/ARelatedfalsefalse
Tri-Way Interventional LLC
c/o 71 Prospect AvenueHudsonNY12534320041811HealthcareNYN/ARelatedfalsefalse73097869260.33340
Capital Health Network LLC
125 Wolf RoadAlbanyNY12205141794727HealthcareNYN/AInvestmentfalsefalse
United Lab Network LLC
125 Wolf RoadAlbanyNY12205141827292HealthcareNYN/AInvestmentfalsefalse
United Lab Network IPA LLC
125 Wolf RoadAlbanyNY12205141832018HealthcareNYN/AInvestmentfalsefalse

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Columbia-Greene Services IncBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1c/o CMH 71 Prospect AvenueAddressLine1
CityHudsonCity
StateNYState
ZIP Code12534ZIPCode
FieldValueIRS element (for citing)
EIN141758524EIN
Primary ActivityHealthcarePrimaryActivity
Legal Domicile StateNYLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityC CorpTypeOfEntity
Percentage Ownership1.00000PercentageOwnership
Controlled OrgfalseControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
Columbia-Greene Hospital Foundation
c1692766
Columbia-Greene Hospital Foundation
m61873
Columbia-Greene Hospital Foundation
q196393
The Second Show Inc
q67101