MOUNT ST MARYS HOSPITAL OF NIAGARA FALLS: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
MOUNT ST MARYS HOSPITAL OF NIAGARA FALLS (EIN 16-1523353)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-14
IRS object ID
201223199349300342
Schema version
2011v1.2
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)
Timestamp2012-11-14T08:29:45-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN861065772EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Deloitte Tax LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1250 East Fifth Street Suite 1900AddressLine1
CityCincinnatiCity
StateOHState
ZIP Code45202ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN161523353EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Mount St Mary's Hospital of Niagara FallsBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMOUNNameControl
Phone7162974800Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line15300 Military RoadAddressLine1
CityLewistonCity
StateNYState
ZIP Code140921997ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJudith A ManessName
TitlePresident/CEOTitle
Phone7162974800Phone
Date Signed2012-11-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameRebecca LyonsName
PTINP01487105PTIN
Phone5137847100Phone
Date Prepared2012-11-12DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1Mount St Mary's Hospital & Health CenterBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonJudith A ManessNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line15300 Military RoadAddressLine1
CityLewistonCity
StateNYState
ZIP Code140921997ZIPCode
FieldValueIRS element (for citing)
Gross Receipts92252477GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web Sitewww.msmh.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1907YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionOur Catholic health ministry is dedicated to spiritually centered, holistic care, which sustains and improves the health of individuals and communities. In furtherance of our mission and in an effort to reduce the government's financial burden, Mount St. Mary's Hospital and Health Center provides essential heath care services to all persons without regard to ability to pay. Our Neighborhood Health Center, located in the poorest and most underserved census tract of the city of Niagara Falls, a full-service emergency room, numerous community education programs and screenings, and more are evidence of our commitment to provide healthcare that leaves no one behind.ActivityOrMissionDescription
Nbr Voting Members Governing Body16NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees982TotalNbrEmployees
Total Nbr Volunteers239TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year398179ContributionsGrantsPriorYear
Contributions Grants Current Year1717541ContributionsGrantsCurrentYear
Program Service Revenue Prior Year80945254ProgramServiceRevenuePriorYear
Program Service Revenue CY86185236ProgramServiceRevenueCY
Investment Income Prior Year667474InvestmentIncomePriorYear
Investment Income Current Year371577InvestmentIncomeCurrentYear
Other Revenue Prior Year942929OtherRevenuePriorYear
Other Revenue Current Year3978123OtherRevenueCurrentYear
Total Revenue Prior Year82953836TotalRevenuePriorYear
Total Revenue Current Year92252477TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year50858245SalariesEtcPriorYear
Salaries Etc Current Year53705918SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year32034099OtherExpensePriorYear
Other Expenses Current Year34071113OtherExpensesCurrentYear
Total Expenses Prior Year82892344TotalExpensesPriorYear
Total Expenses Current Year87777031TotalExpensesCurrentYear
Revenues Less Expenses Prior Year61492RevenuesLessExpensesPriorYear
Revenues Less Expenses CY4475446RevenuesLessExpensesCY
Total Assets BOY48530943TotalAssetsBOY
Total Assets EOY49786220TotalAssetsEOY
Total Liabilities BOY49133679TotalLiabilitiesBOY
Total Liabilities EOY43361599TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-602736NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY6424621NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionThe mission of Mount St. Mary's Hospital and Health Center, sponsored by Ascension Health, is: We are called to continue the healing ministry of Jesus by providing compassionate, person-centered care; while respecting the dignity of all, with special concern for those who are poor and vulnerable.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense31698816Expense
Revenue47082232Revenue
DescriptionMount St. Mary's Hospital provides in-patient medical and surgical services to the community, including acute care, cardiac and medical intensive care, telemetry, maternity, pediatrics, palliative care, stroke care and inpatient alcohol & substance abuse rehab. During the calendar year ending December 31, 2011, our Hospital treated 6,225 inpatient adults and children in the community for a total of 32,570 patient days of service. A substantial portion of services are provided to the elderly and poor. During the calendar year ending December 31, 2011, approximately 58% of the value of services rendered was to elderly patients under the Medicare program, and approximately 13% of the services were provided to patients who were deemed indigent under state, county, or Hospital guidelines. In the spirit of principles adopted by Ascension Health and our Mount St. Mary's Hospital Board of Trustees, Mount St. Mary's has taken proactive steps to address those issues that affect accessibility, financing, and the delivery of healthcare to all persons, especially those who are uninsured, underinsured, and the underserved. All services are designed to provide healing without harm to those we serve.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense27026732Expense
Revenue40142790Revenue
DescriptionMount St. Mary's provides the following outpatient medical services to the community: cardiac services, emergency services, laboratory services, neurology services including EEG and EMG, orthopedic services, pain management, primary care clinic, radiology services, rehabilitation services, surgical services, sleep studies, physical therapy, occupational therapy, speech therapy, wound care, ENT, urology, hyperbaric medicine, respiratory therapy and pulmonary function studies. Some of the services listed, such as the primary care clinic, operate at a deficit but are supported and maintained in order to ensure that all services are available to meet community health care needs. During the calendar year ending December 31, 2011, our Hospital provided services to 141,415 outpatients, including 8,564 outpatient surgery patients, 22,849 emergency room visits, 69,119 referred ambulatory patients, and 40,883 clinic visits.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense5292702Expense
DescriptionDuring the calendar year ending December 31, 2011, the estimated unreimbursed cost of services provided to the elderly, uninsured, and underinsured totaled $5,292,000, including $299,000 cost for charity care, $1,130,000 in programs for the poor, $817,000 in services to the general community, and $3,046,000 in unpaid cost of public programs. Community benefit programs or activities are those that provide treatment and/or promote health and healing as a response to identified community needs. In efforts to promote healthy living, Mount St. Mary's Hospital has made available the following programs to the community: physical fitness activities, community health programs, medical education, cancer screening programs, heart disease screening programs, support groups and educational classes, CPR and first aid classes, flu shot clinics, nutrition and weight loss management, and smoking cessation, among others.Description
FieldValueIRS element (for citing)
Total Program Service Expense64018250TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096138NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees982NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members16NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
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 Line1Tony RispoliBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7162982010TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line15300 Military RoadAddressLine1
CityLewistonCity
StateNYState
ZIP Code140921997ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (27 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Sister Margaret Tuley DC
Chairperson2.00X000
Sister Kathleen Natwin DC
Vice Chairperson2.00X000
Mark J Gabriele
Secretary2.00X000
Robert J Travis
Treasurer2.00X000
Dena Armstrong
Trustee2.00X000
Patrick J Berrigan
Trustee2.00X000
William Bradberry
Trustee2.00X000
Lloyd W Brown MD
Trustee2.00X000
Robert L Bull Jr MD
Trustee (End 9/11)2.00X000
Francis DiCamillo
Trustee2.00X000
Carmen A Granto
Trustee2.00X000
John D Greene MD
Trustee (End 9/11)2.00X000
Donald J Largo Jr MD
Trustee2.00X000
Robert A Minicucci Sr
Trustee2.00X000
Sister Marilyn Perkins DC
Trustee2.00X000
Deborah J Winslow-Schaber
Trustee2.00X000
Michael L Vitch
Trustee2.00X000
Judith A Maness
President/CEO40.00X580744022793X
Michael F Ickowski
VP Finance/CFO40.00217066022100X
Gary Tucker
Sr. VP/COO40.00254265022905X
Deborah Serafin
VP Human Resources40.00213171011748X
Barbara Bucci
VP Patient Care Services40.00157032020674X
Benjamin G Rueda MD
Cardiologist40.00466271022966X
Parmanand K Parikh MD
Otolaryngologist40.00402458017900X
Marc J Veneziano MD
Cardiologist40.00378072019962X
Justin Miller MD
Otolaryngologist40.00355919019322X
Young J Yu MD
Neurosurgeon40.00279403020111X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3304401TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation200481TotalOtherCompensation
Number Individuals GT100 K39NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
TriMedx LLC
PO Box 636129CincinnatiOH452636129Maintenance Services991671
John W Danforth Company
300 Colvin Woods ParkwayTonawandaNY14150Construction Services721494
Exigence Hospitalist Medical
1 John James Audubon PkwyAmherstNY142281145Professional Services611650
Catholic Health Systems Lab
2157 Main StBuffaloNY14214Professional Services507539
Precision Health Care NY LLC
1160 Southwest 21st AveBoca RatonFL33486Professional Services506000
FieldValueIRS element (for citing)
Number Of Contractors GT100 K13NumberOfContractorsGT100K
Related Organizations597208RelatedOrganizations
Government Grants395000GovernmentGrants
All Other Contributions725333AllOtherContributions
Total Contributions1717541TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Net Inpatient Svcs6219904652097846520978
Net Outpatient Svcs6219903966425839664258
FieldValueIRS element (for citing)
Total Program Service Revenue86185236TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column371577TotalRevenueColumn
Exclusion$371,577ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real104262Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real104262Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column104262TotalRevenueColumn
Exclusion$104,262ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Pension Gain9000992435550$2,435,550
Cafeteria722210398525$398,525
Physical Therapy6214007784977849

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column961937TotalRevenueColumn
Related Or Exempt Function Income961937RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue3873861TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column92252477TotalRevenueColumn
Related Or Exempt Function Income87225022RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$3,309,914ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1422278Total
Management And General1422278ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total40209581Total
Program Services28653983ProgramServices
Management And General11555598ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total2027485Total
Program Services1395458ProgramServices
Management And General632027ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total7071314Total
Program Services4866977ProgramServices
Management And General2204337ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2975260Total
Program Services2047784ProgramServices
Management And General927476ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total296547Total
Management And General296547ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total93135Total
Management And General93135ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total112118Total
Management And General112118ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total289299Total
Program Services289299ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1305210Total
Program Services1305210ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total1122921Total
Program Services1122921ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total518575Total
Program Services518575ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2597048Total
Program Services2597048ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total238727Total
Program Services238727ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Supplies12205237109400011265236
Contracted Services574878921207533628036
Equipment Rental328496017467251538235
Professional Fees2606752252299483758

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total3651795Total
Program Services3651795ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total87777031Total
Program Services64018250ProgramServices
Management And General23758781ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY442641BOY
EOY590401EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY8762798BOY
EOY10425711EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY82769BOY
EOY142272EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY2368075BOY
EOY1648436EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY585374BOY
EOY912648EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis50706069LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec30537586LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY19499713BOY
EOY20168483EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY16789573BOY
EOY15898269EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY48530943BOY
EOY49786220EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY14909812BOY
EOY9049545EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY34223867BOY
EOY34312054EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY49133679BOY
EOY43361599EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-5758145BOY
EOY1164376EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY5155409BOY
EOY5260245EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-602736BOY
EOY6424621EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY48530943BOY
EOY49786220EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses4475446ReconcilationRevenueExpenses
Reconcilation Other Changes2551911ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

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 C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators1DirectContactLegislators
Direct Contact Legislators$95,000DirectContactLegislatorsAmount
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$17,118OtherActivitiesAmount
Total Lobbying Expenditures IIB112118TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierExplanation of Lobbying Activities:Identifier
Return ReferencePart II-B, Line 1:ReturnReference
ExplanationLobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. In additition, expenses are paid to consultants for work on behalf of Mount St. Mary's Hospital of Niagara Falls. Mount St. Mary's Hospital of Niagara Falls does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis377517OtherCostOrOtherBasis
Book Value377517BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis24995618OtherCostOrOtherBasis
Depreciation15959572Depreciation
Book Value9036046BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis18116523OtherCostOrOtherBasis
Depreciation11293981Depreciation
Book Value6822542BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis7216411OtherCostOrOtherBasis
Depreciation3284033Depreciation
Book Value3932378BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings20168483TotalOfBookValueLandBuildings

Other Assets OtherAssets (5 entries)

DescriptionDescriptionBook ValueBookValue
Due from Affiliates2016474
Beneficial Interest in Net Assets of Foundation4433699
Health System Depository Account8604752
Assets Limited to Use826546
Executive Deferred Compensation16798
FieldValueIRS element (for citing)
Total Book Value Other Assets15898269TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
Third Party Liabilities$1,610,816
Self-Insurance Liability$181,708
Intercompany Debt to Ascension Health$32,519,530
FieldValueIRS element (for citing)
Total Of Amounts34312054TotalOfAmounts

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1231645TotalCommunityBenefitExpense
Direct Offsetting Revenue933083DirectOffsettingRevenue
Net Community Benefit Expense298562NetCommunityBenefitExpense
Percent Of Total Expense0.00350PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense11786841TotalCommunityBenefitExpense
Direct Offsetting Revenue8790342DirectOffsettingRevenue
Net Community Benefit Expense2996499NetCommunityBenefitExpense
Percent Of Total Expense0.03520PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense134479TotalCommunityBenefitExpense
Direct Offsetting Revenue85091DirectOffsettingRevenue
Net Community Benefit Expense49388NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense13152965TotalCommunityBenefitExpense
Direct Offsetting Revenue9808516DirectOffsettingRevenue
Net Community Benefit Expense3344449NetCommunityBenefitExpense
Percent Of Total Expense0.03930PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense914911TotalCommunityBenefitExpense
Direct Offsetting Revenue77957DirectOffsettingRevenue
Net Community Benefit Expense836954NetCommunityBenefitExpense
Percent Of Total Expense0.00980PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense172822TotalCommunityBenefitExpense
Net Community Benefit Expense172822NetCommunityBenefitExpense
Percent Of Total Expense0.00200PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense1376114TotalCommunityBenefitExpense
Direct Offsetting Revenue611818DirectOffsettingRevenue
Net Community Benefit Expense764296NetCommunityBenefitExpense
Percent Of Total Expense0.00900PercentOfTotalExpense

Research Research

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Total Community Benefit Expense2516TotalCommunityBenefitExpense
Net Community Benefit Expense2516NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense171665TotalCommunityBenefitExpense
Net Community Benefit Expense171665NetCommunityBenefitExpense
Percent Of Total Expense0.00200PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense2638028TotalCommunityBenefitExpense
Direct Offsetting Revenue689775DirectOffsettingRevenue
Net Community Benefit Expense1948253NetCommunityBenefitExpense
Percent Of Total Expense0.02280PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense15790993TotalCommunityBenefitExpense
Direct Offsetting Revenue10498291DirectOffsettingRevenue
Net Community Benefit Expense5292702NetCommunityBenefitExpense
Percent Of Total Expense0.06210PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense839TotalCommunityBuildingExpense
Net Community Building Expense839NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense4112TotalCommunityBuildingExpense
Net Community Building Expense4112NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense169480TotalCommunityBuildingExpense
Net Community Building Expense169480NetCommunityBuildingExpense
Percent Of Total Expense0.00200PercentOfTotalExpense

Total Total

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Total Community Building Expense174431TotalCommunityBuildingExpense
Net Community Building Expense174431NetCommunityBuildingExpense
Percent Of Total Expense0.00200PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$1,242,559BadDebtExpenseAmount
Amount Attributable To21768AmountAttributableTo
Amount Reimbursed By Medicare16877888AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare19507793CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-2629905MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

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Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Mount St Mary's HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line15300 Military RoadAddressLine1
CityLewistonCity
StateNYState
ZIP Code140921997ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

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Business Name Line1Mount St Mary's Hosp of Niagara FallsBusinessNameLine1
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Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent300.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Insurance StatusXInsuranceStatus
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Available On RequestXAvailableOnRequest
Other PublicityXOtherPublicity
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Medicare RateXMedicareRate
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities6NumberOfOtherFacilities

Other Facilities OtherFacilities (6 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
MSM Ctr for Sports Med & Phys Rehab
One Colomba Drive Suite 5Town of NiagaraNY14305Sports Medicine & Physical Rehabilitation
MSM Ear Nose and Throat Services
6941 Elaine DriveNiagara FallsNY14305Ear, Nose, and Throat Services
MSM Specialty Medical Services
One Colomba Drive Suite 5Town of NiagaraNY14305Specialty Medical Services
MSM Primary Care Neighborhood Hlt Ctr
3101 Ninth StreetNiagara FallsNY14305Primary Care
MSM Primary Care MSM Campus
5290 Military Road Suite 8LewistonNY14092Primary Care
MSM Wound Care Center
5300 Military RoadLewistonNY14092Wound Care Center

Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
Part I, Line 7: A cost to charge ratio was used for costing various amounts in the table, using a calculation based on Worksheet 2.
Part I, Line 7g: A loss of $714,072 from the Neighborhood Health Center, a hospital-based clinic located in a low income, economically depressed and health shortage area of the City of Niagara Falls, is included in Part I, line 7. It is located in a census tract which has the largest segment of people who are poor and underserved in Niagara County.
Part I, L7 Col(f): The Bad Debt expense included on Form 990, Part XI, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $2,597,048.
Part II: Among the community building activities the Hospital participates in are physician recruitment and a Parish Nurse Program. The physician recruitment efforts are designed to bring specialty physicians into the area for services that are underserved. The Parish Nurse Program is a partnership between the hospital and local religious congregations in the community. The goal of the program is to enhance the community's quality of life by helping to improve the health and spiritual well being of members of various congregations, through an integration of health care with the religious community. The Hospital incurred a total cost of $174,431 for these programs.
Part III, Line 4: The provision for bad debts is based upon management's assessment of historical and expected net collections considering historical business and economic conditions, trends in health care coverage and other collection indicators. Periodically throughout the year, management assesses the adequacy of allowance for uncollectable accounts based upon historical write off experience by payor category. The results of this review are then used to make any modifications to the provision for bad debts to establish an appropriate allowance for uncollectable accounts. After satisfaction of amounts due from insurance, the Hospital follows established guidelines for placing certain past due patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by Ascension Health. Accounts receivable are written off after collection efforts have been followed in accordance with the Hospital's policies. The organization's share of bad debt expense in 2011 was $2,597,048 at charges ($1,242,559 at cost).
Part III, Line 8: Ascension Health and related health ministries follow the Catholic Health Association (CHA) guidelines for determinning community benefit. CHA community benefit guidelines suggest that Medicare shortfall is not treated as community benefit. In our calculations, the cost was determined by mutiplying total Medicare charges times the ratio of cost to charges.
Part III, Line 9b: The organization has a written debt collection policy that also includes a provision on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance. If a patient qualifies for charity or financial assistance, certain collection practices do not apply.
Part V, Section B, Line 13g: Brochures describing the Financial Assistance Policy and a sign indicating where to call or go to talk to the Financial Counselor, are located at every entry point of the hospital, including all off campus locations. The brochure and application are also posted on the hospital's website.Mount St. Mary's Hosp. of Niagara Falls
The following procedures are followed and are considered reasonable efforts for purposes of questions 15 & 16: The Hospital notifies each individual of the Financial Assistance Policy (FAP). This notification begins on the date care is provided and ends on the 120th day after the first billing statement is provided to the patient. Individuals are notified of the FAP as noted in the response to question 13. For individuals who submit an incomplete FAP application, the Hospital provides that individual with information relevant to assist them with completion of the application. For individuals who submit a complete application, the hospital makes and documents a determination as to whether that person was eligible under the facility's FAP. The Hospital determines eligibility based on one or more of the means tested programs indicated in question 11.Part V, Section B, Line 15 & 16:
Part VI, Line 2: The organization does not conduct a specific survey, but instead relies on a compliation of resources readily available. This includes information from the Healthcare Association of New York State, Niagara County Department of Health, the Niagara Falls Mayor's Health Task Force, and the Ascension Health Environmental Scan. By reviewing information on trends and needs from these sources, Mount St. Mary's also relies on input from its staff as it evaluates the patients that are being treated and any trends. Some of the community health needs indentified were childhood obesity, diabetes, and heart disease. Mount St. Mary's Hospital has developed programs to begin to address these needs.
Part VI, Line 3: Patients are personally informed of the financial assistance and charity care policies at each inpatient and outpatient entry point of the Hospital by Patient Access representatives, who also direct those individuals requiring further information to the Financial Assistance Counselors. Each entry point of the Hospital and all of it's offsite locations have both signs and brochures explaining the Financial Assistance Policy in place. In addition, a summary brochure of the Financial Assistance Policy and application have been placed on the homepage of the hospital's website.
Part VI, Line 4: Mount St. Mary's Primary Service Area includes the City of Niagara Falls (Zip Codes: 14301, 14302, 14303, 14304 and 14305) a city of about 52,000 where 60% of the population is on some form of public assistance. The towns of Lewiston (14092, 14107, 14109, and 14132), Niagara (portions of 14304 and 14305) Wheatfield (portions of 14305 and 14120) and Porter (14174) more suburban and rural areas with slightly higher income levels. Secondary Service Area includes the towns of Wilson (14172) a small agricultural community, Grand Island (14072) a more affluent suburb, and Lockport (14094) a nearby city with similar characteristics to Niagara Falls. In general, the primary service area is described as Western Niagara County.
Part VI, Line 5: Other ways that the Hospital furthers its exempt purpose by promoting the health of the community include health screenings and health fairs as described further in our community benefit report in Schedule O. Also, a majority of the organization's governing body is comprised of persons who reside in the Hospital's primary service area who are not employees, contractors, nor family members thereof. The organization extends medical staff priviledges to all qualified physicians in its community for many of its departments. The organization applies surplus funds to improvements in patient care, such as the expanded cardiology services and Womens Center for Breast Health.
Part VI, Line 6: Mount St. Mary's Hospital of Niagara Falls d/b/a Mount St. Mary's Hospital and Health Center (the Hospital) is a member of Ascension Health. In December 2011, Ascension Health Alliance became the sole corporate member and parent organization of Ascension Health, a Catholic, national health system consisting primarily of nonprofit corporations that own and operate local health care facilities, or Health Ministries, located in 20 of the United States and the District of Columbia. Ascension Health Alliance is sponsored by Ascension Health Ministries, a Public Juridic Person.The Hospital, located in Lewiston, New York, is a nonprofit acute care hospital. The Hospital provides inpatient, outpatient, emergency care, and chemical dependency services for patients who reside primarily in the local geographic region. Admitting physicians are primarily practitioners in the local area. The Hospital is related to Ascension Health's other sponsored organizations through common control. The consolidated financial statements also include the financial results of Our Lady of Peace, Inc. (OLP) and Mount St. Mary's Child Care Center Inc. (CCC), of which the Hospital is the sole corporate member. Unless indicated otherwuse, the three entities are collectively referred to as the Hospital for purposes of these consolidated financial services.OLP is a not-for-profit organization established to operate a freestanding 250-bed skilled nursing facility. CCC is a not-for-profit organization that provides daytime child-care services primarily for employees of the Hospital. Substantially all expenses of Ascension Health and its sponsored organizations are related to providing health care services.Ascension Health Alliance directs its governance and management activities toward strong, vibrant, Catholic Health Ministries united in service and healing and dedicates its resources to spiritually centered care which sustains and improves the health of the individuals and communities it serves. In accordance with Ascension Health Alliance's mission of service to those persons living in poverty and other vulnerable persons, each Health Ministry accepts patients regardless of their ability to pay. Ascension Health Alliance uses four categories to identify the resources utilized for the care of persons living in poverty and community benefit programs:-Traditional charity care includes the cost of services provided to persons who cannot afford health care because of inadequate resources and/or who are uninsured or underinsured.-Unpaid cost of public programs, excluding Medicare, represents the unpaid cost of services provided to persons who cannot afford health care because of inadequate resources and/or who are uninsured or underinsured.-Cost of other programs for persons living in poverty and other vulnerable persons includes unreimbursed costs of programs intentionally designed to serve the for persons living in poverty and other vulnerable persons of the community, including substance abusers, the homeless, victims of child abuse, and persons with Acquired Immune DeficiencySyndrome.-Community benefit consists of the unreimbursed costs of community benefit programs and services for the general community, not solely for persons living in poverty, including health promotion and education, health clinics and screenings, and medical research.Discounts are provided to all uninsured patients, including those with the means to pay. Discounts provided to these patients who did not qualify for assistance under charity care guidelines are not included in the cost of providing care of persons living in poverty and community benefit programs. The cost of providing care of persons living in poverty and community benefit programs is estimated using internal cost data and is calculated in compliance with guidelines established by both the Catholic Health Association (CHA) and the Internal Revenue Service (IRS).
NYReports Filed With StatesPart VI, Line 7

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Judith A Maness
3347220224022022000049000178930603537000
Michael F Ickowski
19990600017160041290179710239166000
Gary Tucker
23226500022000048550180500277170000
Deborah Serafin
17728401388702200003724080240224919000
Barbara Bucci
13506208970013000027810178930177706000
Benjamin G Rueda MD
434662018869012740042880186780489237000
Parmanand K Parikh MD
259377014308100000179000420358000
Marc J Veneziano MD
3713040676800000199620398034000
Justin Miller MD
280885047248027786014220179000375241000
Young J Yu MD
22868005072300000201110299514000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (13 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 6Mount St. Mary's Hospital has a single corporate member, Ascension Health.
Form 990, Part VI, Section A, line 7aMount St. Mary's Hospital of Niagara Falls has a single corporate member, Ascension Health, who has the ability to elect members to the governing body of Mount St. Mary's Hospital of Niagara Falls.
Form 990, Part VI, Section A, line 7bAscension Health has designed a system authority matrix which assigns authority for key decisions that are necessary in the operation of the system. Specific areas that are identified in the authority matrix are: new organizations & major transactions; governing documents; appointments/removals; evaluation; debt limits; strategic & financial plans; assets; system policies & procedures. These areas are subject to certain levels of approval by Ascension per the system authority matrix.
Form 990, Part VI, Section B, line 11Management, including certain Officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Management presents the Form to a designated committee of the Board, to review and answer any questions. Prior to filing the return, all Board Members are provided a copy the Form 990.
Form 990, Part VI, Section B, line 12cThe organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee meeting will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflict of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose.
Form 990, Part VI, Section B, line 15In determining compensation of the organization's CEO, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The Board Compensation Committee reviewed and approved the compensation. In the review of the compensation, the CEO was compared to employees of other hospitals in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the board minutes. The individual was not present when her compensation was decided. In determining compensation of other officers or key employees of the organization, the process included a review of comparability data. In the review of the compensation, the other officers or key employees of the organization were compared to employees of other hospitals in the area that hold the same title.
Form 990, Part VI, Section C, line 19Mount St. Mary's Hospital will provide any documents open to public inspection upon request.
Form 990, Part XI, line 5:Net unrealized losses on investments: -409,089. Pension Liability Adjustment 4,213,000. Transfer to Affiliates -815,000. Change in Interest in Foundation -437,000. Total to Form 990, Part XI, Line 5: 2,551,911.Changes in Net Assets or Fund Balances:
Form 990, Part III, Line 4:For the year ended December 31, 2011. This report illustrates the significant degree to which Mount St. Mary's Hospital and Health Center contributes to the positive health status of the communities we serve. As a member of Ascension Health, the nation's largest Catholic and non-profit health system, Mount St. Mary's continues to build and strengthen sustainable collaborative efforts that benefit the health of individuals, families, and society as a whole. Ascension Health directs its governance and management activities toward strong, vibrant, Catholic Health Ministries united in service and healing and dedicates its resources to spiritually centered care which sustains and improves the health of the individuals and communities it services. In accordance with Ascension Health's mission of service to those who are poor and vulnerable, each Health Ministry accepts patients regardless of their ability to pay. Community Outreach Activities: Mount St. Mary's Hospital seeks to improve the physical, mental, social and spiritual health status of its surrounding community in addition to providing health care services to all individuals who require medical attention. Expanding Awareness, Health Education and Healthcare Promotion: Mount St. Mary's believes that it is essential to educate people regarding the types of behavior that improve their chances of living a healthy life. Mount St. Mary's Hospital has invested to provide quality health education and materials to accomplish its goals. Mount St. Mary's has a positive impact on the surrounding neighborhoods as it contributes to civic and cultural programs, makes space available to support groups, community groups, and improves the healthcare environment. Through our "Health for All Seasons" educational programs, we reach out to the community with unique health education offerings. In 2011 these programs occurred throughout the year and covered a wide-array of topics. To promote attendance and conduct the programs, Mount St. Mary's invested more than $25,000 on services and promotion. A list of the programs is included at the end of this report. Throughout the year Mount St. Mary's conducts a series of community events including a free Community Lipid Panel Screening in February, the free PSA Prostate Screening in June, Stroke Awareness Day in June, Heart Month events in February with free blood pressure screenings, and more. Staff at Mount St. Mary's attend numerous community health fairs and programs, offering screenings as requested for blood pressure and diabetes. Such events attended include those held at the Tuscarora Nation School, Niagara Falls Neighborhood Block Clubs, local businesses such as Dental Care Associates and ParMed Pharmaceuticals, the Head Start Program, among others. To address specific health issues and needs, Mount St. Mary's has launched targeted programs, including: Niagara Falls Mayor's Task Group on Health: CEO participates in a community-based effort to have a demonstrated impact on health issues and awareness of individuals in the community. The area's largest private foundation has invested in the program that is working in a designated area of the city with a high amount of uninsured and underserved. The overall project goal: "Create a Healthier Niagara Falls by developing Sustainable Neighborhoods." HANCI/PACE Program: Mount St. Mary's Hospital and Our Lady of Peace are partnering with the Health Association of Niagara County (HANCI) to implement the "Program of All-Inclusive Care for the Elderly." This program, titled "Complete Senior Care" is designed to assist frail elderly persons to remain in their home and out of institutional care as long as possible. MSMH will support and staff the healthcare component with a clinic located in the center of the facility which is currently being renovated to meet the specific needs of the clients. This is a provider-based Medicare/Medicaid managed care program that follows with stated strategies for reforming healthcare in New York State advanced by the Governor. Pathways to Careers Program: The "Pathways to Careers" Program was initiated by Mount St. Mary's Hospital in collaboration with Niagara Catholic High School and Niagara University, as an adjunct to the hospital's HERO (Health Education Raises Opportunities) Program, to provide unique opportunities for high school students to plan for careers in health and health-related fields. The program was initiated in June 2010 with a Career Fair where several hospital departments provided exhibits on specific health careers which support acute care operations. Students were encouraged to visit each exhibit and pick up information about careers, certification and licensure requirements and local institutions of higher learning which offer courses of study in specific career programs. Students were also given the opportunity to sign up for an internship opportunity for the following September. Dr. Robert Greene, Chair of the Department of Biology at Niagara University is the Academic Moderator for the Program. This program was developed with an eye toward future recruitment as well as for the purpose of providing high school students with enriched educational options to assist them in the selection of college courses of study. The program is designed to move students along a chosen local, educational pathway to potential local employment while affording education and visibility for traditional and non-traditional health care occupations. HERO (Health Education Raises Opportunities) Health Literacy for Faith-Based Schools: The Health Education Raises Opportunities (HERO) Program, initiated by Mount St. Mary's Hospital and Health Center in February 2009 focuses on improving health literacy for local school children. It is currently offered in different menu formats for students in Grades 3 - 12 in four schools with expansion to seven schools planned for the future. The Program brings experts in the health field into classrooms to teach children on important and current health issues. HERO's ultimate goal is to help students and their families to become better consumers of health care. HERO's Collaborative Partners include the following: - The Mental Health Association in Niagara County, Inc. - The Niagara County Health Department - Niagara University Department of Nursing - Niagara University Department of Biology - Catholic Charities of Western New York - The Buffalo Diocesan Catholic Schools - Fidelis Care New York - Catholic Academy of Niagara Falls - St. Peter's Roman Catholic School, Lewiston - St. Peter's Evangelical Lutheran School, Lockport - St. Peter's Lutheran School, Sanborn - The Niagara Charter School - St. Dominic Savio Middle School - DeSales Catholic School - Niagara Catholic High School - St. Mary's Hospital and Health Center, Departments of: Education and Staff Development, Mission Integration, Parish Nursing, Employee Health Services, Rehabilitation and Sports Medicine, and Community Relations. Community Service Education: The Department of Education and Staff Development provides instruction in the following areas for community health providers: - Basic Lifesaving Skills (BLS): Certification and Re-certification - Advanced Lifesaving Skills (ACLS): Certification and Re-certification The Department also coordinates and facilitates education for community health providers for the following: - Neonatal Lifesaving Skills (NALS): Re-certification - Pediatric Lifesaving Skills (PALS): Re-certification As an American Diabetes Association Certified Center, the Department of Education and Staff Development Certified Diabetes Educators provide individual counseling on Diabetes self management for inpatients and outpatients. The Educators also provide instruction on Diabetes and Pre-Diabetes through group classes and serve as faculty support for local health providers on Diabetes education throughout Niagara County. In addition, as a Designated Stroke Center, Stroke Prevention Education is provided through focused programs both on the hospital campus, in local schools and throughout the community. Childhood Weight Management Program: Childhood obesity is a health problem reaching epidemic proportions throughout the United States. Obesity in the young brings along with it, the stigma of being "different". Children who are obese are often challenged with poor self-esteem and the emotional trauma of taunting, bullying and other negative behaviors from other children. In addition, these children are at risk for other health problems as they grow, which may affect them in later life.Mount St. Mary's Hospital and Health Center Community Benefit Report:
Key to the success of any weight management program for children is parental support and encouragement. In an effort to address childhood obesity with a comprehensive, clinically sound, age-appropriate and results-oriented focus, the Hospital has developed a 16-week program comprised of 8 sessions for children, their parents and schools is being piloted beginning in February of 2011. Collaborative Partners include: - The Niagara County Health Department - The Mental Health Association in Niagara County, Inc. - MSMH Department of Nutrition Services - MSMH Department of Education - MSMH Department of Rehabilitation and Sports Medicine Mount St. Mary's Hospital Student Affiliate Agreements: In April, 2009, the process for scheduling students for clinical rotations and internships with hospital departments was transitioned into a new, streamlined approach which reflects a more customer-friendly approach. To date, 56 institutions of higher learning, including three medical schools, have executed Student Affiliate Agreements on file. These facilities include not only local schools, but colleges and universities throughout the country. Employee Health Services: We provide Medical Case Management to employees who are ill or injured in an effort to return them to full pay and benefits as soon as possible. We offer individual health coaching to each employee annually and on an as needed basis to improve the quality of life through health lifestyles and disease management. EAP referrals are made for employees (or employee's families) in crisis. Free onsite exercise classes, wellness seminars, recipes and self guided fitness options are available to all employees, physicians' and volunteers. Catholic Health System of Buffalo - Home Care Service: Potential to work in collaboration with the Catholic Health System of Buffalo to provide Home Health Care services to Niagara. In addition, the Mount St. Mary's Wound Care Center's Medical Director is conducting training for home health care agency personnel. We are working with Buffalo CHS on an additional wide array of initiatives including eClinical Works, a Cardiac Catheterization Lab, CIPA and CIPA EMR rollout, laboratory system, physician recruitment, REACH telemedicine stroke system and educational initiatives with an area Catholic high school and Catholic university. New York State Designated Stroke Center: Application was approved in mid-2010 seeking a designation from the New York State Department of Health as a "Designated Stroke Center". MSMH is working with the Catholic Health System on components of this service. Echocardiography Accreditation: Received from the Intersocietal Commission for the Accreditation of Echocardiography (ICAEL). Chest Pain Center Designation: Accreditation Approved. Mandatory Concussion Training and Athletic Training: With the discussion growing on a local and national level regarding athletes and concussions, Mount St. Mary's Hospital is ahead of the curve in assessment and care. The ATCs at our Center for Sports Medicine and Physical Rehabilitation have been providing on-site coverage under contract at local high schools. During the past five years there has been a collaborative effort with local school systems and physicians to provide the student athletes with the best possible care. Our Center provides a computer program to aid the ATC (Certified Athletic Trainer) with concussion assessment. Student athletes are assessed prior to the start of the season using the SAC (Standardized Assessment of Concussion) program. A summer conditioning program is also held for high schools. Support of Niagara County Diabetes Coalition: The rate of diabetes in Niagara County is 11.9% with 10.6% in males and 13.2% in females. These statistics are higher than the NYS rates of 9.7% overall, 7.6% in males overall and 11.6% overall in females. An estimate of recent hospitalizations at MSM indicates that 1/6 of admissions were for diabetes. Only 1/3 of that population was referred for DSMT. To address these issues, cooperative strategies developed for all Niagara County Hospitals: - Develop a protocol for patients with diabetes entering the hospital. Will include a physician check list that is placed on the front of the chart that will promote referring to class/counseling and A1C testing. - Query lab results for patients whose blood glucose levels are 125 and above for intervention. - Develop pre-diabetes education and offering for the community. - Develop community education lectures that emphasize good nutrition physical activity, mental health and lowering risks for chronic diseases. - Research funding opportunities to assist patients in receiving prediabetes and diabetes education. - Meet with insurance companies to discuss reimbursement of diabetes management services and education. - Develop a Niagara County resource guide to be available at all hospitals, clinics and physicians offices and home health care agencies. - Develop a tool to evaluate a 6 month outcome of patients health to include repeat admissions, weight, quality of life, effectiveness of teaching and A1C level. - Press releases and TV appearances by hospital reps and LHD staff to update community on hospital collaboration.
Establishing a Full Continuum of Care in the Niagara Community: - Expansion of Mount St. Mary's Neighborhood Health Center: Mount St. Mary's Hospital invested more than $1.7 million from donations, public support and private grants to construct a new and expanded Mount St. Mary's Neighborhood Health Center. The new 6,500 square foot facility opened in April 2010. The facility doubles the current treatment space from 6 to 12 exam rooms. This primary care center includes adult and pediatric medicine and OB/GYN and serves as a medical home for the patients. It is located in the inner-city of Niagara Falls in the poorest census tract in the County. In addition, new low-income apartments for 250 families and other subsidized housing have been constructed in the surrounding neighborhood. The community served is predominantly minority (African-American) is of low income and minimally insured, if at all. If the clinic did not exist they would have no readily available health care options. The clinic currently operates at a financial loss, requiring an annual subsidy from MSMH in the $400,000-$500,000 range. We remain committed to operating this clinic knowing its importance in the community, we have hired a full-time medical director to coordinate care and we continue to work to improve efficiency and services, facilitate enrollment in Medicaid plans as much as possible, and to minimize losses. It is anticipated that the new space will improve the productivity and the efficiency of the operations to reduce the losses associated with working in less than optimal conditions. We are already seeing significant increases in patient visits. In addition, staff is looking to add new services to help in the treatment of chronic diseases such as diabetes and adding other specialists as needed. An on-site social worker helps patients of the NHC navigate the social service and governmental and non-government assistance system. A full time physician assistant (PA) was added in August 2011 to provide additional capacity to see adults. Pediatrician coverage is being monitored to assure productivity as volumes have softened in this area as the population ages. A full time MD Obstetrician/Gynecologist is also being added to the staff. - Heart and Soul Food Pantry: Mount St. Mary's Hospital continues to collaborate with the Heart and Soul Food Pantry located in Niagara Falls to provide referral navigation service and education services to those in need of health care and those who are uninsured and unable to obtain health care service. The Parish Nurse is presently on duty in the Heart and Soul location three days a week. She is actively working at Heart and Soul Soup Kitchen identifying health needs and referring to other social services agencies. Health referrals are made to Neighborhood Health Center as needed. Transportation to health services and Social Services is arranged and provided when necessary. Several local agencies have agreed to collaborate by offering services at Heart and Soul. We will continue to work with Heart and Soul and continue support for our Parish Nurse Program. - African/American Churches: Mount St. Mary's Hospital, through its Parish Nurse Program, received a $14,000 wellness grant from the Susan G. Komen Foundation for peer education and outreach for breast cancer and access to mammography. This program was implemented and will be continued as funding is available to enhance our ability to help patients navigate through the healthcare system. Transportation if needed is provided by VanGo, our regular van service.
- Financial Counselors: Mount St. Mary's has two full-time Financial Counselors positions to aid in identifying and assisting with charity care as well as facilitating the Medicaid enrollment process. The Financial Counselors are well-versed in our charity/financial assistance care policy which provides discounts from 0%-100%. - VanGo: Provides transportation services for patients (from all over the western part of Niagara County) to get to the hospital campus and to off-site services such as rehab and the Neighborhood Health Center. The charge is $1 each way unless patients cannot afford it. Volunteers drive the vans and scheduling is coordinated by hospital staff. As a rural county with an elderly population, the van provides reliable convenient service which fills a gaping hole in the public transportation system. The two mini-vans were purchased through the generous donation of a local businessman who also provides funds annually for the upkeep of the vans. - Women's Health Conference: One major event initiated by Mount St. Mary's that has become a major community event is the annual "Women's Healthcare Conference" which now attracts more than 350 persons in a day-long program in downtown Niagara Falls. Community information support groups hosted by Mount St. Mary's each year cover Alzheimers, Breast Cancer, Diabetes, Fibromyalgia, Lupus, Parent Grief, Sleep Apnea, and Prostate Cancer. - Parish Nurse: The Mount St. Mary's Parish Nurse also provides a direct link between the Neighborhood Health Center and the nearby Heart and Soul food pantry. Regular screenings are held for the clients of the soup kitchen at Heart and Soul and those identified with health issues are referred to the Health Center. In addition, an on-staff social worker helps patients of the Neighborhood Health Center and others navigate important government and private programs. Summary: In summary, Mount St. Mary's furthers its charitable purposes by providing a broad array of services to meet the healthcare needs of patients and organizations in the community. We provide essential medical services to the community, train and recruit healthcare professionals to serve the needs of the broader community, provide appropriate charity services to those patients unable to pay, and provide services to others.
Form 990, Part VII, Section B:Amounts reported for John W. Danforth Company represents amounts paid for both services and materials. These amounts cannot be separated.Explanation of Independent Contractor Amounts:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Ascension Health
PO Box 45998St LouisMO63145311662309National Health SystemMO501(c)(3)Schedule A, Line 11aN/A0
Our Lady of Peace Inc
5285 Lewiston RoadLewistonNY140921997161608735Nursing HomeNY501(c)(3)Schedule A, Line 31Mount St Mary's Hospital of Niagara Falls
Mount St Mary's Hospital Child Care Center
5310 Military RoadLewistonNY140921997161523352Child Care CenterNY501(c)(3)Schedule A, Line 91Mount St Mary's Hospital of Niagara Falls
Mount St Mary's Hospital Foundation
5300 Military RoadLewistonNY140921997161360884FoundationNY501(c)(3)Schedule A, Line 11a1Mount St Mary's Hospital of Niagara Falls
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Our Lady of Peace Inc
D79068Actual Amount Paid
Our Lady of Peace Inc
N5008749Actual Amount Paid
Ascension Health
E2166649Actual Amount Paid
Mount Saint Mary's Hospital Foundation
C597208Actual Amount Paid

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