NICHOLAS H NOYES MEMORIAL HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- NICHOLAS H NOYES MEMORIAL HOSPITAL (EIN 16-0743979)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-15
- IRS object ID
- 201223209349304307
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-15T12:08:26-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 264298079 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EFP ROTENBERG LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 280 KENNETH DRIVE | AddressLine1 |
| City | ROCHESTER | City |
| State | NY | State |
| ZIP Code | 14623 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 160743979 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NICHOLAS H NOYES MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | NICH | NameControl |
| Phone | 5853356001 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 CLARA BARTON STREET | AddressLine1 |
| City | DANSVILLE | City |
| State | NY | State |
| ZIP Code | 14437 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AMY POLLARD | Name |
| Title | PRESIDENT / CEO | Title |
| Phone | 5853356001 | Phone |
| Date Signed | 2012-11-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | WILLIAM MCDONALD | Name |
| PTIN | P01600766 | PTIN |
| Phone | 5854278900 | Phone |
| Date Prepared | 2012-11-12 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | AMY POLLARD | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 CLARA BARTON STREET | AddressLine1 |
| City | DANSVILLE | City |
| State | NY | State |
| ZIP Code | 14437 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 50679325 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.NOYES-HEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1927 | YearFormation |
| State Legal Domicile | NY | StateLegalDomicile |
| Activity Or Mission Description | NICHOLAS H. NOYES MEMORIAL HOSPITAL IS A 72 BED HOSPITAL WHICH PROVIDES ACUTE, SUB-ACUTE, EMERGENCY AND OTHER OUTPATIENT CARE AND WHOSE MISSION IS TO SUPPORT AND PROMOTE THE HEALTH OF OUR COMMUNITIES THROUGH COMPASSIONATE QUALITY CARE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 20 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 615 | TotalNbrEmployees |
| Total Nbr Volunteers | 110 | TotalNbrVolunteers |
| Total Gross UBI | 607869 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -67188 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 395232 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 397733 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 48323463 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 48996147 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 72638 | InvestmentIncomePriorYear |
| Investment Income Current Year | 69428 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 796552 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1086057 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 49587885 | TotalRevenuePriorYear |
| Total Revenue Current Year | 50549365 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 26607732 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 27383376 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 56889 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 23900802 | OtherExpensePriorYear |
| Other Expenses Current Year | 23477330 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 50508534 | TotalExpensesPriorYear |
| Total Expenses Current Year | 50860706 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -920649 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -311341 | RevenuesLessExpensesCY |
| Total Assets BOY | 40642575 | TotalAssetsBOY |
| Total Assets EOY | 39858292 | TotalAssetsEOY |
| Total Liabilities BOY | 19895660 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 21013443 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 20746915 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 18844849 | NetAssetsOrFundBalancesEOY |
| Mission Description | NICHOLAS H. NOYES MEMORIAL HOSPITAL SUPPORTS AND PROMOTES THE HEALTH OF OUR COMMUNITIES THROUGH COMPASSIONATE QUALITY CARE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 39742690 | Expense |
| Revenue | 49096710 | Revenue |
| Description | NICHOLAS H. NOYES MEMORIAL HOSPITAL IS A 72 BED HOSPITAL WHICH PROVIDES ACUTE, SUB-ACUTE, AND OUTPATIENT CARE. | Description |
| Total Program Service Expense | 39742690 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 85 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 615 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 1 | PremiumsPaid |
| Form8899 Filed | 0 | Form8899Filed |
| Form1098 C Filed | 0 | Form1098CFiled |
| Excess Business Holdings | 0 | ExcessBusinessHoldings |
| Taxable Distributions | 0 | TaxableDistributions |
| Distribution To Donor | 0 | DistributionToDonor |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 20 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 1 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NY | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAY MASLYN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5853354306 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 CLARA BARTON STREET | AddressLine1 |
| City | DANSVILLE | City |
| State | NY | State |
| ZIP Code | 14437 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (26 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|
| JAMES CULBERSTON | |||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||||
| JOHN LOCKHART | |||||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||||
| MICHAEL JOHNSEN | |||||||||
| FIRST VICE CHAIRPERSON | 2.00 | X | 0 | 0 | 0 | ||||
| LESLIE COLE JR | |||||||||
| SECOND VICE CHAIRPERSON | 2.00 | X | 0 | 0 | 0 | ||||
| GEOFFREY MARKOWSKI MD | |||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||||
| THOMAS DWYER MD | |||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||||
| JOAN FLENDER MD | |||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||||
| GRAHAM FRAZER | |||||||||
| TREASURER | 2.00 | X | 0 | 0 | 0 | ||||
| ROBERT HART | |||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||||
| ARIF QURESHI MD | |||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||||
| ANDREW LONG | |||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||||
| MARILYN MOORE | |||||||||
| CHAIRPERSON | 5.00 | X | 0 | 0 | 0 | ||||
| MAUREEN WOLCOTT | |||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||||
| SALLY WEST | |||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||||
| MARK LYONS | |||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||||
| PETER SOSCIA | |||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||||
| LINDSAY QUINTILONE | |||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||||
| AMY POLLARD | |||||||||
| PRESIDENT/CEO | 40.00 | X | 160375 | 0 | 17312 | X | |||
| JAY MASLYN | |||||||||
| CFO | 40.00 | 136854 | 0 | 3022 | X | ||||
| DOUGLAS MAYHLE MD | |||||||||
| MEDICAL DIRECTOR | 40.00 | 339945 | 0 | 15747 | X | ||||
| ROBERT CAPECCI MD | |||||||||
| PHYSICIAN - ORTHOPEDIST | 40.00 | 591586 | 0 | 8372 | X | ||||
| ASAD MAJID MD | |||||||||
| PHYSICIAN | 40.00 | 418202 | 0 | 15152 | X | ||||
| ROBERT SUPINSKI | |||||||||
| PHYSICIAN - ORTHOPEDIST | 40.00 | 623025 | 0 | 18823 | X | ||||
| ROBERT BONVINO MD | |||||||||
| PHYSICIAN - OB/GYN | 40.00 | 337405 | 0 | 12542 | X | ||||
| BARRY HAICKEN MD | |||||||||
| GENERAL SURGEON | 40.00 | 321420 | 0 | 15979 | X | ||||
| JAMES WISSLER | |||||||||
| FORMER PRESIDENT/CEO | 0.00 | 175836 | 0 | 11439 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3104648 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 118388 | TotalOtherCompensation |
| Number Individuals GT100 K | 9 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| DANVILLE ANESTHESIA & PAIN MGMT | |||||
| PO BOX 784891 | PHILADELPHIA | PA | 19178 | ANESTHESIOLOGIST | 790621 |
| ARUP LABORATORIES | |||||
| PO BOX 27964 | SALT LAKE CITY | UT | 84127 | LAB TESTING SERVICES | 683393 |
| SLEEP INSIGHTS MEDICAL SERVICES | |||||
| 10 HAGEN DRIVESUITE 200 | ROCHESTER | NY | 14625 | POLYSOMNOGRAPHY SERVICES | 374892 |
| SMA MEDICAL PLLC | |||||
| 85-43 167 STREET | JAMAICA | NY | 11432 | INTERNIST | 239400 |
| VIRGINIA WOHLTMANN MD | |||||
| 1108 ROOSEVELT RD | ROCHESTER | NY | 14445 | PSYCHIATRIST | 150579 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| Government Grants | 317067 | GovernmentGrants |
| All Other Contributions | 80666 | AllOtherContributions |
| Total Contributions | 397733 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICE REVENU | Description |
| Business Code | 621990 | BusinessCode |
| Total Revenue Column | 48996147 | TotalRevenueColumn |
| Related Or Exempt Function Income | 48996147 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 48996147 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 56027 | TotalRevenueColumn |
| Exclusion | $56,027 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 51432 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 38031 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 13401 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 13401 | TotalRevenueColumn |
| Exclusion | $13,401 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 24083 | GrossIncomeFundraisingEvents |
| Fundraising Direct Expenses | 8336 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 15747 | TotalRevenueColumn |
| Exclusion | $15,747 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 184156 | GrossSalesOfInventory |
| Cost Of Goods Sold | 83593 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 100563 | TotalRevenueColumn |
| Related Or Exempt Function Income | 100563 | RelatedOrExemptFunctionIncome |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|
| OTHER REVENUE | 541380 | 969329 | 607451 | $361,878 |
| SEAGATE ALLIANCE, LLC | 900000 | 418 | 418 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 969747 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 50549365 | TotalRevenueColumn |
| Related Or Exempt Function Income | 49096710 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 607869 | UnrelatedBusinessRevenue |
| Exclusion | $447,053 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 673254 | Total |
| Program Services | 235992 | ProgramServices |
| Management And General | 437262 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22473011 | Total |
| Program Services | 18162067 | ProgramServices |
| Management And General | 4284975 | ManagementAndGeneral |
| Fundraising | 25969 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 197492 | Total |
| Program Services | 157953 | ProgramServices |
| Management And General | 37656 | ManagementAndGeneral |
| Fundraising | 1883 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2537598 | Total |
| Program Services | 2050704 | ProgramServices |
| Management And General | 483849 | ManagementAndGeneral |
| Fundraising | 3045 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1502021 | Total |
| Program Services | 1124529 | ProgramServices |
| Management And General | 375505 | ManagementAndGeneral |
| Fundraising | 1987 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13710 | Total |
| Program Services | 12600 | ProgramServices |
| Management And General | 1110 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 73945 | Total |
| Management And General | 73945 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 38510 | Total |
| Management And General | 38510 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 63194 | Total |
| Management And General | 63194 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3608648 | Total |
| Program Services | 2554221 | ProgramServices |
| Management And General | 1054427 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 227374 | Total |
| Program Services | 52667 | ProgramServices |
| Management And General | 165972 | ManagementAndGeneral |
| Fundraising | 8735 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9213100 | Total |
| Program Services | 8416447 | ProgramServices |
| Management And General | 781383 | ManagementAndGeneral |
| Fundraising | 15270 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 563252 | Total |
| Program Services | 422439 | ProgramServices |
| Management And General | 140813 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1196456 | Total |
| Program Services | 508734 | ProgramServices |
| Management And General | 687722 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16758 | Total |
| Program Services | 1119 | ProgramServices |
| Management And General | 15639 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 103449 | Total |
| Program Services | 39756 | ProgramServices |
| Management And General | 63693 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 485693 | Total |
| Program Services | 37495 | ProgramServices |
| Management And General | 448198 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2057092 | Total |
| Program Services | 1143530 | ProgramServices |
| Management And General | 913562 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 760587 | Total |
| Program Services | 669195 | ProgramServices |
| Management And General | 91392 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| OTHER PURCHASED SERVICE | 1530124 | 1301501 | 228623 |
| BAD DEBT | 1476797 | 1476797 | |
| EQUIPMENT RENTAL | 852699 | 464682 | 388017 |
| REPAIRS & MAINTENANCE | 762139 | 636409 | 125730 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 433803 | Total |
| Program Services | 273853 | ProgramServices |
| Management And General | 159950 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50860706 | Total |
| Program Services | 39742690 | ProgramServices |
| Management And General | 11061127 | ManagementAndGeneral |
| Fundraising | 56889 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4664 | BOY |
| EOY | 4360 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2703682 | BOY |
| EOY | 2942979 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 35300 | BOY |
| EOY | 10313 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5520151 | BOY |
| EOY | 5012983 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 868988 | BOY |
| EOY | 835329 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 871986 | BOY |
| EOY | 1111004 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 46457552 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 30092984 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16574893 | BOY |
| EOY | 16364568 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1352993 | BOY |
| EOY | 1360784 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12709918 | BOY |
| EOY | 12215972 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 40642575 | BOY |
| EOY | 39858292 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4518254 | BOY |
| EOY | 4763456 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 637872 | BOY |
| EOY | 656700 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9189986 | BOY |
| EOY | 9102732 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5549548 | BOY |
| EOY | 6490555 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19895660 | BOY |
| EOY | 21013443 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19877759 | BOY |
| EOY | 18068096 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 125450 | BOY |
| EOY | 33047 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 743706 | BOY |
| EOY | 743706 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20746915 | BOY |
| EOY | 18844849 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 40642575 | BOY |
| EOY | 39858292 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -311341 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -1590725 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $10,593 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 10593 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | AS MEMBERS OF 3 ASSOCIATIONS (AHA - AMERICAN HOSPITAL ASSOCIATION, HANYS-THE HEALTHCARE ASSOCIATION OF NEW YORK STATE & RRHA/SEAGATE ALLIANCE) A PORTION OF THE DUES (TOTAL REFLECTED ABOVE) ARE PAID AS PART OF MEMBERSHIP AND REPRESENT AMOUNTS DESIGNATED FOR LOBBYING ACTIVITIES. THESE ASSOCIATE ORGANIZATIONS OF WHICH WE ARE MEMBERS HANDLE THE DIRECT LOBBYING/ADVOCACY ACTIVITIES ON BEHALF OF THEIR MEMBERS. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1434453 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 24558 | InvestmentEarningsOrLosses |
| Administrative Expenses | 9648 | AdministrativeExpenses |
| End Of Year Balance | 1449363 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1335945 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 107551 | InvestmentEarningsOrLosses |
| Administrative Expenses | 9043 | AdministrativeExpenses |
| End Of Year Balance | 1434453 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1155614 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 188466 | InvestmentEarningsOrLosses |
| Administrative Expenses | 8135 | AdministrativeExpenses |
| End Of Year Balance | 1335945 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1614612 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -273730 | InvestmentEarningsOrLosses |
| Other Expenditures | 175000 | OtherExpenditures |
| Administrative Expenses | 10268 | AdministrativeExpenses |
| End Of Year Balance | 1155614 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.44410 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.55590 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 372690 | OtherCostOrOtherBasis |
| Book Value | 372690 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 22218909 | OtherCostOrOtherBasis |
| Depreciation | 12035668 | Depreciation |
| Book Value | 10183241 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 22143089 | OtherCostOrOtherBasis |
| Depreciation | 18057316 | Depreciation |
| Book Value | 4085773 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1722864 | OtherCostOrOtherBasis |
| Book Value | 1722864 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 16364568 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (5 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION | 9418454 |
| DEBT ORIGINATION COSTS - NET | 483270 |
| DUE FROM RELATED ENTITY | 432745 |
| MORTGAGE REPAYMENT ESCROW FUNDS | 805638 |
| OTHER | 1075865 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 12215972 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (5 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO THIRD PARTY PAYORS- LONG TERM | $1,118,401 |
| DUE TO THIRD PARTY PAYORS- SHORT TERM | $1,100,722 |
| LINE OF CREDIT | $210,000 |
| PENSION LIABILITY | $3,863,752 |
| WORKERS COMPENSATION | $197,680 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 6490555 | TotalOfAmounts |
| Total Revenue | 50549365 | TotalRevenue |
| Total Expenses | 50860706 | TotalExpenses |
| Excess Or Deficit For Year | -311341 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -37347 | NetUnrealizedGLOnInvestments |
| Other | -$1,553,378 | OtherAmount |
| Total Adjustments | -1590725 | TotalAdjustments |
| Excess Or Deficit Per FS | -1902066 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 50549365 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 50549365 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 50549365 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 50860706 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 50860706 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 50860706 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | EMPLOYEE EDUCATION. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | IN ACCORDANCE WITH ASC 740-10-50, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, THE SYSTEM RECOGNIZES THE TAX BENEFITS FROM UNCERTAIN TAX POSITIONS ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES. MANAGEMENT BELIEVES THAT THE SYSTEM IS CURRENTLY OPERATING IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE INTERNAL REVENUE CODE. THEREFORE, NO LIABILITY FOR UNRECOGNIZED TAX BENEFITS HAS BEEN INCLUDED ON THE SYSTEMS FINANCIAL STATEMENTS. THE EXEMPT SYSTEMS INFORMATIONAL RETURNS ARE SUBJECT TO AUDIT BY VARIOUS TAXING AUTHORITIES AND ITS OPEN AUDIT PERIODS ARE 2009 THROUGH 2011. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | CHANGE IN INTEREST IN FOUNDATION 82,068. PENSION RELATED CHANGES OTHER THAN NET PERIODIC PENSION COSTS -1,635,446. TOTAL TO SCHEDULE D, PART XI, LINE 8: -1,553,378. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF TOURNAMENT | NameOfEvent1 |
| Gross Receipts Event1 | 17885 | GrossReceiptsEvent1 |
| Gross Revenue Event1 | 17885 | GrossRevenueEvent1 |
| Rent Facility Costs Event1 | 1584 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 2164 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 830 | OtherDirectExpensesEvent1 |
| Name Of Event2 | FLOWER SALE | NameOfEvent2 |
| Gross Receipts Event2 | 6198 | GrossReceiptsEvent2 |
| Gross Revenue Event2 | 6198 | GrossRevenueEvent2 |
| Other Direct Expenses Event2 | 3758 | OtherDirectExpensesEvent2 |
| Gross Receipts Total | 24083 | GrossReceiptsTotal |
| Gross Revenue Total Events | 24083 | GrossRevenueTotalEvents |
| Rent Facility Costs Total Events | 1584 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 2164 | FoodAndBeverageTotalEvents |
| Other Direct Expenses Total Events | 4588 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 8336 | DirectExpenseSummaryEvents |
| Net Income Summary | 15747 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 0 | FPGReferenceFreeCare |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 947 | PersonsServed |
| Total Community Benefit Expense | 612646 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 612646 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01200 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 7518 | PersonsServed |
| Total Community Benefit Expense | 7069634 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6083710 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 985924 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01940 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 457 | PersonsServed |
| Total Community Benefit Expense | 580389 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 493030 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 87359 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00170 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 8922 | PersonsServed |
| Total Community Benefit Expense | 8262669 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6576740 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1685929 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03310 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 16 | NumberOfActivitiesOrPrograms |
| Persons Served | 7085 | PersonsServed |
| Total Community Benefit Expense | 78245 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 12218 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 66027 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00130 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 3 | NumberOfActivitiesOrPrograms |
| Persons Served | 202 | PersonsServed |
| Total Community Benefit Expense | 102931 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 297 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 102634 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00200 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 2354 | PersonsServed |
| Total Community Benefit Expense | 3584892 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3018970 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 565922 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01110 | PercentOfTotalExpense |
Research Research
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 0 | PersonsServed |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 3 | NumberOfActivitiesOrPrograms |
| Persons Served | 1045 | PersonsServed |
| Total Community Benefit Expense | 57305 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 13211 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 44094 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00090 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 24 | NumberOfActivitiesOrPrograms |
| Persons Served | 10686 | PersonsServed |
| Total Community Benefit Expense | 3823373 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3044696 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 778677 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01530 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 24 | NumberOfActivitiesOrPrograms |
| Persons Served | 19608 | PersonsServed |
| Total Community Benefit Expense | 12086042 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9621436 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2464606 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04840 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 182 | PersonsServed |
| Total Community Building Expense | 12466 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 12466 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 182 | PersonsServed |
| Total Community Building Expense | 12466 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 12466 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $1,476,797 | BadDebtExpenseAmount |
| Amount Attributable To | 381465 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 8976740 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 7574035 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 1402705 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NICHOLAS H NOYES MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 CLARA BARTON STREET | AddressLine1 |
| City | DANSVILLE | City |
| State | NY | State |
| ZIP Code | 14437 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NOT REQUIRED | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| State Regulation | X | StateRegulation |
| Other Factors | X | OtherFactors |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Lowest Negotiated Rates | X | LowestNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 5 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (5 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| AFTER HOURS CARE CENTER | ||||
| 4440 LAKEVILLE ROAD | GENESEO | NY | 14454 | URGENT CARE CENTER |
| LIVINGSTON HEALTH SERVICES | ||||
| 50 EAST SOUTH STREET | GENESEO | NY | 14454 | OUTPATIENT SURGERY AND DIAGNOSTIC |
| MENTAL HEALTH CLINIC | ||||
| 1 MAIN STREET | DANSVILLE | NY | 14437 | MENTAL HEALTH CLINIC |
| NOYES CTR FOR KIDNEY DISEASE & DIALYSIS | ||||
| 4616 MELLENIUM DRIVE | GENESEO | NY | 14454 | CHRONIC DIALYSIS CENTER AND NEPHROLOGIST |
| OB-GYN ASSOC OF THE FINGER LAKES | ||||
| 253 MAIN STREET | DANSVILLE | NY | 14437 | OUTPATIENT PHYSICIAN CLINIC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART II: NOYES HOSPITAL STAFF ACTIVELY PARTICIPATES IN MULTIPLE COMMUNITY COALITIONS AND PARTNERSHIPS TO COLLABORATIVELY ADDRESS THE HEALTH CARE NEEDS OF OUR COMMUNITY. THE FOLLOWING IS A LIST OF AGENCY AND ORGANIZATIONAL COMMITTEES/TEAMS THAT NOYES PARTICIPATES ON TO IMPROVE THE HEALTH OF THE COMMUNITY WE SERVE: GENESEE VALLEY HEALTH PARTNERSHIP (GVHP): EXECUTIVE BOARD AND GENERAL MEMBERSHIP GVHP LIVINGSTON COUNTY COMMUNITY HEALTH IMPROVEMENT (CHIP) WORK GROUPS: PREVENTION AND MANAGEMENT OF CHRONIC DISEASE (NOYES MEMBER) IMPROVE ACCESS TO HEALTH CARE STRENGTHEN SOCIAL AND EMOTIONAL HEALTH (NOYES MEMBER) PROMOTE SAFE COMMUNITIES (NOYES MEMBER) LIVINGSTON WELLNESS PARTNERSHIP LIVINGSTON COUNTY LONG TERM CARE COUNCIL LIVINGSTON COUNTY MATERNAL CHILD HEALTH COALITION (NOYES LEAD) LIVINGSTON COUNTY DIABETES COALITION (NOYES LEAD) LIVINGSTON COUNTY SEXUAL RESPONSIBILITY COALITION LIVINGSTON COUNTY TOBACCO ACTION COALITION LIVINGSTON COUNTY TRAFFIC SAFETY COALITION LIVINGSTON COUNTY OFFICE FOR AGING ADVISORY BOARD FAITH IN ACTION ADVISORY BOARD NEW ACHIEVE GRANT (ACTION COMMUNITIES FOR HEALTH, INNOVATIONS, AND ENVIRONMENTAL CHANGE) GVHP/DOH/NOYES HEALTH PARTNERSHIP: IN LATE 2010, THE LOCAL DOH APPLIED FOR AND RECEIVED A NACCHO ACHIEVE GRANT IN COLLABORATION WITH GVHP AND NOYES HEALTH TO STRENGTHEN THE COMMUNITY WELLNESS COLLABORATION AND DEVELOP COMMUNITY ACTION PLANS THAT ADDRESS COMPREHENSIVE CHRONIC DISEASE PREVENTION THROUGH POLICY, SYSTEMS, AND ENVIRONMENTAL (PSE) CHANGE STRATEGIES. | ||
| PART III, LINE 4: COSTING METHOD FOR BAD DEBT EXPENSE AT COST IS RATIO OF PATIENT CARE COST TO CHARGES FROM WORKSHEET 2.THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO CHARITY CARE IS ESTIMATED USING THE SELF PAY % OF TOTAL BAD DEBT AND MULTIPLYING BY THE DEMOGRAPHICS OF OUR PRIMARY SERVICE AREA FOR THOSE WHO WOULD RECEIVE CHARITY CARE IF GIVEN ENOUGH INFORMATION. | ||
| PART III, LINE 8: THE SOURCE OF THE MEDICARE ALLOWABLE COSTS IS THE 2009 CMS 2552 WORKSHEET I-4. | ||
| PART V, SECTION B, LINE 11H: LOWEST COMMERICIAL RATE | NOT REQUIRED | |
| PART VI, LINE 2: NOYES HEALTH CONTINUES TO BE AN ACTIVE MEMBER OF THE GENESEE VALLEY HEALTH PARTNERSHIP (GVHP) WHOSE MEMBERSHIP INCLUDES OVER 40 AGENCIES AND COMMUNITY MEMBERS INVOLVED WITH HEALTH CARE SERVICES IN LIVINGSTON COUNTY. THE HOSPITAL CEO IS ON THE GENESEE VALLEY HEALTH PARTNERSHIP (GVHP) EXECUTIVE BOARD. THE GVHP COORDINATED THE LIVINGSTON COUNTY COMMUNITY NEEDS ASSESSMENT USING MAPP (MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS) PROCESS INITIATED IN 2010 TO DEVELOP THE LIVINGSTON COUNTY DOH COMMUNITY HEALTH IMPROVEMENT PLAN 2011-2015. IN 2011, THE MAPP ADVISORY BOARD CHARGED FOUR COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) TEAMS TO FOCUS ON INDICATORS, RESOURCES, BARRIERS, OBJECTIVES, GOALS AND INTERVENTIONS TO ADDRESS THE TOP FOUR COMMUNITY HEALTH NEEDS.NOYES COMMUNITY OUTREACH STAFF ATTENDS THE QUARTERLY GENERAL MEMBERSHIP MEETINGS AND PARTICIPATE ON ONE OR MORE OF THE FOUR CHIP TEAMS THAT FOCUS ON PREVENTION AGENDA PRIORITIES SET IN OUR 2009 NOYES COMPREHENSIVE PLAN: PREVENTION AND MANAGEMENT OF CHRONIC DISEASE IMPROVE ACCESS TO HEALTH CARE STRENGTHEN SOCIAL AND EMOTIONAL HEALTH PROMOTE SAFE COMMUNITIES | ||
| PART VI, LINE 3: IN 2011, NOYES HEALTH CONTINUED EFFORTS TO EFFECTIVELY COMMUNICATE OUR FINANCIAL AID POLICY. EVERY UNINSURED AND UNDERINSURED PATIENT RECEIVED A FINANCIAL AID PACKET CONSISTING OF THE FINANCIAL AID PROGRAM SUMMARY AND BROCHURE, A FINANCIAL AID (FA) APPLICATION AND INSTRUCTIONS ON HOW TO APPLY, AS WELL AS HOW TO RECEIVE ASSISTANCE IN APPLYING. WE HAVE A SOCIAL WORKER AND A DEDICATED FA BILLING REPRESENTATIVE WHO WORK SPECIFICALLY WITH ALL UNINSURED PATIENTS UPON ADMISSION. WE EMPLOY A FACILITATED ENROLLER FOR PRESUMPTIVE MEDICAID FOR PRENATAL CARE AND EDUCATION/SUPPORT SERVICES. ALL OTHER FACILITATED ENROLLMENT NEEDS ARE REFERRED TO APPROPRIATE COUNTY DEPARTMENT OF SOCIAL SERVICESPATIENTS ARE MAILED FINANCIAL AID INFORMATION WITH THEIR FIRST STATEMENTS. INFORMATION ABOUT THE HOSPITALS FINANCIAL ASSISTANCE PROGRAM IS ALSO POSTED IN ALL PUBLIC AREAS THROUGHOUT THE HOSPITAL. THE FINANCIAL ASSISTANCE COMMITTEE MEETS AS NEED TO REVIEW POLICY AND ADDRESS SPECIAL NEEDS. THE REVENUE CYCLE COMMITTEE MEETS MONTHLY AND INCLUDED FINANCIAL AID DATA REVIEW. | ||
| PART VI, LINE 4: NOYES MEMORIAL HOSPITAL SERVES A RURAL COMMUNITY IN THE NEW YORK FINGER LAKES AREA. OUR PRIMARY MARKET SHARE ZIP CODE REPORT DEMONSTRATES THAT LIVINGSTON COUNTY IS OUR HEALTH CARE SYSTEMS PRIMARY SERVICE AREA AND WE ALSO SERVE A SMALLER PERCENTAGE OF RESIDENTS IN THE SURROUNDING COUNTIES INCLUDING STEUBEN, ALLEGANY, WYOMING AND ONTARIO RESPECTIVELY. LIVINGSTON COUNTY IS A RURAL COUNTY IN WESTERN NEW YORK COVERING 640 SQUARE MILES WITH POPULATION OF 65,393.HEALTH CARE SERVICES ARE PROVIDED AT THE FOLLOWING LOCATIONS THROUGHOUT LIVINGSTON COUNTY: NICHOLAS H. NOYES MEMORIAL HOSPITAL: A 72-BED ACUTE CARE HOSPITAL LOCATED IN DANSVILLE PROVIDING MEDICAL, SURGICAL, AND EMERGENCY INPATIENT/OUTPATIENT SERVICES THAT ALSO INCLUDE COMMUNITY OUTREACH WELLNESS, EDUCATION AND PREVENTION PROGRAMS. LIVINGSTON HEALTH SERVICES: AN AMBULATORY CARE FACILITY IN GENESEO THAT PROVIDES OUTPATIENT SURGICAL, RADIOLOGY, LABORATORY, PHYSICAL THERAPY, PAIN MANAGEMENT, AND PHYSICIAN SERVICES. NOYES MENTAL HEALTH: AN OUT-PATIENT CLINIC PROVIDING INDIVIDUAL, GROUP AND FAMILY COUNSELING SERVICES. NOYES PHYSICIAN SERVICE OFFICES OB-GYN ASSOCIATES OF THE FINGER LAKES: DANSVILLE AND GENESEO GENESEE REGIONAL ORTHOPEDICS: DANSVILLE CREEKSIDE FAMILY PRACTICE NOYES SURGICAL SERVICS NOYES CENTER FOR KIDNEY DISEASE AND DIALYSIS: A 12 STATION OUTPATIENT DIALYSIS AND RENAL DISEASE MANAGEMENT CENTER IN GENESEO. | ||
| PART VI, LINE 5: THE NOYES BOARD OF DIRECTORS HAS 14 ACTIVE COMMUNITY REPRESENTATIVES ON THEIR 20 MEMBER BOARD. NOYES HAS AN OPEN MEDICAL STAFF PROVIDING A VARIETY OF MEDICAL SERVICES INCLUDING: CARDIOLOGY, EARS/NOSE/THROAT, FAMILY MEDICINE, GASTROENTEROLOGY, ORTHOPEDICS, GENERAL AND VASCULAR SURGERY, INTERNAL MEDICINE, OB/GYN, NEPHROLOGY, OPHTHALMOLOGY, PEDIATRICS, AND UROLOGY. | ||
| NY | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AMY POLLARD | |||||||||||||
| 157184 | 0 | 0 | 0 | 3191 | 0 | 0 | 0 | 17312 | 0 | 177687 | 0 | 0 | 0 |
| DOUGLAS MAYHLE MD | |||||||||||||
| 333734 | 0 | 0 | 0 | 6211 | 0 | 0 | 0 | 15747 | 0 | 355692 | 0 | 0 | 0 |
| ROBERT CAPECCI MD | |||||||||||||
| 590398 | 0 | 0 | 0 | 1188 | 0 | 0 | 0 | 8372 | 0 | 599958 | 0 | 0 | 0 |
| ASAD MAJID MD | |||||||||||||
| 417932 | 0 | 0 | 0 | 270 | 0 | 0 | 0 | 15152 | 0 | 433354 | 0 | 0 | 0 |
| ROBERT SUPINSKI | |||||||||||||
| 622281 | 0 | 0 | 0 | 744 | 0 | 0 | 0 | 18823 | 0 | 641848 | 0 | 0 | 0 |
| ROBERT BONVINO MD | |||||||||||||
| 336217 | 0 | 0 | 0 | 1188 | 0 | 0 | 0 | 12542 | 0 | 349947 | 0 | 0 | 0 |
| BARRY HAICKEN MD | |||||||||||||
| 319393 | 0 | 0 | 0 | 2027 | 0 | 0 | 0 | 15979 | 0 | 337399 | 0 | 0 | 0 |
| JAMES WISSLER | |||||||||||||
| 40461 | 0 | 0 | 0 | 135375 | 0 | 0 | 0 | 11439 | 0 | 187275 | 0 | 0 | 0 |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|
| LIVINGSTON COUNTY INDUSTRIAL DEVELOPMENT AGENCY | |||||||
| 161136853 | 538655AD3 | 2005-06-29 | 9471914 | SEE PART VI | 0 | 0 | 0 |
| LIVINGSTON COUNTY INDUSTRIAL DEVELOPMENT AGENCY | |||||||
| 161136853 | 538655AE1 | 2007-12-20 | 615060 | REFUND OF PRIOR BONDS (06/30/99) | 0 | 0 | 1 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Amount RetiredAmountRetired | Total ProceedsTotalProceeds | Amount In Reserve FundAmountInReserveFund | Capitalized InterestCapitalizedInterest | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Other Spent ProceedsOtherSpentProceeds | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Credit EnhancementCreditEnhancement |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1720000 | 9763548 | 805638 | 625676 | 189438 | 6449941 | 1692856 | 2006 | 1 | 0 | 1 | 1 | |
| 159732 | 615060 | 12301 | 10309 | 589366 | 2003 | 1 | 0 | 1 | 1 | 3084 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Engage Bond Counsel ContractsEngageBondCounselContracts | Any Research AgreementsAnyResearchAgreements | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Total Private Business UseTotalPrivateBusinessUse | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|---|---|---|
| 0 | 0 | 1 | 1 | 0 | 0.02400 | 0.02400 | 0 |
| 0 | 0 | 0 | 0 | 0 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 | 1 |
| 0 | 1 | 0 | 0 | 0 | 1 |
Form990 Schedule K Part VI Form990ScheduleKPartVI (3 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART I, LINE A, COLUMN (F): | ACQUISITION, RENOVATION, CONSTRUCTION AND EQUIPPING OF IMPROVEMENTS TO A HOSPITAL FACILITY; REFUNDING OF PRIOR BONDS (9/17/1998) |
| PART I, LINE B, COLUMN (E) AND PART II, LINES 1 - 12, COLUMN B | REPRESENTS AM ALLOCATION OF 12.24% OF THIS BOND ISSUE; THE REMAINING 87.76% IS ALLOCATED TO RED JACKET CENTER, INC., A RELATED ORGANIZATION. |
| PART II, LINE 3, COLUMN A | THE TOTAL PROCEEDS DO NOT AGREE WITH THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVESTMENTS EARNINGS. |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | NANCY JOHNSON | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | WIFE OF BOARD MEMBER | Relationship |
| Amount Of Transaction | 57825 | AmountOfTransaction |
| Description Of Transaction | COMPENSATION | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | FORM 990 IS REVIEWED BEFORE IT IS FILED. | |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD OF DIRECTORS REGULARLY REVIEWS THE CONFLICT OF INTEREST POLICY AND ASSURES ITS COMPLIANCE. | |
| FORM 990, PART VI, SECTION B, LINE 15A | THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS THE GOALS AND OBJECTIVES OF THE CEO ALONG WITH COMPARABILITY DATA TO DETERMINE HIS COMPENSATION. THE DELIBERATION AND DECISION IS RECORDED IN THE MINUTES OF THE EXECUTIVE COMMITTEE MEETING. | |
| FORM 990, PART VI, SECTION C, LINE 18 | BY REQUEST TO THE CEO, CFO OR ADMINISTRATIVE ASSISTANT. ALSO AVAILABLE ON GUIDESTAR WEBSITE. | |
| FORM 990, PART VI, SECTION C, LINE 19 | BY REQUEST TO THE CEO, CFO OR ADMINISTRATIVE ASSISTANT. | |
| FORM 990, PART VII | JAMES CULBERSTON - 5879 DIETER RD, DANSVILLE, NY 14437. JOHN LOCKHART - 32 MAIN STREET, GENESEO, NY 14454. MICHAEL JOHNSEN - 3927 COLTON HILL ROAD, DALTON, NY 14836. LESLIE COLE, JR. - 3186 BRONSON HILL ROAD, LIVONIA, NY 14487. GEOFFREY MARKOWSKI, MD - 50 EAST SOUTH STREET, GENESEO, NY 14454. THOMAS DWYER, MD - 9107 RICKETTS RD, DANSVILLE, NY 14437. JOAN FLENDER, MD - STONY BROOK PEDIATRICS, P.O. BOX 499, DANSVILLE, NY 14437. GRAHAM FRAZER - 8889 REEDS CORNERS ROAD, DANSVILLE, NY 14437. ROBERT HART - 10 MOREY AVENUE, DANSVILLE, NY 14437. ANDREW LONG - 5563 COTTONWOOD DRIVE, CONESUS, NY 14435. MARILYN MOORE - 1856 DUNKLEY RD, LEICESTER, NY 14481. MAUREEN WOLCOTT - 10799 EDMOND ROAD, COHOCTON, NY 14826. SALLY WEST - 14 MAIN STREET, GENESEO, NY 14454. MARK LYONS - 28 EAST MAIN ST, ROCHESTER, NY 14614. PETER SOSCIA - 4458 LATIMER RD, GROVELAND, NY 14462. LINDSAY QUINTILONE - 2 COURT STREET, GENESEO, NY 14454. | CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -37,347. CHANGE IN INTEREST IN FOUNDATION 82,068. PENSION RELATED CHANGES OTHER THAN NET PERIODIC PENSION COSTS -1,635,446. TOTAL TO FORM 990, PART XI, LINE 5: -1,590,725. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| PART XII, LINCE 2C | THE HOSPITAL DID NOT CHANGE THE OVERSIGHT PROCESS IN THE CURRENT YEAR. | OVERSIGHT PROCESS |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|
| THE FOUNDATION FOR NOYES MEMORIAL HEALTH SYSTEM INC | |||||||||
| 111 CLARA BARTON ST | DANSVILLE | NY | 14437 | 161584778 | TO PROVIDE FUNDS FOR BENEFIT OF THE HOSPITAL | NY | 501(C)(3) | 170(B)(1)(A) (VI) | 0 |
| RED JACKET CENTER INC | |||||||||
| 111 CLARA BARTON ST | DANSVILLE | NY | 14437 | 161037658 | TO MAINTAIN A BUILDING AND LEASE SPACE TO THE HOSPITAL | NY | 501(C)(3) | SECTION 509 (A)(3) | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| RED JACKET CENTER INC | |
| P | 1295185 |
| FOUNDATION FOR NOYES MEMORIAL HEALTH SYSTEM INC | |
| O | 862440 |
| RED JACKET CENTER INC | |
| J | 570614 |
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