2025-11-14T12:59:54-06:00 2024-12-31 222027092 WITHUM SMITH & BROWN PC 424 MAIN STREET SUITE 800 BUFFALO NY 142023508 990 2024-01-01 160743921 BERTRAND CHAFFEE HOSPITAL BERT 7165922871 224 EAST MAIN STREET SPRINGVILLE NY 14141 CAROLE FRANCIS CFO 7165922871 2025-11-14 1 0 MARY MADONIA P00405803 7168472651 2025-11-12 2024 2025-03-06 01:10:19Z TERESA DONOHUE 224 EAST MAIN STREET SPRINGVILLE NY 14141 36397684 0 X BERTRANDCHAFFEE.COM X 1946 NY BERTRAND CHAFFEE HOSPITAL IS A COMMUNITY-GOVERNED ORGANIZATION RECOGNIZED AS THE REGION'S LEADING PROVIDER AND ADVOCATE OF HEALTHCARE SERVICES. OUR PATIENT-FOCUSED APPROACH ENSURES HIGH QUALITY, EXTRAORDINARY VALUE AND EXCELLENT PATIENT EXPERIENCES. 11 11 348 13 0 0 130897 57463 27173063 35046251 1611 494 1365970 1293476 28671541 36397684 0 0 0 0 18732349 19295786 0 0 0 10288719 12930686 29021068 32226472 -349527 4171212 21863385 24605456 6622986 5193845 15240399 19411611 BERTRAND CHAFFEE HOSPITAL PROVIDES ACUTE CARE SERVICES TO THE RESIDENTS OF SPRINGVILLE AND THE SURROUNDING REGION TO ENHANCE THE HEALTH STATUS OF RESIDENTS AND RESPOND TO COMMUNITY HEALTH CARE NEEDS. 0 0 27712443 36181999 DELIVERED HIGH QUALITY ACUTE HOSPITAL AND PRIMARY CARE SERVICES TO THOSE IN NEED AND TO SERVE AS AN EDUCATIONAL RESOURCE PROMOTING WELLNESS AND POSITIVE HEALTH WITHIN THE ENTIRE COMMUNITY ALONG WITH ALL OTHER MEDICAL SUPPLIERS. 27712443 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 42 0 1 348 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X THE ORGANIZATION 7165922871 224 EAST MAIN STREET SPRINGVILLE NY 14141 MICHAEL BOZA BOARD MEMBER/TREASURER (TO 5/31/2024) 2.00 2.00 X X 0 0 0 ASHLEY LOWRY BOARD MEMBER 2.00 2.00 X 0 0 0 ALLISON DUWE BOARD MEMBER 2.00 2.00 X 0 0 0 ROBERT ROGGIE BOARD MEMBER 2.00 2.00 X 0 0 0 JOHANNA HEALY BOARD MEMBER/SECRETARY 3.00 3.00 X X 0 0 0 CLAUDIA MILLER BOARD MEMBER 2.00 2.00 X 0 0 0 ROBBIN HANSEN BOARD MEMBER/VICE PRESIDENT 2.00 2.00 X X 0 0 0 STAN HANDZLIK BOARD MEMBER 2.00 2.00 X 0 0 0 GARY EPPOLITO BOARD MEMBER/PRESIDENT 3.00 3.00 X X 0 0 0 PETER SWALES BOARD MEMBER 2.00 2.00 X 0 0 0 LIZ MELOCK BOARD MEMBER 2.00 2.00 X 0 0 0 JOSEPH PILLITTERE BOARD MEMBER/TREASURER (BEGAN 6/1/24) 2.00 2.00 X X 0 0 0 CAROLE M FRANCIS CFO 30.00 10.00 X 141456 0 8904 TERESA DONOHUE CEO 40.00 X 184748 0 30461 DR WILLIAM WNUK MD AND DIRECTOR OF PRIMARY 40.00 X 326846 0 31398 EDWIN HEIDELBERGER PHYSICIAN AND VPMA 40.00 X 234890 0 42343 GAVIN DAVISON GENERAL SURGEON 40.00 X 435941 0 104896 TRACEY FABIAN MD 40.00 X 147768 0 19742 SYDNEY DOMANOWSKI MD 40.00 X 240880 0 24055 1712529 0 261799 34 0 1 0 RP OAK HILL BUILDING COMPANY INC 3556 LAKESHORE ROAD SUITE 620 BUFFALO NY 14219 CONSTRUCTION 1705752 BUFFALO BONE AND JOINT 5056 ROCKHAVEN DRIVE CLARENCE NY 14031 MEDICAL COVERAGE 1150924 KEYSTONE MEDICAL SERVICES OF NEW YORK 4728 SPOTTSWOOD AVE 372 MEMPHIS TN 38117 MEDICAL COVERAGE 369361 MANATT 2049 CENTURY PARK EAST SUITE 1700 LOS ANGELES CA 90067 ADVISORY & LOBBYING 307943 MEDICAL SERVICES OF BUFFALO PC 4728 SPOTTSWOOD AVE 372 MEMPHIS TN 38117 MEDICAL COVERAGE 280000 11 57463 57463 NET PATIENT SERVICE REVENUE 621110 26039028 26039028 GRANT REVENUE 621110 9007223 9007223 35046251 494 494 157728 0 157728 157728 157728 MISCELLANEOUS REVENUE 621110 1124722 1124722 MEALS ON WHEELS 621110 10878 10878 CAFETERIA/COFFEE SHOP SALES 621110 148 148 1135748 36397684 36181999 0 158222 326204 326204 15547301 15245600 301701 576277 515768 60509 1667174 1492120 175054 1178830 1055053 123777 67745 67745 108083 108083 42000 42000 23270 23270 11346 11346 4031130 3907299 123831 248464 248464 22202 21323 879 1396637 1326805 69832 451726 451726 CONTRACTED SERVICES 2263272 1713272 550000 EQUIPMENT REPAIRS & MAI 1884901 1423875 461026 PHYSICIAN FEES 1426748 1426748 MISCELLANEOUS 649643 513554 136089 303519 207310 96209 32226472 27712443 4514029 0 983535 1842323 5365283 7071887 229579 366116 393755 437781 170387 264819 39670959 26275722 12369688 13395237 68887 147865 2282271 1079428 21863385 24605456 3479648 3241410 171200 0 452519 768887 2519619 1183548 6622986 5193845 X 15193070 19364282 47329 47329 15240399 19411611 21863385 24605456 4171212 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 42000 42000 0 PART II-B, LINE 1: THE EXPENSES ARE INCURRED TO INFLUENCE PUBLIC HEALTHCARE POLICY AND MEDICARE AND MEDICAID REGULATIONS THAT IMPACT THE ORGANIZATION'S ABILITY TO OPERATE AND SERVE PATIENTS. 24980 24980 19894778 9486977 10407801 608447 605842 2605 19142754 16182903 2959851 13395237 DUE TO 3RD PARTIES 328496 NYS SURCHARGE LIABILITY 10255 INSURANCE LIABILITIES 508000 OPERATING LEASE LIABILITIES 336797 1183548 X PART X, LINE 2: THE HOSPITAL AND HOME ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE), AND ACCORDINGLY, ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL AND HOME ACCOUNT FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH US GAAP, WHICH REQUIRES THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS THAT THE HOSPITAL AND HOME HAVE TAKEN OR EXPECT TO TAKE ON THE HOSPITAL OR HOME'S TAX RETURNS. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN REFLECTED IN THE ACCOMPANYING FINANCIAL STATEMENTS. 1 1 1 X 1 X 1 1 0 1 1 34584 11147 23437 0.00070 6615931 2411653 4204278 0.13050 6650515 2422800 4227715 0.13120 6650515 2422800 4227715 0.13120 1 90781 6355 2893 3065 -172 X 1 1 1 1 BERTRAND CHAFFEE HOSPITAL 224 EAST MAIN STREET SPRINGVILLE NY 14141 X X X BERTRAND CHAFFEE HOSPITAL 1 0 0 1 X X X X X X 22 1 0 1 1 X BERTRANDCHAFFEE.COM X 1 22 1 BERTRANDCHAFFEE.COM 0 1 X 200.000000000000 300.000000000000 X X 1 1 X X X X 1 X BERTRANDCHAFFEE.COM X X X X 1 X 0 X 1 0 0 BERTRAND CHAFFEE HOSPITAL PART V, SECTION B, LINE 6B: JENNIE B. RICHMOND CHAFFEE NURSING HOME COMPANY, INC. BERTRAND CHAFFEE HOSPITAL PART V, SECTION B, LINE 11: IN THE DEVELOPMENT OF OUR 2022-2024 COMMUNITY NEEDS SERVICE PLAN, WE HAVE PRIORITIZED PREVENTION OF CHRONIC ILLNESS AND DISEASE. INCLUDED ARE HYPERTENSION PREVENTION, DIABETES PREVENTION AND SMOKING PREVENTION. STRATEGIES TO HELP EDUCATE THE COMMUNITY ON PREVENTION MEASURES TO HELP THE AGING POPULATION OF NEW YORK BETTER MANAGE THESE ISSUES INCLUDE PROMOTING HEALTHY EATING AND EXERCISE. WITH THE HELP OF COMMUNITY BASED ORGANIZATIONS SUCH AS LOCAL FOOD BANKS, COUNTY SERVICES AND HEALTH INSURANCE PROGRAMS, WE ARE INCREASING OUR REFERRALS FOR THOSE WHO ARE MOST IN NEED OF THESE SERVICES. WE WILL CONTINUE TO BRIDGE THE GAP CAUSED BY DISTANCE AND TRANSPORTATION TO HEALTHY FOODS.OUR SECOND PRIORITY RELATED TO OUR COMMUNITY SERVICE PLAN IS TO PROMOTE HEALTH AND WELLBEING BY PROMOTING MENTAL HEALTH AND PREVENTING SUBSTANCE USE DISORDERS. IN COLLABORATION WITH OUR COMMUNITY PARTNERS, WE ARE EDUCATING AND EVALUATING OUR PATIENTS FOR SIGNS AND SYMPTOMS OF DEPRESSION AND ANXIETY WHICH MAY LEAD TO SELF-MEDICATING AND SUBSTANCE ABUSE. WE WILL CONTINUE TO WORK WITH THE SCHOOLS TO EDUCATE STUDENT ON THE DANGERS OF VAPING, TOBACCO AND MARIJUANA USE AMONG TEENS. RESOURCES AND ASSETS TO BE USED IN THESE PRIORITIES OF PREVENTING CHRONIC ILLNESS AMONG THE AGING POPULATION BY INCREASING PHYSICAL ACTIVITY, HEALTHY EATING AND FOOD INSECURITY WILL BE MEDIA, FACEBOOK AND NEWSPAPER ADS. IN REFERENCE TO PROMOTING MENTAL WELLNESS AND PREVENTING SUBSTANCE ABUSE, WE ARE PROVIDING EDUCATION TO THE STUDENTS AND WORKING WITH COMMUNITY PARTNERS TO ADDRESS THE SOCIAL DETERMINANTS OF HEALTH THAT HAVE BEEN SHOWN TO LEAD TO MENTAL HEALTH DISORDERS AND SUBSTANCE USE DISORDERS. PART I, LINE 7: TOTAL PATIENT GROSS CHARGES AND NET REIMBURSEMENT DATA WAS OBTAINED FROM THE NEW YORK STATE INSTITUTIONAL COST REPORT ("ICR") WHICH REPORTS ALL REVENUE BY FINANCIAL CLASS. THE COST TO CHARGE RATIO WAS DERIVED FROM USING WORKSHEET 2 OF THE INSTRUCTIONS FOR THIS FORM. TOTAL OPERATING EXPENSES, EXCLUSIVE OF BAD DEBTS, PER THE AUDITED FINANCIAL STATEMENTS WAS OFFSET BY NON-PATIENT CARE REVENUE, MEDICAID PROVIDER TAXES AND COMMUNITY BENEFIT EXPENSE. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 6,355. PART III, LINE 3: THE HOSPITAL CARRIES ITS PATIENT ACCOUNTS RECEIVABLE AT ANTICIPATED AMOUNTS DUE FOR THIRD PARTY PAYERS. THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE AND UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE HOSPITAL ESTIMATES APPROXIMATELY 7% OF ITS BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS THAT QUALIFY FOR THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. PART III, LINE 4: THE HOSPITAL'S BAD DEBT EXPENSE IS DESCRIBED ON PAGE 7 OF THE HOSPITAL'S 2024 AUDITED FINANCIAL STATEMENTS. PART III, LINE 9B: OUR POLICY ALLOWS FOR ACCOUNTS ALREADY IN COLLECTION STATUS TO BECOME ELIGIBLE FOR CHARITY CARE BASED UPON CURRENT INCOME LEVELS. PART VI, LINE 5: BERTRAND CHAFFEE HOSPITAL IS A NOT-FOR-PROFIT ACUTE CARE HOSPITAL LOCATED IN SPRINGVILLE, NEW YORK. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY SERVICES FOR THE RESIDENTS IN THE SURROUNDING AREA. THE MISSION IS TO ENHANCE THE HEALTH STATUS OF THE RESIDENTS BY RESPONDING TO THE COMMUNITY HEALTHCARE NEEDS. THAT INCLUDES COMPASSION, DEDICATION, AND A COMMITMENT TO QUALITY WHILE MAINITAINING ECONOMIC VIABILITY AND A VISION FOR THE FUTURE. SCHEDULE H, PART VI, LINE 7: THE HOSPITAL COMPLETES AND FILES A REPORT WITH THE NEW YORK STATE DEPARTMENT OF HEALTH WHICH INCLUDES COMMUNITY BENEFITS THAT THE HOSPITAL PROVIDES. IN 2013, THE HOSPITAL FILED A FIVE-YEAR PLAN WITH THE DEPARTMENT. THE PLAN WAS UPDATED THROUGH THE DEPARTMENT OF HEALTH IN 2016 AND AGAIN IN 2019. SCHEDULE H, PART VI, LINE 6: THE HOSPITAL HAS ALIGNED WITH CATHOLIC MEDICAL PARTNERS ("CMP") BY BECOMING A MEMBER FACILITY AND BY EMPLOYING CMP PHYSICIANS. X X X 0 0 0 0 0 0 0 0 0 GAVIN DAVISON GENERAL SURGEON 435941 0 0 0 0 0 27225 0 77671 0 540837 0 0 0 DR WILLIAM WNUK MD AND DIRECTOR OF PRIMARY 251846 0 0 0 75000 0 17523 0 13875 0 358244 0 0 0 EDWIN HEIDELBERGER PHYSICIAN AND VPMA 206044 0 0 0 28846 0 11483 0 30860 0 277233 0 0 0 SYDNEY DOMANOWSKI MD 230880 0 0 0 10000 0 0 0 24055 0 264935 0 0 0 TERESA DONOHUE CEO 184748 0 0 0 0 0 8983 0 21478 0 215209 0 0 0 TRACEY FABIAN MD 147768 0 0 0 0 0 8623 0 11119 0 167510 0 0 0 CAROLE M FRANCIS CFO 141456 0 0 0 0 0 8319 0 585 0 150360 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN OUTSIDE, INDEPENDENT ACCOUNTING FIRM. THE BOARD REVIEWS THE ORGANIZATION'S FORM 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST QUESTIONAIRE FORMS ARE COMPLETED BY DIRECTORS AND MANAGERS ANNUALLY. THEY ARE REVIEWED BY THE COMPLIANCE OFFICER AND ADDRESSED AS NEEDED. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION FORMED AN INDEPENDENT SEARCH COMMITTEE THAT WAS INVOLVED IN NEGOTIATING THE CONTRACT OF THE CURRENT CEO. OTHER OFFICER AND KEY EMPLOYEE SALARIES ARE REVIEWED BY THE BOARD OF DIRECTORS AND COMPARED TO PEERS IN SURROUNDING AREA TO DETERMINE AN APPROPRIATE PAY SCALE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: AUDIT OVERSIGHT THE AUDIT OVERSIGHT PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART IV, LINE 34: RELATED PARTIES THE BERTRAND CHAFFEE HOSPITAL FOUNDATION, INC. (THE FOUNDATION) WAS ORGANIZED TO RECEIVE AND ADMINISTER FUNDS AND BEQUESTS TO BENEFIT THE COMMUNITY. WHILE THE FOUNDATION MAY, AT TIMES, MAKE DONATIONS TO BERTRAND CHAFFEE HOSPITAL ("BCH") OR JENNIE B. RICHMOND CHAFFEE NURSING HOME COMPANY ("JBR"), THERE IS NO OBLIGATION TO DO SO. THE FOUNDATION WAS NOT ORGANIZED SOLELY TO BENEFIT EITHER OF THESE ENTITIES. THE RELATIONSHIP BETWEEN THE FOUNDATION, BCH AND JBR DOES NOT MEET ANY "RELATED PARTY OR "CONTROL" DEFINITIONS STATED IN THE FORM 990 INSTRUCTIONS. JENNIE B RICHMOND CHAFFEE NURSING HOME COMPANY INC 222 EAST MAIN STREET SPRINGVILLE NY 14141 237259920 NURSING HOME NY 501(C)(3) LINE 10 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0