2025-11-17T12:08:27-06:00 2024-12-31 160765486 LUMSDEN & MCCORMICK LLP 369 FRANKLIN STREET BUFFALO NY 14202 990 2024-01-01 160755761 CUBA MEMORIAL HOSPITAL INC CUBA 5859682000 140 WEST MAIN ST CUBA NY 147271398 RUTH IRELAND CHIEF EXECUTIVE OFFICER 5859682000 2025-11-14 0 JILL M JOHNSON CPA P01701478 7168563300 2025-11-14 2024 2025-03-06 01:10:19Z RUTH IRELAND 140 WEST MAIN ST CUBA NY 147271398 14393157 0 X WWW.CUBAMEMORIALHOSPITAL.COM X 1925 NY ACUTE AND LONG TERM PATIENT CARE 6 6 0 6 0 0 1116505 1700963 8397629 12051457 16401 33900 -3579 603706 9526956 14390026 0 0 0 0 6462815 6908636 0 0 0 5314853 5296731 11777668 12205367 -2250712 2184659 11773233 14064541 3532636 3639285 8240597 10425256 TO PROVIDE A CONTINUUM OF APPROPRIATE HEALTH RELATED SERVICES TO ENHANCE THE QUALITY OF LIFE IN OUR COMMUNITY. 0 0 10025275 12457519 CUBA MEMORIAL HOSPITAL IS A NOT FOR PROFIT PUBLIC BENEFIT CORPORATION. ACUTE AND SKILLED NURSING HOME CARE IS PROVIDED IN ADDITION TO A 24 HOUR URGENT CARE CENTER. THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN REQUIREMENTS UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN THE ESTABLISHED RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMED TO QUALIFY AS CHARITY CARE, THESE AMOUNTS ARE NOT REPORTED AS INCOME. 10025275 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 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 29 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X RUTH IRELAND 5859682000 140 W MAIN ST CUBA NY 14727 DAVID CROWLEY CHAIRMAN 1.00 X X 0 0 0 MIKLOS FARKAS TRUSTEE 1.00 X X 0 0 0 MARJANNE KUNZ TRUSTEE 1.00 X 0 0 0 KATHY MORRIS TRUSTEE 1.00 X 0 0 0 BONNIE VANHOUSEN TRUSTEE 1.00 X 0 0 0 LISA YATES TRUSTEE 1.00 X 0 0 0 NORMA J KERLING CHIEF EXECUTIVE OFFICER THROUGH AUG 2024 37.50 X 163697 0 6682 RUTH E IRELAND CHIEF EXECUTIVE OFFICER EFFECTIVE AUG 2024 37.50 X 133365 0 6620 JOYCE KRATTS DIRECTOR OF NURSING 48.00 X 110757 0 1167 MARK STANCOMBE PHYSICIAN ASSISTANT 48.00 X 271527 0 16135 DAVID HANRAHAN PHYSICIAN ASSISTANT 48.00 X 216274 0 2291 MARY O'BRIEN PHYSICIAN ASSISTANT 48.00 X 217695 0 15537 1113315 0 48432 6 0 1 0 AFFINITY REHABILITATION LLP 536 OLD HOWELL ROAD GREENVILLE SC 29615 PROFESSIONAL SERVICES 308689 1 1700813 150 1700963 PATIENT SERVICE REVENUE 622110 12051457 12051457 12051457 20762 20762 121966 0 121966 121966 121966 16269 3131 13138 13138 13138 RATE AND REVENUE ENHANCEMENTS 622110 406062 406062 OTHER REVENUE 900099 75678 75678 481740 14390026 12457519 0 231544 X 310364 257602 52762 5810511 4822725 987786 335927 278819 57108 451834 375023 76811 62229 62229 40500 40500 2865374 2408765 456609 5470 4540 930 103273 83889 19384 267552 222068 45484 5548 5548 6776 6776 744798 469223 275575 198537 162800 35737 MEDICAL SUPPLIES 643009 643009 SHARED SERVICES 192468 159748 32720 MAINTENANCE AND REPAIRS 161197 137064 24133 12205367 10025275 2180092 0 6699994 7529733 347828 901876 1082530 109808 95103 9714 13282 24808400 19917344 3958302 4891056 69609 74135 23930 30874 11773233 14064541 2084258 2811004 13341 1435037 828281 3532636 3639285 X 8093034 10278701 147563 146555 8240597 10425256 11773233 14064541 2184659 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 21665 21665 12512783 8698743 3814040 11884091 10932344 951747 389861 286257 103604 4891056 RESIDENT FUNDS HELD IN TRUST 30874 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 797407 828281 1 1 X 1 X 250.000000000000 1 X 1 1 0 1 1 210738 210738 0.01730 2013278 2843383 0 0.00000 2224016 2843383 210738 0.01730 2224016 2843383 210738 0.01730 0 215016 27520 1086677 1120125 -33448 X 1 1 1 1 CUBA MEMORIAL HOSPITAL 140 W MAIN ST CUBA NY 14727 WWW.CUBAMEMORIALHOSPITAL.COM 0226700C X CUBA MEMORIAL HOSPITAL INC 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X HTTP://WWW.CUBAMEMORIALHOSPITAL.COM X HTTP://WWW.ALLEGANYCO.COM X 1 22 1 HTTP://WWW.CUBAMEMORIALHOSPITAL.COM 0 1 X 250.000000000000 300.000000000000 X X X 1 1 X X X 1 X WWW.CUBAMEMORIALHOSPITAL.COM X WWW.CUBAMEMORIALHOSPITAL.COM X WWW.CUBAMEMORIALHOSPITAL.COM X X X X X 1 X 0 X X X 1 X 0 0 CUBA MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 5: A CORE GROUP OF KEY STAKEHOLDERS ASSEMBLED ON NOVEMBER 18, 2022. THEY DISCUSSED CHANGES TO AND REVIEWED POSSIBLE FOCUS AREAS AND HEALTH PRIORITIES. CUBA MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 6A: THE COMMUNITY HEALTH ASSESSMENT WAS COMPLETED IN CONJUNCTION WITH JONES MEMORIAL HOSPITAL IN WELLSVILLE, NY. CUBA MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 6B: THE COMMUNITY HEALTH ASSESSMENT WAS COMPLETED IN CONJUNCTION WITH THE ALLEGANY COUNTY DEPARTMENT OF HEALTH AND ARDENT SOLUTIONS, INC. CUBA MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 11: THE WORK PLAN INCLUDES THE GOALS, OBJECTIVES, INTERVENTION STRATEGIES AND ACITVIITES THAT WILL BE IMPLEMENTED FOR THE PRIORITY AREAS AND THE PROCESS MEASURES USED TO TRACK PROGRESS. PART I, LINE 7: SPECIFIED WORKSHEETS WERE UTILIZED TO DETERMINE APPROPRIATE REVENUES AND COSTS TO BE REPORTED USING A RATIO OF COST TO CHARGES AS DEFINED IN THE WORKSHEETS. PART I, LN 7 COL(F): FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 2: A RATIO OF COST TO CHARGES WAS APPLIED TO THE NET UNCOLLECTIBLE BAD DEBT PROVISION. PART III, LINE 9B: IF A PATIENT IS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE, THE ACCOUNT IS MOVED TO A PRESUMED CHARITY CATEGORY AND COLLECTION EFFORTS ARE TERMINATED. PART VI, LINE 2: THE HOSPITAL, ALONG WITH OTHER COMMUNITY STAKEHOLDERS CONDUCT COMMUNITY SURVEYS, FOCUS GROUPS, STATISTICAL DATA ON THE LEADING CAUSE OF DEATH AND PREMATURE DEATH, AND COMMUNITY HEALTH INDICATORS. THE STAKEHOLDERS MEET TO REVIEW THE RESULTS AND PRIORITIZE THE NEEDS. PART VI, LINE 3: PATIENTS WHO ARE NOT COVERED, OR RECEIVE SERVICES NOT COVERED BY A THIRD-PARTY INSURER WILL BE GIVEN AN EDUCATIONAL PACKAGE BY THE PATIENT ACCESS REGISTRAR. THIS EDUCATIONAL PACKAGE WILL INCLUDE INFORMATION REGARDING THE SELF-PAY DISCOUNT APPLIED TO ALL UNINSURED OR UNDER INSURED PATIENTS AS WELL AS INFORMATION ON THE FINANCIAL ASSISTANCE PROGRAM. THE PACKAGE WILL INCLUDE A FINANCIAL SCREENING DOCUMENT CHECKLIST AND AN APPLICATION FORM. PATIENTS HAVE 90 DAYS FROM THE DATE OF DISCHARGE OR SERVICES TO APPLY FOR FINANCIAL ASSISTANCE AND AT LEAST 30 DAYS TO SUBMIT A COMPLETED APPLICATION. PART VI, LINE 4: THE COMMUNITY ENCOMPASSES THE TOWNS/VILLLAGES OF FRIENDSHIP, WELLSVILLE, BELFAST, BOLIVAR AND CUBA AS PRIMARY SERVICE AREAS, AND OLEAN, BELMONT, ANDOVER, SCIO AND RUSHFORD AS SECONDARY SERVICE AREAS.ALLEGANY COUNTY IS A RURAL COUNTY LOCATED ALONG THE SOUTHERN TIER OF UPSTATE NEW YORK, WITH AN AREA OF 1,030 SQUARE MILES. THE POPULATION DENSITY IS 47.6 PEOPLE PER SQUARE MILE ON THE 2020 CENSUS. THE 2022 ESTIMATED POPULATION IS 46,694. CAUCASIANS COMPRISE THE VAST MAJORITY OF ALLEGANY COUNTY RESIDENTS, MAKING UP 97.03% OF THE POPULATION. AFRICAN AMERICANS (0.28%); AMERICAN NATIVE/ALASKA NATIVE (0.28%); ASIANS (0.72%); HISPANIC OR LATINO (0.91%). THE 2020 U.S. CENSUS SHOWED THE MEDIAN AGE OF ALLEGANY COUNTY RESIDENTS TO BE 35 YEARS. CENSUS DATA ALSO SHOWS THAT 24.4% OF THE POPULATION IS 18 YEARS OF AGE OR YOUNGER. 61.6% OF THE POPULATION IS AGE 18-64 AND 14% IS AGE 65 OR OLDER. THE DATA ALSO INDICATES THAT THE COUNTRY'S POPULATION IS LIVING LONGER. THE CENSUS ALSO SHOWS 54.2% OF THE POPULATION IS MARRIED; 9.0% HAD A FEMALE HOUSEHOLD WITH NO HUSBAND; AND 32.3% WERE NON-FAMILIES. 26.0% OF ALL HOUSEHOLDS WERE MADE UP OF INDIVIDUALS, AND 11.3% HAD SOEMONE LIVING ALONE WHO WERE 65 YEARS OF AGE AND OLDER. THE AVERAGE HOUSEHOLD SIZE WAS 2.53 AND THE AVERAGE FAMILY SIZE WAS 3.04.INCOME LEVELS IN ALLEGANY COUNTY ARE AMONG THE LOWEST IN THE STATE. PER CAPITA INCOME SHOWS THE COUNTY'S STANDARD OF LIVING AT $14,975. ABOUT 10.50% OF FAMILITIES AND 15.50% OF THE POPULATION WERE BELOW THE POVERTY LINE. X X X X 0 0 0 0 0 0 0 0 0 MARK STANCOMBE PHYSICIAN ASSISTANT 271527 0 0 0 0 0 0 0 16135 0 287662 0 0 0 MARY O'BRIEN PHYSICIAN ASSISTANT 217695 0 0 0 0 0 0 0 15537 0 233232 0 0 0 DAVID HANRAHAN PHYSICIAN ASSISTANT 216274 0 0 0 0 0 0 0 2291 0 218565 0 0 0 NORMA J KERLING CHIEF EXECUTIVE OFFICER THROUGH AUG 163697 0 0 0 0 0 0 0 6682 0 170379 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF TRUSTEES IS PROVIDED A COPY OF THE 990 DRAFT FOR REVIEW. ANY QUESTIONS OR CONCERNS ARE DISCUSSED AND RESOLVED. THE REVISIED SUBMISSION IS THEN SENT TO OUR INDEPENDENT AUDITORS FOR REVIEW AND SUBMISSION. THE FINAL VERSION OF THE 990 IS THEN PROVIDED TO ALL BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, ALL TRUSTEES AND OFFICERS COMPLETE AND SIGN AN ATTESTATION FORM IDENTIFYING ANY PERSONAL AND/OR FAMILY CONFLICT SITUATIONS. FORM 990, PART VI, SECTION B, LINE 15 ANNUALLY, THE BOARD OF TRUSTEES EXECUTIVE COMMITTEE REVIEWS THE CEO'S PERFORMANCE AND COMPENSATION. KEY EMPLOYEE COMPENSATION IS REVIEWED AND ESTABLISHED BY EXECUTIVE OFFICER CONSISTENT WITH THE BOARD APPROVED OPERATING BUDGET. FORM 990, PART VI, SECTION C, LINE 19 MONTHLY AND ANNUAL FINANCIAL STATEMENTS ARE FILED WITH ALL FINANCIAL INSTITUTIONS WITH RELATIONSHIPS WITH THE HOSPITAL. ANNUAL COST REPORTS ARE FILED WITH MEDICARE AND MEDICAID. THE 990 IS ELECTRONICALLY FILED AND IS AVAILABLE FROM THE ORGANIZATION UPON REQUEST. FORM 990, PART IX, LINE 11G PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 169,820. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 169,820. OTHER: PROGRAM SERVICE EXPENSES 1,314,823. MANAGEMENT AND GENERAL EXPENSES 269,301. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,584,124. EMPLOYMENT AGENCY FEES: PROGRAM SERVICE EXPENSES 664,870. MANAGEMENT AND GENERAL EXPENSES 136,178. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 801,048. MEDICAL EQUIPMENT SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 9,619. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,619. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 249,633. MANAGEMENT AND GENERAL EXPENSES 51,130. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 300,763. FORM 990, PART 12, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. CMHR CORPORATION 140 WEST MAIN ST CUBA NY 14727 562495396 PROPERTY MANAGEMENT NY 501(C)(3) 501(C)(3) CUBA MEMORIAL HOSPITAL INC 0 CUBA MEMORIAL RETIREMENT COMMUNITY INC 140 WEST MAIN ST CUBA NY 14727 271463624 ASSISTED LIVING NY 501(C)(3) 501(C)(3) CUBA MEMORIAL HOSPITAL INC 0 CUBA MEMORIAL HOSPITAL FOUNDATION INC 140 WEST MAIN ST CUBA NY 14727 810995565 FUNDRAISING NY 501(C)(3) 501(C)(3) CUBA MEMORIAL HOSPITAL INC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 PART V, SECTION 2 THE CEO OF OF CUBA MEMORIAL HOSPITAL, INC. IS FUNCTIONING AS THE OFFICER OF BOTH SUBSIDIARY CORPORATIONS. AT THIS TIME, THE PAPERWORK IS AT THE LAWYERS OFFICE AND THE PROPERTIES ARE IN THE PROCESS OF BEING DISOLVED.