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Edward John Noble Hospital
Gouverneur, NY 13642
| Bed count | 47 | Medicare provider number | 330177 | Member of the Council of Teaching Hospitals | NO | Children's hospital | NO |
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)
(as % of total functional expenses)
Community Benefit Expenditures: 2012
All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Operating expenses $ 22,234,998 Total amount spent on community benefits as % of operating expenses$ 204,364 0.92 %- Amount spent in the following IRS community benefit categories:
Financial Assistance at cost as % of operating expenses$ 128,232 0.58 %Medicaid as % of operating expenses$ 0 0 %Costs of other means-tested government programs as % of operating expenses$ 0 0 %Health professions education as % of operating expenses$ 0 0 %Subsidized health services as % of operating expenses$ 0 0 %Research as % of operating expenses$ 0 0 %Community health improvement services and community benefit operations*
as % of operating expensesNote: these two community benefit categories are reported together on the Schedule H, part I, line 7e.$ 76,132 0.34 %Cash and in-kind contributions for community benefit* as % of operating expenses$ 0 0 %Community building*
as % of operating expenses$ 0 0 %- * = CBI denoted preventative categories
- Community building activities details:
Did tax-exempt hospital report community building activities? Not available Number of activities or programs (optional) 0 Physical improvements and housing 0 Economic development 0 Community support 0 Environmental improvements 0 Leadership development and training for community members 0 Coalition building 0 Community health improvement advocacy 0 Workforce development 0 Other 0 Persons served (optional) 0 Physical improvements and housing 0 Economic development 0 Community support 0 Environmental improvements 0 Leadership development and training for community members 0 Coalition building 0 Community health improvement advocacy 0 Workforce development 0 Other 0 Community building expense
as % of operating expenses$ 0 0 %Physical improvements and housing as % of community building expenses$ 0 Economic development as % of community building expenses$ 0 Community support as % of community building expenses$ 0 Environmental improvements as % of community building expenses$ 0 Leadership development and training for community members as % of community building expenses$ 0 Coalition building as % of community building expenses$ 0 Community health improvement advocacy as % of community building expenses$ 0 Workforce development as % of community building expenses$ 0 Other as % of community building expenses$ 0 Direct offsetting revenue $ 0 Physical improvements and housing $ 0 Economic development $ 0 Community support $ 0 Environmental improvements $ 0 Leadership development and training for community members $ 0 Coalition building $ 0 Community health improvement advocacy $ 0 Workforce development $ 0 Other $ 0
Other Useful Tax-exempt Hospital Information: 2012
In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.
Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt
as % of operating expenses$ 829,642 3.73 %Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program? YES - Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.
Does the organization have a written financial assistance (charity care) policy? YES Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients? YES Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy
as % of operating expenses$ 0 0 %- Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Reported to credit agency Not available Filed lawsuit Not available Placed liens on residence Not available Issue body attachments? (an order by the court commanding a sheriff or other official to physically bring before the court a person who is guilty of contempt of court) Not available Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
After enactment of the ACA, has the state in which this tax-exempt hospital is located expanded Medicaid? YES The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
If not, is the state's Medicaid threshold for working parents at or below 76% of the federal poverty guidelines? Not available In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.
Does the state in which the tax-exempt hospital is located have a mandatory community benefit reporting statute? YES
Community Health Needs Assessment Activities: 2012
The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.
Did the tax-exempt hospital report that they had conducted a CHNA? YES Did the CHNA define the community served by the tax-exempt hospital? YES Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital? YES Did the tax-exempt hospital make the CHNA widely available (i.e. post online)? YES Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA? YES Did the tax-exempt hospital execute the implementation strategy? YES Did the tax-exempt hospital participate in the development of a community-wide plan? YES
Supplemental Information: 2012
- Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4A (Expenses $ 16393854 including grants of $ 0) (Revenue $ 17366197) ACUTE DIRECT PATIENT CARE - INPATIENT REFERRED AMBULATORY, EMERGENCY CARE AND CLINICS. IN 2012, EDWARD JOHN NOBLE HOSPITAL SERVED 1,014 INPATIENTS, 8,333 E.R. VISITS, PATIENT PROCEDURES TOTALED 28,945 FOR INPATIENTS AND 88,132 FOR OUTPATIENTS.
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Supplemental Information
PART I, LINE 7: THE COSTING METHODOLOGY USED IN PART I IS THE COST-TO-CHARGE RATIO METHOD. THE RATIO WAS DERIVED FROM WORKSHEET 2 INCLUDED IN THE INSTRUCTIONS.
PART II: THROUGH WORKING RELATIONS WITH THE VILLAGE/TOWN OF GOUVERNEUR WE HAVE SUCCESSFULLY IMPLEMENTED A PRIMARY CARE PHYSICIAN PRIVATE PRACTICE WITHIN A SENIOR CITIZENS HOUSING PROJECT. WE ALSO, AS A COMMUNITY SERVICE FOR BUSINESSES IN THE INDUSTRY WITHIN OUR ENCATCHMENT, PROVIDE FLU SHOTS, EMPLOYEE PHYSICALS, AND BREATH ALCOHOL AND DRUG TESTING.
PART III, LINE 4: THE AMOUNT REPORTED ON LINE 2 FOR BAD DEBT EXPENSE IS DETERMINTED BY COST, AND AGREES TO THE BAD DEBT EXPENSE REPORTED ON THE FINANCIAL STATEMENTS. THE AMOUNT REPORTED ON LINE 3 IS FROM THE 2012 ICR, WHICH IS CALCULATED USING THE COST-TO-CHARGE RATIO. FOOTNOTE FOR ACCOUNTS RECEIVABLE AND ALLOWANCE FOR DOUBTFUL ACCOUNTS: THE HOSPITAL HAS AGREEMENTS WITH THIRD-PARTY PAYORS THAT PROVIDE FOR PAYMENTS AT AMOUNTS DIFFERENT FROM ITS ESTABLISHED RATES. PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE OR VISIT, COST-BASED REIMBURSEMENT, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE AND THE RELATED PATIENT ACCOUNTS RECEIVABLE ARE REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS DUE TO FUTURE AUDITS, REVIEWS AND INVESTIGATIONS. RETROACTIVE ADJUSTMENTS ARE INCLUDED IN THE RECOGNITION OF PATIENT SERVICE REVENUE ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS ADJUSTMENTS BECOME KNOWN OR AS YEARS ARE NO LONGER SUBJECT TO SUCH AUDITS, REVIEWS AND INVESTIGATIONS. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE HOSPITAL RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES PROVIDED. ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE HOSPITAL'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR SERVICES PROVIDED. THUS, THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED.
PART III, LINE 8: APPROXIMATELY 10% OF THE SHORTFALL IS ABSORBED BY THE COMMUNITY BENEFIT. THE MEDICARE COST REPORT, WHICH USES THE COST-TO-CHARGE RATIO IS USED TO DETERMINE THE AMOUNT REPORTED ON PART III, LINE 6.
PART III, LINE 9B: THE CREDIT AND COLLECTIONS OFFICE AND/ OR PATIENT ADVOCATE WILL MAKE INTERMITTENT ATTEMPTS TO CONTACT PATIENTS WITH NO INSURANCE REGARDING FINANCIAL ASSISTANCE OPTIONS. A PATIENT ACCOUNT IS NOT REFERRED TO COLLECTION SERVICES UNTIL AT LEAST 120 DAYS AFTER THE DATE OF SERVICE/DISCHARGE OR AFTER AN APPLICATION FOR FINANCIAL ASSISTANCE HAS BEEN ACCEPTED/DENIED BY THE FACILITY, WHICHEVER IS LONGER. BILLS AND COLLECTION NOTICES WILL ROUTINELY BE HELD ONCE A PATIENT HAS INITIATED THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE.
EDWARD JOHN NOBLE HOSPITAL PART V, SECTION B, LINE 4: CANTON POTSDAMN HOSPITAL, PUBLIC HEALTH, CLIFTON FINE HOSPITAL, CLAXTON HEPBURN MEDICAL CENTER, COUNTY OF ST. LAWRENCE, MASSENA MEMORIAL HOSPITAL, ST. LAWRENCE COUNTY HEALTH INTIATIVE.
EDWARD JOHN NOBLE HOSPITAL PART V, SECTION B, LINE 20D: A SLIDING FEE/ CHARITY CARE POLICY IS USED.
PART VI, LINE 2: PRIORITIES FOR IMPLEMENTING CLINICS ARE REVIEWED AND DISCUSSED AT ADMINISTRATIVE STAFF MEETINGS ON A MONTHLY BASIS. THE CFO, CEO, DIRECTOR OF NURSING, HR DIRECTOR AND THE NURSING MEDICAL DIRECTOR ARE INVOLVED IN THE REVIEWING OF THESE PROGRAMS. WE SHARE OUR ANALYSIS OF A POTENTIAL PROGRAM WITH THE EXECUTIVE COMMITTEE AND BOARD OF TRUSTEES, AS DEEMED NECESSARY WE WILL CALL TOGETHER A JOINT CONFERENCE COMMITTEE WITH THE BOARD AND MEDICAL STAFF TO FURTHER ANALYSIS A POTENTIAL CLINICAL IMPLEMENTATION. THE HOSPITAL HAS OVER THE YEARS ESTABLISHED NYS APPROVED CLINICS IN THE FOLLOWING COMMUNITIES WITHIN THE ENCATCHMENT AREAS ANTWERO, DEKALB, RUSSELL AND EDWARDS. EACH CLINIC IS STAFFED BY A PHYSICIAN OR PHYSICIAN ASSISTANT THAT INTERFACES WITH THE HOSPITAL. WE ALSO SERVE AS A REFERENCE TO TERRITORY CARE CENTERS IN SYRACUSE FOR CARDIOLOGY AND GENERAL TRAUMA. WE WORK CLOSE WITH ST LAWRENCE PUBLIC HEALTH TO DETERMINE IMPROVEMENTS IN PRIMARY PATIENT CARE NEEDS IN RESPIRATORY THERAPY, WITH CONCERNS SUCH AS ELIMINATION OF SMOKING AND CANCER AWARENESS.
PART VI, LINE 3: WE HAVE A FINANCIAL ASSISTANCE POLICY AVAILABLE IN THE ER, WAITING ROOM PATIENT REGISTRATION, PATIENT ACCOUNTING OFFICE, CREDIT COLLECTIONS, OUTPATIENT CLINICS, AND IT IS PRINTED ON THE PATIENT BILLS THAT WE OFFER FINANCIAL ASSISTANCE. WE ALSO HAVE A PATIENT ADVOCATE, JUDY PECK, WHO ASSISTS PATIENTS WITH THEIR FINANCIAL NEEDS. THIS IS A FULL TIME POSITION THAT IS HELPING PATIENTS ON A DAILY BASIS.
PART VI, LINE 4: EDWARD JOHN NOBLE HOSPITAL IS A RURAL SOLE-COMMUNITY MEDICAL, SURGICAL HOSPITAL THAT SERVES A LARGE GEOGRAPHICAL AREA OF SOUTHERN ST. LAWRENCE, WEST LEWIS AND NOTHERN JEFFERSON COUNTIES. THE POPULATION SERVICE AREA IS 22,000 AND THE PRIMARY INDUSTRIES ARE AGRICULTURE, MINING (LEAD, ZINC, TALC, IRON ORE) WITH HEADQUARTERS FOR A REGIONAL RETAIL DRUG STORE.
PART VI, LINE 5: EDWARD JOHN NOBLE HOSPITAL PROVIDES CONTINUOUS COMMUNITY FORUMS ON CURRENT HEALTH CARE TOPICS AT THE HOSPITALS CONTINUING EDUCATION CENTER. WE WORK CLOSELY WITH THE GOUVERNEUR RESCUE SQUAD FOR VARIOUS CATEGORIES OF EMT TRAINING. HOSPICE ACTIVITIES, MOMS-TO-BE PROGRAM, WEIGHT WATCHERS, BREAST CANCER SURVIVORS, EACH OF THESE UTILIZE THE EDUCATION PROGRAM TO MAINTAIN THESE COMMUNITY SERVICE PROGRAMS.
REPORTS FILED WITH STATES PART VI, LINE 7 NY
