2021-10-29T12:22:57-07:00 2020-12-31 990 2020-01-01 150533564 SCHUYLER HOSPITAL INC SCHU 6075357121 220 Steuben Street Montour Falls NY 14865 Rebecca Gould President, CFO 6075358639 2021-10-29 1 11 0 AAL2 2020 2022-09-23 18:48:47Z Rebecca Gould President and CFO 220 Steuben Street Montour Falls NY 14865 40172760 0 X http://www.schuylerhospital.org X 1929 NY Schuyler Hospital is a 25 bed acute care facility with critical access hospital status and 24 hour emergency services. It provides a full complement of healthcare services to the public in support of the community need for healthcare close to home, which includes the residents of Schuyler County and its surrounding communities. Medical services in 2020 included 3,729 inpatient days, 41,110 Long Term Care days, 189,353 outpatient procedures and 23,092 physician visits. In 2020 Schuyler Hospital provided $116k in free and reduced cost care through its charity care policy and incurred over $938k in bad debt due to the remaining uninsured and increasing under-insured population in the community. 17 12 509 33 0 0 1032162 3645653 35767242 35564027 101230 86894 849576 876186 37750210 40172760 0 0 0 0 23326507 24614894 0 0 139082 11684096 13607382 35010603 38222276 2739607 1950484 43182689 55680265 13245969 18455595 29936720 37224670 Schuyler Hospital is a network of providers, programs and services that meets the healthcare needs of a population of over 32,000 residents, through a wide range of medical services, highly skilled medical staff, and our devotion to customer service. Our Mission: Together with valued partners, Cayuga Health will be the region's leading healthcare system, and most trusted driver of integrated health services. We will empower our people and employ our capabilities to equitably improve the communities we serve. Our Vision: To be an essential organization that inclusively and cooperatively drives superior health outcomes and demonstrable community benefit . Our Values Include: Integrity and Honesty - We keep our word and treat everyone with mutual trust; Quality and Accountability - We accept responsibility for the trust placed in us; Dignity and Respect - We treat everyone with honor and compassion; Teamwork - We align our energies and enhance patient/resident care by working together 0 0 33486222 36394187 Schuyler Hospital is a 25 bed acute care facility with critical access hospital status and 24 hour emergency services. It provides a full complement of healthcare services to the public in support of the community need for healthcare close to home, which includes the residents of Schuyler County and its surrounding communities. Medical services in 2020 included 3,729 inpatient days, 41,110 Long Term Care days, 189,353 outpatient procedures and 23,092 physician visits. In 2020 Schuyler Hospital provided $116k in free and reduced cost care through its charity care policy and incurred over $938k in bad debt due to the remaining uninsured and increasing under-insured population in the community. 0 0 0 33486222 1 0 0 1 0 0 0 0 1 0 1 0 0 1 0 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 1 123 0 509 1 0 0 0 0 0 0 0 0 X 17 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X Rebecca Gould President and CFO 6075353801 220 Steuben Street Montour Falls NY 14865 Martin Stallone MD President/CEO Cayuga Medical Center 1 39 X 0 817183 43826 Ashraf Sabahat Physician 40 0 X 419691 0 66994 John Collett CFO/VP 1 39 X 0 353657 60800 Jagmohan Singh Physician 40 0 X 300937 0 53804 Ben Saks Medical Staff President, ex-officio 40 0 X 277106 0 53274 Rebecca Gould COO/CFO until 2/7/20 then President and CFO 38.00 2 X 289096 0 40641 Stephen Spaulding Family Medicine Physician 36 0 X 181252 0 41215 Matthew Rouff Provider Administrator 40 0 X 158806 0 37938 Mary Ann Mahajan Pharmacy Director 40 0 X 154768 0 37715 James Watson SH President & CEO, ex-officio, until 2/7/20 38 2 X 141596 0 16021 Eunice Nayo Board Member and Physician 40 0 X 35400 0 0 Thomas LiVigne Chair 1 0 X X 0 0 0 Larry Baum Vice-Chair 1 0 X X 0 0 0 Greg Hartz Treasurer 2 1 X X 0 0 0 Suzanne Blowers Secretary 1 0 X X 0 0 0 James Brown Board Member 1 0 X 0 0 0 Rev Dr Kenneth Clarke Board Member 1 0 X 0 0 0 Dr John Lambert Board Member 1 0 X 0 0 0 Joel Malina Board Member 1 0 X 0 0 0 Jerry Mickelson Board Member 1 0 X 0 0 0 Carl Sgrecci Board Member 1 0 X 0 0 0 Fred Wickham Board Member 1 0 X 0 0 0 Paula Younger Board Member 1 0 X 0 0 0 Elizabeth Plocharczyk MD CMC Medical Staff President, Ex-officio 1 0 X 0 0 0 Sharon Malick Schuyler Auxiliary President, ex-officio 2 0 X 0 0 0 1958652 1170840 452228 22 0 1 0 Welliver McGuire 706 Clinton Street Ithaca NY 14850 Construction 4021490 Medline Industries 1 Medline Place Mundelein IL 600604486 Medical Supplies 393839 Ames Linen Service 67 Huntington Street Cortland NY 13045 Linen Services 280148 Postler and Jaeckle 615 South Avenue Rohester NY 146201385 Maintenance Service Contract 232309 Medical Information Technology Inc PO Box 74569 Chicago IL 60696 Software and support services 229762 27 0 0 0 129109 3463086 53458 52765 3645653 Net Patient Service Revenue 622000 33271732 33271732 0 0 2292295 2292295 0 0 35564027 86894 0 0 86894 0 0 0 0 0 0 0 0 0 0 0 0 0 -55493 0 -55493 0 0 -55493 Cafe sales, Vending, Rebates and Other Misc Revenues 622000 929012 827493 0 101519 Non Operating - Misc Revs 622000 2667 2667 0 0 0 0 0 0 931679 40172760 36394187 0 132920 694117 364380 329737 18559060 16529737 1952623 76700 385909 339913 44318 1678 3592622 3125309 452448 14865 1383186 1218324 158847 6015 86680 11442 75043 195 84605 1027 76286 7292 29075 29075 208064 889 196704 10471 3581489 3400948 172822 7719 643890 522729 119735 1426 6516 6258 257 1 18122 10611 5515 1996 27381 27381 0 1414246 1170494 243752 247695 185792 61903 Purchased Services 5189495 4844083 341206 4206 Provisions for Bad Debt 938482 938482 0 0 1131642 815804 309320 6518 38222276 33486222 4596972 139082 745119 331863 13731803 22013514 1836075 1548815 4412828 4296588 792719 936415 297649 373980 42629276 21443543 17170393 21185733 4196103 4993357 43182689 55680265 12582948 15092559 0 0 0 2916664 0 0 47851 124150 0 0 615170 322222 0 0 13245969 18455595 X 26226586 32883236 3710134 4341434 29936720 37224670 43182689 55680265 X 1950484 0 0 0 0 5337466 X X 0 1 X 1 0 X 0 4158 4158 38218118 38222276 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 35580 26717 25645 4158 92100 250000 250000 250000 250000 1000000 1500000 0 0 0 0 0 0 1 X 0 131599 131599 0 30618759 12223986 18394773 0 20143 20143 0 0 11858775 9199414 2659361 0 0 0 0 21185733 Beneficial Interest in Schuyler Health Foundation 2638090 Due From Affiliate 6904 Assets whose use is limited 1352982 Pension - Pre-funded status 871231 Other Assets 124150 4993357 Schedule D, Part IV, Line 2b Schuyler Hospital serves as a custodian for residents in our Skilled Nursing Facility. Residents have access to their funds 24 hours a day, 7 days a week. 1 1 1 X 0 1 1 0 1 1 1179739 59945 1119794 0.03 12601314 7926636 4674678 0.1254 0 0 13781053 7986581 5794472 0.1554 110477 47283 63194 0.0017 109306 0 109306 0.0029 4806891 3358306 1448585 0.0389 19365 0 19365 0.0005 0 0 5046039 3405589 1640450 0.0440 0 0 18827092 11392170 7434922 0.1994 6296 0 6296 0.00017 4984 0 4984 0.00013 2857 2205 652 0.00002 2000 0 2000 0.00005 0 0 16137 2205 13932 0.00037 1 938482 281545 7883405 8234307 -350902 X 1 0 1 1 Schuyler Hospital 220 Steuben Street Montour Falls NY 14865 http://www.schuylerhospital.org X X X X Surgical Services,Lab,Imaging,Respiratory,Rehab,Skilled Nursing Facility,Employed Physicians Schuyler Hospital 1 0 0 1 X X X X X X X X X 19 1 0 1 1 X https://schuylerhospital.org/ X X 1 20 1 https://schuylerhospital.org/ 0 0 1 X 100 1000 X X X X X 1 1 X X X X 1 X https://schuylerhospital.org/wp-content/uploads/Financial-Assistance-Policy_CMC_2019_NEW-1.pdf X https://schuylerhospital.org/wp-content/uploads/Financial-Assistance-Policy_CMC_2019_NEW-1.pdf X https://schuylerhospital.org/wp-content/uploads/Financial-Assistance-Policy_CMC_2019_NEW-1.pdf X X X X X 1 X 0 X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-Schuyler Hospital Selection of the 2019-2021 Community Health Assessment (CHA), Community Service Plan (CSP) and Community Health Improvement Plan (CHIP) priority and disparity areas was a joint process which began in the summer of 2018 with assistance from the S2AY Rural Health Network and Common Ground Health. A variety of partners were engaged throughout the process including the public health departments and hospital staff, Community Based Organizations (CBOs), Office for Aging, county legislation, the S2AY Rural Health Network, Common Ground Health, and more. The community at large was engaged throughout the assessment period via a regional health survey in 2018 (My Health Story 2018) and focus groups. Partners' role in the assessment was to help inform and select the 2019-2021 priority areas by sharing any pertinent data or concerns and actively participating in planning meetings. Schedule H, Part V, Section B, Line 6b-Schuyler Hospital The hospital facility took into account input from persons who represent the community. The primary partners in the assessment process include Schuyler County Public Health, Schuyler Hospital and Primary Care, S2AY Rural Health Network, however, there are a wide variety of other community partners that serve on the Schuyler County Public Health Professional Advisory Committee (PAC) and other community based organization non for profits that participated at some point along this process and priority setting meetings. Schedule H, Part V, Section B, Line 7d-Schuyler Hospital Schuyler also filed Community Health Needs Assessment with NYS DOH, as the Annual Required Community Service Plan. Schedule H, Part V, Section B, Line 11-Schuyler Hospital Schuyler Hospital is working with Public Health and other County agencies to improve overall community Health. The CHNA is divided into two goals. Goal 1: Prevent Chronic Diseases; Goal 2: Promote Well-Being and Prevent Mental and Substance Use Disorders. Priority Area 1: Prevent Chronic Diseases - Preventing chronic disease has been a long standing priority area. Efforts have largely been focused on reducing illness, disability and death related to hypertension, tobacco use and second hand smoke, and reducing obesity in children and adults & increase Access to High Quality Chronic Disease Preventive Care and Management in Both Clinical and Community Settings, selected goals which revolve around increasing cancer screening rates. The first Schuyler County priority has not changed (Prevent Chronic Diseases - focusing on obesity and hypertension) from the 2019-2021 Community Health Assessment (CHA) and Community Health Improvement Plan (CHIP), although the strategies to be used to address these priorities have evolved as seen in CHIP. Obesity: 37% of adults in Schuyler County are classified obese (Source: Behavioral Risk Factor Surveillance System, 2016). About 15% of Schuyler County children are considered obese, this puts Schuyler County children in the lowest percentage for county ranking when compared to the 8 County Region (Source: NYS Student Weight Status Category). Obesity is important due to the many related health conditions linked to obesity, including heart disease, hypertension, diabetes, lower back pain, arthritis, high cholesterol and several types of cancer. Therefore by addressing obesity, several other health-related problems may be prevented. Hypertension: An estimated 36% of adults in the region have been diagnosed with hypertension. However, it is important to note the hypertension control rate for residents. According to the December 2018 High Blood Pressure Registry, 79% of hypertensive patients in the region are in control of their blood pressure. Rates of blood pressure control in the eight county region range from 72-87%, with an overall target of 85% control. Maintaining greater control of blood pressure can lead to lower risk of heart attack, stroke and death. Among those who reported they were not managing their high blood pressure well in the My Health Story 2018 survey, respondents indicated that prescriptions and better diet and nutrition would help them manage their disease better. Schuyler County has a below target control rate in the region for hypertension with approximately 82% of the population registering as in-control (Source: December 2018 Common Ground Health Hypertension Registry). Priority Area 2: Promote Mental Well-Being and Prevent Substance Use Disorders - Prevent mental and substance use disorders. Substance Abuse: Rates of substance use are growing in the region. Binge drinking is a measure used to help gauge substance abuse in communities. According to data retrieved from the 2016 Behavioral Risk Factor Surveillance System, approximately 13% of Schuyler County adult residents reported binge drinking in the past month. This has increased slightly from prior years (10% in 2013-2014 estimates). Regionally, rates of adults who have been told they have a depressive disorder range from 11-22% of populations. Rates reach almost 20% of adults in Schuyler County, which is higher than average for the region. In addition, almost half of My Health Story 2018 respondents indicated they have personally dealt with depression or sadness. Many others also reported they have dealt with anxiety, fear, and trouble sleeping. For those who have dealt with mental or emotional health issues, 79.3% said they got the help that they needed. The most commonly reported support was from doctors, counselors, and other mental health professionals followed by support from friends and family. Schedule H, Part V, Section B, Line 16j-Schuyler Hospital Schuyler Hospital includes on every patient statement reference to the Financial Assistance Policy as well as the hospital's internet address where the policy can be found. Schedule H, Part V, Section B, Line 20c-Schuyler Hospital The Hospital chooses not to utilize presumptive eligibility determinations within their financial assistance policies (FAPs) to proactively identify patients in need of assistance. Schedule H, Part V, Section B, Line 20d-Schuyler Hospital n/a - did not authorize/perform 1 Seneca View Long Term Skilled Nursing Facility 220 Steuben Street Montour Falls NY 14865 120 Bed Skilled Nursing Facility, attached to and operated under Schuyler Hospital (provider based). Schedule H, Part I, Line 3c The organization uses a sliding fee scale for persons over 100% of the poverty guideline. There is no family income limit (though had to put a % in box on line 3 of 1000%) sliding fee scale is based on number of persons in household, % above FPG and then % of gross charges is determined by % over FPG as follows: 90% of 101-125% FPG, 80% of 126-150% FPG, 70% of 151-175% FPG, 60% of 176-200% FPG, 50% of 201-250% and 40% of 251-300% above FPG. Schedule H, Part I, Line 6a The organization's community benefit report is contained in a report prepared by HANYS - Healthcare Association of New York State, Inc. Schedule H, Part I, Line 7 Used ratio of cost to charge calculation for lines 7a, 7b and 7g and used actual costs on lines 7e, 7f and 7i. Schedule H, Part I, Line 7, Column f $938,482 is the amount of bad debt expense that was included in Form 990, Part IX, line 25, Column (A), but removed for this figure for purposes of calculating the percentage in Schedule H, Part I, Line 7, column (f). Schedule H, Part I, Line 7g No physician amounts were included. Schedule H, Part II Schuyler Hospital, the county's largest employer of over 360 people, supports and promotes the community it operates in. The Hospital extends use of its facilities for health care related meetings of any type, along with other community meetings and events (due to Covid-19 Pandemic, in person meetings turned into Zoom meetings/conference calls). It hosts blood draws each year (none in 2020 due to COVID restrictions), annually sends employees to Leadership Schuyler (due to COVID turned into Zoom meetings), provides a local credit union with space within the facility (closed March 2020 due to COVID restrictions, re-opened in 2021) for minimal rent to provide its employees easier access to banking due to its rural location, and is a disaster preparedness hub for the county. Its employees volunteered over 300 hours to support community events this year (lower volunteer hours due to COVID, as well as minimum community events held in 2020). Schuyler actively works with the County Department of Health and the Schuyler Health Foundation, Inc. to enrich the healthcare of the population it serves. Schedule H, Part III, Section A, Line 4 The Hospital estimates the amount to be recognized in the consolidated financial statements for doubtful accounts by analyzing patient and resident accounts for collectability and applying historically established percentages for self-pay and various third-party payers to the aging categories in the accounts receivable aging and reviewing specific outstanding balances. Accounts for which no payments have been received for a significant amount of time are considered delinquent and the account is written-off when customary collection efforts are exhausted. The Hospital's accounting policy with respect to the consolidated financial statements is to report the consolidated bad debt expense as an expense, see page 14 of the AFS. Schedule H, Part III, Section B, Line 8 The Medicare shortfall of uncompensated care should be included as a community benefit due to the rural demographic area in which the hospital is located, as it consists of a high Medicare/Medicaid (dual eligible) payer mix. Medicare is the Hospital's largest payer (followed by Commercial/other at 21% and Medicaid at 20%), consisting of 43% of our patients. Due to accessibility and transportation, (which is why we are a critical access hospital), it is easier for community member to come to the hospital for services that it is for them to travel 25 miles or more on rural roads to access care at other facilities. The costing methodology to determine Medicare allowable costs of care relating to payments on line 5 was the ratio of cost from the 2020 Medicare cost report from charges from our system on gross Medicare charges for dates of service 01/01/2020 to 12/31/2020. Schedule H, Part III, Section C, Line 9b The policy does not specifically contain a provision on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance, however the hospital's financial counselors do not send an account to collection if they are aware that the patient qualifies for charity care or financial assistance, as they are also the persons responsible for the charity care or financial assistance processes. Schedule H, Part VI, Line 2 In all S2AY Network Counties, every three years, NYS request that local health departments and their local hospital systems work together to create a joint community health assessment and improvement plan using the Prevention Agenda guidelines. During each new cycle, public health and hospital systems turn to key partners and community informants to help determine what the course of action ought to be to improve the population's health. For this particular cycle, Eight local health departments and hospitals opted to leverage a local regional health planning agency (Common Ground Health) to conduct a community health assessment for the eight county region. Data collection and analysis effort focused on data related to the main priorities in the past years CHA for the region as well as some emerging issues that the hospitals and Public Health agreed should be analyzed based both on their knowledge of what they were seeing in their communities and what was revealed in the for Delivery System Reform Incentive Payment Program (DSRIP) needs assessment. The 2019-2021 Regional Priority Areas included: Prevent chronic disease (focus areas within are (1) chronic disease prevention care management, (2) tobacco prevention, and (3) healthy eating and food security), Promote well-being and prevent mental and substance use disorders, and Promote healthy women, infants and children. An Emerging issue identified in the region is the use of e-cigarettes and other nicotine delivery systems, especially among younger adults. The collaborative Mobilizing for Action through Planning and Partnership (MAPP) process was used by all eight health departments to develop their health assessments and improvement plans. On April 10, 2019, the health department engaged key stakeholders in a prioritization meeting facilitated by the S2AY Rural Health Network. Data were collected from a variety of different sources including, but not limited, to the American Community Survey, the enhanced Behavioral risk Factor Surveillance System, Vital Statistics, communicable disease and dental reports and primary data collected from My Health Story 2018 Survey. Selection of the 2019-2021 Community Health Assessment (CHA), Community Service Plan (CSP), and Community Health Improvement Plan (CHIP) priority areas was a joint process which began in the summer of 2018 with assistance from the S2AY Rural Health Network and Common Ground Health. A variety of partners were engaged throughout the process including the public health departments and hospitals staff, Community Based Organizations (CBOs), Office for Aging, county legislation, the S2AY Rural Health Network, Common Ground Health, and more. The community at large was engaged throughout the assessment period via a regional health survey in 2018 (My Health Story 2018) and focus groups. Partners' role in the assessment was to help inform and select the 2019-2021 priority areas by sharing any pertinent data or concerns and actively participating in planning meetings. Schedule H, Part VI, Line 3 Schuyler Hospital recognizes the needs in our community to provide financial counseling and assistance to those patients with limited income, no insurance, or high deductible insurance plans, who find it difficult to meet the expenses incurred in receiving health care services. The hospital has successfully been administering its financial aid policies and procedures for reducing charges otherwise applicable to low-income individuals without health insurance, or who have exhausted their health insurance benefits, and who can demonstrate an inability to pay full charges. Our Financial Assistance and Charity Program Policy defines the Financial Assistance Program and establishes the necessary criteria, guidelines and approval process for the provision of financial assistance and Sliding Fee Scale to eligible individuals to help ease the burden of the costs of health care services provided. Therefore, Schuyler Hospital updated its financial assistance program in 2007, 2010, 2014, and 2016. In 2010 we established a self-pay task force to review our policies and follow up on any issues that arose from such financial aid policies and procedures. Currently, the monthly Revenue Cycle meetings handle any issues that may arise. We have a prompt pay discount for any payments from an individual, which is good for all balances except co-pays. Also, Schuyler Hospital has been able to discount co-pays and deductible payments from those individuals who can demonstrate an inability to pay such amounts. All patients who are self-pay or have large self-pay balances are proactively given Information regarding our charity care program and our sliding scale program, which is administered using the federal poverty guidelines. The hospital employs two full time financial counselors, who are located by the Admissions Department in the Emergency Room of the Hospital from 7:30am to 4:30pm Monday through Friday, who make it their mission to reach out to those in need and help find a way to fund their health service's needs. Schuyler Hospital has also worked to provide monthly on-site facilitated enrollment for Medicaid and Child Health Plus and Family Health Plus programs. A large challenge Schuyler Hospital faces is actually getting people to apply for the program. It is a challenge to get the paperwork filled out and have patients who may be eligible under our financial aid policies and procedures to complete the application requirements and necessary documentation. The application process has been simplified in an attempt to make it easier for those in need to get the assistance they so desperately need. However, it continues to be a barrier to the success of the program. Also, it has been challenging ensuring that we have disseminated the information about the many policies we have that can be taken advantage of by patients. But the largest challenge has been the financial burden of such programs; reduced reimbursement for quality services provided additional overhead costs and additional time/resources. Schuyler Hospital provides emergency care and medically necessary Essential Health Services without regard to a patient's source of payment. In 2014, we created conspicuous signs that reside near every registration area indicating our FAP, and where it can be found. We also added the application to the Schuyler Hospital website for easy reference. Schedule H, Part VI, Line 4 Schuyler Hospital, Inc, located in Montour Falls, Schuyler County, is situated in rural upstate New York in the heart of the Finger Lakes, and is the only hospital in Schuyler County, a Federally Designated Medically Underserved Population and a Health Professional Shortage Area. Schuyler Hospital, established in 1920, is a 25-bed Critical Access Hospital that provides acute, ambulatory and long-term care services in Primary and Secondary Service areas with a population of 32,000. This rural population includes: Schuyler County residents and the rural residents of adjoining Chemung, Steuben, Tompkins, Seneca and Yates counties. Additionally, Schuyler Hospital is the resource for medical services to over 2 million tourists who visit Schuyler County and the surrounding area each year. Schuyler County itself is the second smallest county in NYS and a rural county with a declining population. The county's census data (ACS 2019 5-year unless noted) revealed a population to a total of 17,920 residents. Schuyler County is largely a "bedroom" community, with residents traveling a mean average of 25.6 minutes to/from their workplace. With that said, due to the county's rural nature, transportation to and from remote areas of the county is a challenge. In 2010, the county began operating its first public transit system, which reaches into the more populated villages of the county. Our service area also encompasses a large Amish and Mennonite population. Median household income is $52,327 (under the NYS median income of $68,486) and 15.4% of the county's population lives below the poverty level. The county's current rate of unemployment as of December 2019 is 7.1%. 20% of Schuyler Hospital patients are on Medicaid and another 16% are under-insured (Source page 14 of the AFS.). While Schuyler Hospital's main campus is located in Montour Falls, Schuyler has evolved over the years into a network of providers, programs, and services that reaches throughout Schuyler County and into southern Yates and Seneca Counties. For the purpose of the Community Service Plan, Schuyler Hospital and Schuyler County Public Health consider Schuyler County to be the Primary Service Area - encompassing the towns of Montour, Reading, Dix, Orange, Hector, Cayuta, Catherine and Tyrone; as well as the villages of Montour Falls, Burdett, Odessa and Watkins Glen. Schuyler County has a population of 17,920 within 328 square miles. This underserved rural population experiences significant social, economic and health issues. For nearly 100 years, Schuyler Hospital has provided basic and emergency care to the people of this community. As the county's largest employer, it is a large economic generator - $69 million last year - due to jobs, purchasing, and taxes. Schuyler Hospital is accredited by The Joint Commission (formerly JCAHO). The medical staff includes physicians, specializing in internal medicine, family practice, surgery, orthopedics and sports medicine, pathology, critical care, pain management, sleep disorders, colon-rectal and anesthesiology. The hospital offers a wide array of services - including 24 hour ER, ICU, and Imaging department (MRI, CT, Ultrasound, X-ray, Mammo, bone density testing). Extensive physical, occupational, respiratory and speech therapy programs, as well as pulmonary testing are offered. The primary care and family health centers in Montour Falls, Dundee, and Ovid provide pediatric, adolescent, and adult health and wellness care. Seneca View, our 120 bed skilled nursing facility, located in the hospital offering inpatient services that include physical, speech and occupational rehabilitation. Schedule H, Part VI, Line 5 Schuyler Hospital, Inc. is proud to provide care to our community. Our doors are open 24 hours a day, seven days a week, 365 days a year. Also, in 2018 Schuyler Hospital was awarded $10.3 MIL Transformation Grant to build a new Medical Surgical Building (completed in April 2020) and to renovate the old Medical Surgical space to Primary Care Center in the Hospital (Completed February 2021). Every year, we serve thousands of individuals and keep our community healthy, strong, and vibrant. This record of service is, and always will be, our most valuable contribution to the community. Additionally, Schuyler Hospital, being the largest employer in the county, is seeking to have a positive impact in the region, promote area development and hopefully also advance economic development, for which there is a documented need. The people of Appalachia must have adequate healthcare to promote socially and economically competitive communities, and Schuyler Hospital helps fulfill this need. It has been especially difficult to deliver services to remote rural regions due to the closing of independent community hospitals and/or some of the services they provide. Schuyler Hospital does not plan on being one of them and has continued to morph its vision and strategic plan to survive and continue to move forward, especially during difficult financial and economic times, to remain a pillar of strength in the community. In general, health-care and the delivery of medical services to patients, as well as the underlying operations to support patient services, have become increasingly dependent upon technology - especially communications and information technology. Schedule H, Part VI, Line 6 On September 29, 2014 Schuyler Hospital became a part of the Cayuga Health System. The mission of Cayuga Health System is to further the ability of its member healthcare organizations to honor their community based missions of providing the highest quality, patient centered care in a safe, compassionate and sustainable manner. The Vision of CHS is to "Further the ability for both organizations to meet their missions and realize their visions to improve the overall health care of our communities and generating loyalty and pride in the health care of our communities." Cayuga Health System will be recognized as an innovative, integrated regional health care leader committed to the health of our communities through the collaborative efforts of all members characterized by: * An ever improving quality of care provided within a culture of safety across the entire health system. * An unwavering focus on the health of the population served in our communities while empowering members of our communities to make healthy choices. * A steadfast drive to exceed the expectations of those we serve. * A sustainable business model with rigorous attention on achieving system efficiencies, regional growth, and sharing of expertise within an ever changing healthcare environment. * Local access to appropriate community based healthcare services enhanced by collaborations with regionally and nationally recognized healthcare resources. * An inclusive system that generates loyalty and pride from all of the communities we serve. Schedule H, Part VI, Line 7 New York X X X 0 0 0 0 0 0 0 0 0 Rebecca Gould COO/CFO until 2/7/20 then President and CFO 261596 0 27500 0 0 0 0 0 40641 0 329737 0 0 0 Matthew Rouff Provider Administrator 156306 0 2500 0 0 0 0 0 37938 0 196744 0 0 0 Mary Ann Mahajan Pharmacy Director 154536 0 232 0 0 0 0 0 37715 0 192483 0 0 0 Ben Saks Medical Staff President, ex-officio 247106 0 30000 0 0 0 0 0 53274 0 330380 0 0 0 Ashraf Sabahat Physician 419691 0 0 0 0 0 0 0 66994 0 486685 0 0 0 Jagmohan Singh Physician 280912 0 20025 0 0 0 0 0 53804 0 354741 0 0 0 Stephen Spaulding Family Medicine Physician 181005 0 247 0 0 0 0 0 41215 0 222467 0 0 0 James Watson SH President & CEO, ex-officio 85572 0 56024 0 0 0 0 0 16021 0 157617 0 0 0 Martin Stallone MD President/CEO Cayuga Medical Center 0 609055 0 104775 0 103353 0 0 0 43826 0 861009 0 0 John Collett CFO/VP 0 315160 0 32288 0 6209 0 0 0 60800 0 414457 0 0 Schedule J, Part I, Line 3 The executive compensation policy involves an annual survey of wages for the President/CFO and CNO/COO, compared to the market using the regional and national Healthcare Wage Surveys. Due to constraints of the economy, the compensation of these positions may not be adjusted annually. Any change in President/CFO compensation is approved by the Executive Committee. In addition, the Medical director's salary is compared to MGMA data at the contract renewal date. Form 990, Part VI, Section B, Line 11b The hospital Controller, Assistant Controller, and Cost Accountant prepares the annual form 990 (with oversight from President/CFO) and President/CFO distributes to the Board of Directors and members of the Hospital Executive Team for review, comment, and questions prior to filing with IRS. Form 990, Part VI, Section B, Line 12c The hospital has a written conflict of interest policy. Each Member of the Board of Directors and senior management reviews annually and signs the corresponding conflict of interest statement. In addition, as new members are inducted, prior to induction they read the policy and sign the conflict of interest statement. Form 990, Part VI, Section B, Line 15 The executive compensation policy involves an annual survey of wages for the President/CFO and CNO/COO, compared to the market using the regional and national Healthcare Wage Surveys. Due to constraints of the economy, the compensation of these positions may not be adjusted annually. Any change in President/CFO compensation is approved by the Executive Committee. In addition, the Medical director's salary is compared to MGMA data at the contract renewal date. Form 990, Part VI, Section C, Line 19 Upon request, appropriate schedules of the annual financial statements, IRS Form 990 and conflict of interest forms can be released to the public. The forms are housed in the executive office of the President/CFO and are available at a minimum copying fee. Form 990, Part XI, Line 9 Part XI - Line 9 - ($5,337,466) consists of the following: $965,823 Change in Pension Obligation; $3,740,346 in Net Assets released from restriction and used for the purchase of property and equipment; $214,123 change in beneficial interest in Schuyler Health Foundation; $2,309,421, Contributions and Grants Net; ($1,981,999) in Other Net Assets released from restriction; $89,755 change in permanently restricted Net Assets due to the market. Minus 2 for rounding Form 990, Part XII, Line 2c No changes to this process from the prior year Schuyler Health Foundation 220 Steuben Street Montour Falls NY 14965 222890619 To raise funds to support the mission of Schuyler Hospital and healthcare in Schuyler County. NY 501(c)(3) 7 N/A 0 Cayuga Medical Center 101 Dates Drive Ithaca NY 14850 222325405 Hospital NY 501(c)(3) 3-Hospital N/A 0 Cayuga Health System 101 Dates Drive Ithaca NY 14850 471899601 To bring together organizations to serve community healthcare needs. NY 501(c)3 12 N/A 0 0 1 0 1 0 0 0 0 0 0 0 1 1 1 1 1 0 0 Schuyler Health Foundation c 234384 Schuyler Health Foundation holds an annual capital fund raising campaign to benefit Schuyler Hospital. Each year those funds are released to Schuyler Hospital as the purpose of the funds is met. In 2020 Schuyler Health Foundation donated $234,384 for purchase of equipment, COVID supplies, a vehicle, and project expenses. Schuyler Health Foundation e 1000000 Schuyler Hospital has a line of credit with Chemung Canal Trust Company which is secured by investments owned by Schuyler Health Foundation. Schuyler Health Foundation o 78084 Schuyler Hospital reports wages and remits taxes for the employees who carry out the Foundation responsibilities, including one Finance employee. Total 2020 wages for the Schuyler Health Foundation Executive Director, the Foundation Assistant, and the Accounting Clerk Totaled $78,084 Schuyler Health Foundation q 39691 Schuyler Health Foundation reimburses Schuyler Hospital for expenses paid on their behalf. These expenses include the associated costs of office space and a copier/scanner/fax. Expenses are reconciled and reimbursed on a monthly basis. For 2020 total reimbursements to Schuyler Hospital amounted to $39,691 Cayuga Medical Center p 1578698 Schuyler Hospital reimburses Cayuga Medical Center for the following services: Anesthesia, Lab testing, Insights, KRONOS and Relay Health Software costs, AP mailings, Split Advertising, RL Solutions and iContracts, supplies, as well as shared insurance and legal fees. ($1,578,698) Cayuga Medical Center m 599408 Schuyler Hospital utilizes Cayuga Medical Center to perform the following services: Sleep, EKG Staff, Payroll, AP, Wound Clinic Staff, Remote Pharmacy, 340B services, Radiology Techs, Case Management, Oversight, and Bio-Engineering. Cayuga Medical Center l 69250 Schuyler Hospital provides staffing for nursing, pharmacy, lab, and nurse aid training positions as needed to CMC. In 2020, total services amounted to $69,250 We submitted an extension to ensure that information submitted was complete and accurate and to ensure Board of Directors have time to review. Extensions were filed timely and were granted by the IRS to extend filing date to November 15, 2021.