2019-11-13T22:30:37-07:00 2018-12-31 990 2018-01-01 160743310 ST JAMES HOSPITAL STJA 6073248110 411 Canisteo Street Hornell NY 14843 Mark Prunoske SVP Finance/CFO 5853701815 2019-11-12 128.151.71.17 2018 2020-03-31 21:24:44Z Bryan O'Donovan 411 Canisteo Street Hornell NY 14843 30434740 0 X https://www.urmc.rochester.edu/st-james X 1992 NY SEE SCHEDULE O. 12 8 374 28 0 1372 4428596 4401665 26479025 25136390 53968 100000 3460061 796685 34421650 30434740 0 0 0 0 15587975 16840401 0 0 0 14859670 16147812 30447645 32988213 3974005 -2553473 18016126 50200664 10848220 25669644 7167906 24531020 X See Schedule O for Part I, Line 1 0 0 22099606 25933075 ST. JAMES HOSPITAL IS AN ACUTE HEALTHCARE FACILITY PROVIDING ROUTINE, AMBULATORY AND ANCILLARY SERVICES. MAJOR SERVICES INCLUDE MEDICAL, SURGICAL, RADIOLOGY, AND LABORATORY. TOTAL ACUTE DISCHARGES FOR THE HOSPITAL WERE 848. OUTPATIENT REGISTRATIONS FOR THE HOSPITAL WERE 126,406. ST. JAMES HOSPITAL OPERATES SEVERAL PHYSICIAN PRACTICES. TOTAL OFFICE VISITS WERE 16,745, INCLUDING EXPRESS CARE. 0 0 0 22099606 1 1 0 0 0 0 0 0 0 1 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 1 1 0 0 1 95 0 1 374 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 8 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X Jodi Howe 6073248000 411 Canisteo Street Hornell NY 14843 Sue Gray PhD Chair 1 0 X X 0 0 0 Shawn Hogan Vice Chair 1 0 X X 0 0 0 Brian Schu Treasurer 1.00 0 X X 0 0 0 Pete Wall Secretary 1 0 X X 0 0 0 Spencer Annabel MD Board Member 36 0 X 138000 0 0 Matt Shick Board Member 1 0 X 0 0 0 Skip Sullivan Board Member 1 0 X 0 0 0 John Eagleton Board Member 1 0 X 0 0 0 Ismail Mehr MD Board Member 1 0 X 487549 0 0 John Weyand DC Board Member 1 0 X 0 0 0 Michael Kamali MD Board Member 1 55.00 X 0 629891 64505 Aileen Shinaman Board Member 1 55 X 0 303394 78182 Bryan O'Donovan President/CEO (starting 6/1/2018) 39 1 X 99119 0 240 Jennifer Sullivan President & CEO (through 5/11/2018) 39 1 X 896282 0 3820 Stanley Konopko CFO (through 5/11/2018) 39.7 0.3 X 839765 0 9722 John Robshaw Physician 40 0 X 475092 0 2024 M Tariq Randhawa Physician 40 0 X 406514 0 7596 Kevin Wentworth Physician Assistant 40 0 X 300480 0 10885 Kevin Briceland Physician Assistant 40 0 X 228922 0 2751 Giacomo Floria Chief Advanced Practice Provider 40 0 X 196389 0 10407 4068112 933285 190132 16 0 1 0 Le Chase Construction 205 Indigo Creek Dr Rochester NY 14626 Construction Proj New Hosp 12628841 FSI Acoustical Systems LLC 90 Goodway Dr Rochester NY 14623 Construction Project MOB 1347266 Univ of Rochester 135 Corporate Woods Suite 100 Rochester NY 14623 Office Rent MOB and Constr 1284383 Univ of Rochester Strong Mem Hosp 601 Elmwood Ave PO Box 608 Rochester NY 14642 Lab Tests 518504 Razak Assoc Architecture Eng and Land Survey PLLC 2060 Fairport Nine Mile Road Suite 300 Penfield NY 14526 Architect 505282 26 0 0 0 0 3860811 540854 0 4401665 Net Patient Service Revenue 621990 25136390 25136390 0 0 25136390 100000 0 0 100000 0 0 0 0 0 0 0 0 207302 0 0 0 207302 0 207302 207302 0 0 0 0 0 Lifeline Revenue 900099 261634 261634 0 0 Trinity Revenue 900099 28517 28517 0 0 DSRIP Funding 900099 160470 160470 0 0 138762 138762 0 0 589383 30434740 25933075 0 100000 1094086 734939 359147 0 12070316 7424357 4645959 0 245121 151926 93195 0 1571649 974108 597541 0 1859229 1152350 706879 0 240764 170942 69822 0 73618 52269 21349 0 1246653 885124 361529 0 159575 113298 46277 0 123565 40776 82789 0 798981 263664 535317 0 375660 123968 251692 0 416284 137374 278910 0 Physician Fees 3941212 3941212 0 0 Supplies 3493679 2480512 1013167 0 Purchased Services 3246289 2304865 941424 0 Equipment Rental/Equipment Lease 774911 255721 519190 0 1256621 892201 364420 0 32988213 22099606 10888607 0 2750768 1184607 17013 17030 12254049 6172578 3307803 5441600 620090 705405 246676 245365 25860724 670786 6178348 25189938 2030653 1854867 18016126 50200664 5900796 16658653 1314192 0 2000000 7486980 1633232 1524011 10848220 25669644 X 6797760 23959262 342414 647122 27732 -75364 7167906 24531020 18016126 50200664 X -2553473 0 0 0 0 19916587 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 27732 0 -1366 0 0 0 26366 27732 0 0 0 0 0 27732 27732 0 0 0 0 0 27732 26332 0 1400 0 0 0 27732 26332 0 0 0 0 0 26332 0 1 0 0 1 1 0 1203414 1203414 0 0 0 0 0 136058 107317 28741 0 2305023 563469 1741554 0 22216229 0 22216229 25189938 0 Due to Third Parties 1446006 Malpractice IBNR and Tail Coverage 63000 Misc Liabilities 15005 1524011 X Schedule D, Part V, Line 4 WITH THE HELP OF NEARLY 350 COMMUNITY MEMBERS, BUSINESS PARTNERS, EMPLOYEES, PROVIDERS, AND FRIENDS AND DONORS LIKE YOU, SJ FOUNDATION RAISES CHARITABLE GIFTS TO MAKE POSSIBLE A RANGE OF FACILITIES IMPROVEMENTS, CAPITAL EQUIPMENT, AND PROGRAM INITIATIVES. Schedule D, Part X, Line 2 As of December 31, 2018, the Hospital does not have a liability for unrecognized tax positions. The Hospital files informational tax returns in the U.S. federal jurisdiction and New York State. 1 1 1 X 1 X 1 1 1 0 0 7293604 3252504 4041100 0.1225 0 0 7293604 3252504 4041100 0.1225 102804 0 102804 0.0031 27157 0 27157 0.0008 97561 0 97561 0.003 0 0 227522 0 227522 0.0069 0 0 7521126 3252504 4268622 0.1294 1 704920 11911 6131564 7554082 -1422518 X 1 1 1 1 St James Hospital 411 Canisteo Street Hornell NY 14843 www.urmc.rochester.edu/st-james 5002001H X X X St James Hospital 1 0 0 1 X X X X X X X X X 16 1 1 1 1 X See Supplemental Information X See Supplemental Information 1 17 1 See Supplemental Information 0 0 1 X 200 300 X X X X X 1 1 X X X X 1 X See supplemental information X See supplemental information X See supplemental information X X X X X X 1 X 0 X 1 X 0 0 Schedule H, Part V, Section B, Line 5-St James Hospital THE COMMUNITY NEEDS ASSESSMENT (CHNA) WAS CONDUCTED 2016 IN COLLABORATION WITH STEUBEN COUNTY PUBLIC HEALTH. THIS INCLUDED THE THREE HOSPITALS LOCATED WITHIN THE COUNTY. IN ADDITION, THERE WERE SEVERAL OTHER PARTNERS INCLUDING REPRESENTATION FROM FEDERALLY QUALIFIED HEALTH CENTERS (FQHC), COMMUNITY BASED ORGANIZATIONS (CBO), THE LEGISLATURE, COMMUNITY ACTION ORGANIZATIONS AND REPRESENTATIVES FROM LOCAL SCHOOLS. CHNA INCLUDED REVIEW AND ANALYSIS OF CURRENT AND LOCAL DATA, NEEDS ASSESMENT INFORMATION FROM THE DELIVERY SYSTEM REFORM INCENTIVE PAYMENT (DSRIP) PROGRAM AND FROM 12 COMMUNITY FOCUS GROUPS. THE INPUT WAS USED TO INDENTIFY HEALTH FACTORS AND DISPARITIES. A FULL LIST OF PARTICIPANTS CAN BE FOUND IN THE COMMUNITY SERVICE PLAN LOCATED ON THE ST. JAMES HOSPITAL WEBSITE. Schedule H, Part V, Section B, Line 6a-St James Hospital IRA DAVENPORT MEMORIAL HOSPITAL (ARNOT HEALTH), CORNING HOSPITAL (GUTHRIE HEALTH SYSTEM). Schedule H, Part V, Section B, Line 6b-St James Hospital STEUBEN COUNTY PUBLIC HEALTH DEPARTMENT, IRA DAVENPORT MEMORIAL HOSPITAL (ARNOT HEALTH), CORNING HOSPITAL (GUTHRIE HEALTH SYSTEM), ST. JAMES HOSPITAL, S2AY RURAL HEALTH NETWORK, GENESEE VALLEY BOCES, COMMON GROUND HEALTH (FORMERLY KNOWN AS FINGER LAKES HEALTH SYSTEM AGENCY), FINGER LAKES COMMUNITY HEALTH, STEUBEN COUNTY LEGISLATURE, STEUBEN RURAL HEALTH NETWORK, CORNELL COOPERATIVE EXTENSION, PRO ACTION OF STEUBEN AND YATES, SOUTHERN TIER TOBACCO AWARENESS COALTION, CENTER FOR TOBACCO FREE FINGER LAKES AND CANCER SERVICES PROGRAM OF STEUBEN COUNTY. Schedule H, Part V, Section B, Line 7a-St James Hospital https://www.urmc.rochester.edu/st-james/patients-visitors.aspx Schedule H, Part V, Section B, Line 7b-St James Hospital https://www.steubencony.org/pages.asp?PID=419 Schedule H, Part V, Section B, Line 10a-St James Hospital https://www.urmc.rochester.edu/st-james/patients-visitors.aspx Schedule H, Part V, Section B, Line 11-St James Hospital NEEDS IDENTIFIED VIA THE CHNA ARE BEING ADDRESSED THROUGH THE STEUBEN COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). THIS PLAN CAN BE REVIEWED WITHIN THE COMMUNITY SERVICE PLAN. THE PLAN OUTLINES PRIORITY AND FOCUS AREAS AS A RESULT OF THE CHNA. THESE FOCUS AREAS ARE FURTHER DEVELOPED INTO GOALS, OBJECTIVES, INTERVENTIONS/STRATEGIES/ACTIVITIES AND PROCESS MEASURES. PARTNER ROLES AND RESOURCES ARE ALSO DOCUMENTED IN THE CHIP. Schedule H, Part V, Section B, Line 16a-St James Hospital https://www.urmc.rochester.edu/st-james/patients-visitors/financial Schedule H, Part V, Section B, Line 16b-St James Hospital https://www.urmc.rochester.edu/st-james/patients-visitors/financial.aspx#finasst Schedule H, Part V, Section B, Line 16c-St James Hospital https://www.urmc.rochester.edu/st-james/patients-visitors/financial.aspx#finasst Schedule H, Part V, Section B, Line 20a-St James Hospital St James Hospital did not perform any of the above mentioned activities. Schedule H, Part V, Section B, Line 20b-St James Hospital St James Hospital did not perform any of the above mentioned activities. Schedule H, Part V, Section B, Line 20c-St James Hospital St James Hospital did not perform any of the above mentioned activities. Schedule H, Part V, Section B, Line 20d-St James Hospital St James Hospital did not perform any of the above mentioned activities. Schedule H, Part V, Section B, Line 22-St James Hospital A PATIENT WHOSE HOUSEHOLD INCOME IS BETWEEN 201% AND 250% OF THE MOST RECENT FEDERAL POVERTY LEVEL QULAIFIED FOR A PARTIAL CHARITY CARE DISCOUNT. THE PATIENT LIABILITY IS 40% OF THE RATE OF REIMBURSEMENT SJH WOULD HAVE RECEIVED FROM ITS "HIGHEST VOLUME PAYOR" (EXCELLUS BLUE CROSS) FOR LIKE SERVICES (INPATIENT, OUTPATIENT AND EMERGENCY ROOM). THE PATIENT IS ELIGIBLE FOR A CHARITY CARE DISCOUNT EQUAL TO THE DIFFERENCE BETWEEN CHARGES AND 40% OF THE EXCELLUS BLUE CROSS RATE. A PATEINT WHOSE HOUSEHOLD INCOME IS BETWEEN 251% AND 300% OF THE MOST RECENT REDERAL POVERTY LEVEL QUALIFIES FOR A PARTIAL CHARITY CARE DISCOUNT. THE PATIENT IS RESPONSIBLE FOR PAYING THE EXCELLUS BLUE CROSS RATE. THE CHARITY CARE DISCOUNT WOULD EQUAL THE DIFFERENCE BETWEEN CHARGES AND THE EXCELLUS BLUE CROSS RATE. SJH DETERMINED THAT EXCELLUS BLUE CROSS IS THE "HIGHEST VOLUME" PAYOR AS REFERENCED IN THE NYS STATUE 2807-K. THEREFORE, FOR UNISURED PATIENTS WITH HOUSEHOLD INCOMES BELOW 300% OF THE MOST RECENT FEDERAL POVERTY LEVEL, THE PAIENT RESPONSIBILITY WILL NOT EXCEED THE RATE OF REIMBURSEMENT SJMH WOULD HAVE RECEIVED FROM EXCELLUS BLUE CROSS. Schedule H, Part I, Line 7 THE COST-TO-CHARGE RATIO IS USED FOR LINES 7A AND 7B, COMPUTED BY TAKING TOTAL EXPENSES DIVIDED BY TOTAL GROSS PATIENT REVENUE. Schedule H, Part I, Line 7f PATIENT SERVICE BAD DEBTS ARE TREATED AS A CONTRA-REVENUE LINE ITEM ON THE STATEMENT OF REVENUE. Schedule H, Part III, Section A, Line 2 THE COSTING METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED ON LINE 2 ARE BASED ON ACTUAL CHARGES WRITTEN OFF (AMOUNTS THAT ARE DEEMED TO BE UNCOLLECTIBLE). Schedule H, Part III, Section A, Line 3 THE AMOUNT REPORTED IN PART III, SECTION A, LINE 3 IS DETERMINED BY ESTIMATING THE AMOUNT OF BAD DEBT EXPENSE THAT WOULD BE ATTRIBUTED TO PATIENTS WHO WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE BUT FOR WHOM SUFFICIENT INFORMATION WAS NOT OBTAINED TO MAKE THAT DETERMINATION. Schedule H, Part III, Section A, Line 4 THE TEXT OF THE BAD DEBT FOOTNOTE FOR THE HOSPITAL CAN BE FOUND ON PAGE 7 (ITEM ASU 2014 09) OF THE ELECTRONICALLY ATTACHED AUDITED FINANCIAL STATEMENTS. Schedule H, Part III, Section B, Line 8 TO DETERMINE MEDICARE ALLOWABLE COSTS REPORTABLE IN THE MEDICARE COST REPORT, THE COST-TO-CHARGE RATIO IS APPLIED TO GROSS PATIENT REVENUE ASSOCIATED WITH SERVICES PERFORMED FOR PATIENTS WHO ARE ELIGIBLE FOR MEDICARE. Schedule H, Part III, Section C, Line 9b A BAD DEBT RESULTS FROM A PATIENT ACCOUNT BALANCE FROM WHICH PAYMENT WAS ANTICIPATED FROM THE PATIENT, CREDIT EXTENDED AND THE ACCOUNT LATER DEEMED TO BE UNCOLLECTIBLE. A BAD DEBT DOES NOT MEET THE CRITERIA FOR CHARITY CARE, THAT IS, BAD DEBT PATIENTS ARE CONSIDERED TO HAVE THE FINANCIAL CAPABILITY AND ABILITY TO PAY, BUT ARE UNWILLING TO PAY. COLLECTION ACTIVITIES ARE ONLY PURSUED WITH RESPECT TO AMOUNTS THAT PATIENTS ARE ABLE TO PAY AS DETERMINED BY THE HOSPITAL'S CHARITY CARE POLICY. NO COLLECTION ACTIVITIES TAKE PLACE WITH RESPECT TO AMOUNTS THAT PATIENTS ARE NOT EXPECTED TO PAY UNDER THIS POLICY. A SEPARATE CHARITY CARE POLICY IS IN PLACE AND WOULD BE EXHAUSTED BEFORE A PATIENT BALANCE WOULD BE DEEMED SELF-PAY. UNDER THE CHARITY CARE POLICY, CHARITY CARE/FINANCIAL ASSISTANCE IS PROVIDED TO A PATIENT WITH A DEMONSTRATED INABILITY TO PAY. A PATIENT IS ELIBIBLE FOR CHARITY CARE/FINANCIAL ASSISTANCE CONSIDERATION BASED UPON MEETING CERTAIN INCOME ELIGIBILITY CRITERIA AS ESTABLISHED BY THE FEDERAL POVERTY INCOME GUIDELINE SLIDING SCALE. PER NYS PHL 2807K, THIS CONSIDERS PATIENTS WHOSE HOUSEHOLD INCOME IS UP TO 300% OF THE MOST RECENT FEDERAL POVERTY GUIDELINES. ALL UNINSURED, LOW-INCOME PATIENTS WITHIN ST. JAMES HOSPITAL'S PRIMARY SERVICE AREA WHO CAN DEMONSTRATE AN INABILITY TO PAY CHARGES MAY APPLY FOR CHARITY CARE/FINANCIAL ASSISTANCE FOR ADJUSTMENTS TO THEIR BALANCES FOR ALL MEDICALLY NECESSARY HEALTHCARE SERVICES, PROVIDED THAT A MEMBER, IN GOOD STANDING, OF ST. JAMES HOSPITAL'S MEDICAL STAFF DETERMINES THE NEED FOR SUCH MEDICAL CARE TREATMENT. Schedule H, Part VI, Line 2 IN CONJUNCTION WITH THE COMMUNITY NEEDS ASSESSMENT THAT IS DONE EVERY THREE YEARS IN CONJUNCTION WITH STEUBEN COUNTY PUBLIC HEALTH, THE ORGANIZATION USES THE FOLLOWING TO DETERMINE THE HEALTH NEEDS OF THE COMMUNITY: COMMUNITY TOWN HALL MEETINGS, SURVEYING PARTICIPANTS AT PUBLIC HEALTH EDUCATION PROGRAMS, LOCAL CASE MANAGEMENT MEETINGS, AND PHYSICIAN/MEDICAL OFFICE INFORMATION SHARED. IN ADDITION, REGIONAL DATA AND INFORMATION FROM DSRIP PROJECTS IS USED TO ASSESS COMMUNITY NEED. ST. JAMES HOSPITAL CONDUCTS A COMMUNITY NEEDS ASSESSMENT EVERY THREE YEARS IN CONJUNCTION WITH STEUBEN COUNTY PUBLIC HEALTH. BASED ON RESIDENTS' FEEDBACK, THE COUNTY'S HEALTH CARE PRIORITIES, STRATEGIES, AND PROGRAMS ARE DETERMINED. ST. JAMES HOSPTIAL CREATES AN ANNUAL PLAN BASED ON THIS ASSESSMENT, AND THE PROGRESS OF THESE INITIATIVES IS REPORTED ANNUALLY TO THE NYS DEPARTMENT OF HEALTH. LOCAL HEALTH CARE PRIORITIES ARE ALSO IDENTIFIED THROUGH SURVEYING PARTICIPANTS AT PUBLIC HEALTH EDUCATION PROGRAMS. Schedule H, Part VI, Line 3 PART VI, LINE 3: AT THE TIME OF REGISTRATION, ALL SELF-PAY INDIVIDUALS RECEIVE AN INFORMATION SHEET DESCRIBING THE TYPES OF FEDERAL, STATE AND LOCAL GOVERNMENT PROGRAMS AVAILABLE, INCLUDING ST. JAMES HOSPITAL'S CHARITY CARE POLICY. THE ELIGIBILITY PROCESS IS COORDINATED BY A FINANCIAL COUNSELOR, WHO CONTACTS THE PATIENT OR PATIENT FAMILY MEMBER BY PHONE AND/OR LETTER. PATIENTS WHO QUALIFY FOR MEDICAID ARE ALSO DIRECTED TO AN IN-HOUSE FACILITATED ENROLLER, WHO COORDINATES THE MEDICAID APPLICATION PROCESS ON BEHALF OF THE PATIENT. Schedule H, Part VI, Line 4 THE PRIMARY SERVICE AREA FOR ST. JAMES HOSPITAL IS THE 15-MILE RADIUS EXTENDING FROM HORNELL (STEUBEN COUNTY), NEW YORK, AND INCLUDES THE TOWNS OF WAYLAND TO THE NORTHEAST AND TROUPSBURG TO THE SOUTHEAST (JUST OUTSIDE OF THE 15-MILE RADIUS). THE SECONDARY SERVICE AREA IS THE 30-MILE RADIUS EXTENDING FROM HORNELL. PER THE 2010 CENSUS, THE POPULATION FOR THE PRIMARY SERVICE AREA (STEUBEN COUNTY) REMAINED RELATIVELY FLAT, INCREASING 0.3% FROM 2000 TO 2010 TO 98,990 AND IS PROJECTED TO REMAIN FLAT THROUGHOUT 2014. THE POPULATION AGED 65 AND OVER COMPRISES 16% OF THE PRIMARY SERVICE AREA COMPARED TO 13% FOR NEW YORK STATE. THE POPULATION IS RACIALLY AND ETHNICALLY HOMOGENOUS WITH 95.3% WHITE, 1.6% BLACK, 1.4% HISPANIC/LATINO, AND 1.2% ASIAN. PERSONS OVER THE AGE OF 65 REPRESENT 15.6% OF THE COUNTY, 2 PERCENTAGE POINTS HIGHER THAN THE STATE. MEDIAN HOUSEHOLD INCOME IS $42,764 COMPARED TO $54,554 FOR THE STATE. APPROXIMATELY 20% OF THE COUNTY POPULATION HAVE A BACHELOR'S DEGREE OR HIGHER COMPARED TO 32% OF STATE RESIDENTS. Schedule H, Part VI, Line 5 ST. JAMES HOSPITAL IS THE LEAD AGENCY FOR THE CANCER SERVICES PROGRAM (CSP) OF STEUBEN COUNTY. A COMMUNITY-BASED, GRANT-FUNDED PROGRAM OF NEW YORK STATE DEPARTMENT OF HEALTH (NYSDOH), THE CSP SERVES UNINSURED MEN AND WOMEN WITH COMPREHENSIVE, AGE-APPROPRIATE, NO-COST SCREENINGS FOR BREAST, CERVICAL AND COLORECTAL CANCER. IN ADDITION, ST. JAMES HOSPITAL RECEIVED THE NYSDOH BREAST AND PROSTATE PEER EDUCATION PROGRAM IN 2016 AND BEGAN IMPLEMENTATION OF A COMMUNITY EDUCATION BASED PROGRAM. ST. JAMES HOSPITAL PARTICIPATES IN COORDINATING THE ANNUAL HEALTHY KIDS DAY AT THE MAPLE CITY KIDS QUARTER MILER. THIS EVENT IS DIRECTED TO PARENTS AND COMMUNITY YOUTH AND INCLUDES A PEDIATRIC HEALTH FAIR AND A LOGSTANDING COMMUNITY KIDS "FUN RUN" TO PROMOTE EXERCISE AND HEALTHY LIFESTYLES. THE ORGANIZATION PARTICIPANTES IN LOCAL HEALTH FAIRS AND WORKS WITH LOCAL BUSINESSES TO PROMOTE WORKPLACE WELLNESS VIA THE CSP PROGRAM MENTIONED ABOVE. IN ADDITION, ST. JAMES HOSPITAL OPERATES A CARDIAC REHAB PROGRAM AND A COUMADIN CLINIC THAT PROVIDE OUTPATIENT BASED SERVICES TO THE COMMUNITY. A COLLABORATION WITH NOYES MEMORIAL HOSPITAL SUPPORTS A DIABETES EDUCATION PROGRAM AVAILABLE TO THE COMMUNITY. ST. JAMES HOSPITAL STAFF MEMBERS THROUGHOUT THE ORGANIZATION PARTICIPATE IN COMMUNITY INITIATIVES AND HOLD SEATS ON BOARDS, INCLUDING THE STUEBEN RURAL HEALTH NETWORK, CATHOLIC CHARITIES, YMCA, UNITED WAY OF THE SOUTHERN TIER, SMART STEUBEN, STEUBEN PREVENTION COALITION AND OTHER NON-PROFIT ORGANIZATIONS WHOSE PRIMARY MISSION IS TO ASSESS AND ADDRESS COMMUNITY NEEDS. ST. JAMES HOSPITAL WELCOMES COMMUNITY ORGANIZATIONS TO UTILIZE SPACE FOR MEETINGS, PROGRAMS AND ACTIVITIES THAT ARE DEEMED SUPPORTIVE TO THE HEALTH OF THE COMMUNITY. THIS INCLUDES SUPPORT GROUPS, DRIVER SAFETY PROGRAMS, BLOOD DRIVES, ETC. Schedule H, Part VI, Line 6 On March 1, 2018, University of Rochester became the sole corporate member of the Hospital. The University of Rochester Medical Center (URMC) and its other health care affiliates provide comprehensive healthcare services in New York State, This affiliation will provide enhanced care to all residents of the Hospital's service area through access to specialists and services, etc. Schedule H, Part VI, Line 7 LIST OF STATES RECEIVING COMMUNITY BENEFIT REPORT: NY X X X X 1 1 0 0 0 0 0 1 0 Ismail Mehr MD Board Member 487549 0 0 0 0 0 0 0 0 0 487549 0 0 0 John Robshaw Physician 475092 0 0 0 0 0 0 0 2024 0 477116 0 0 0 M Tariq Randhawa Physician 406514 0 0 0 0 0 0 0 7596 0 414110 0 0 0 Kevin Wentworth Physician Assistant 300480 0 0 0 0 0 0 0 10885 0 311365 0 0 0 Kevin Briceland Physician Assistant 208922 0 20000 0 0 0 0 0 2751 0 231673 0 0 0 Giacomo Floria Chief Advanced Practice Provider 196389 0 0 0 0 0 0 0 10407 0 206796 0 0 0 Jennifer Sullivan President & CEO (through 5/11/2018) 476670 0 44612 0 375000 0 0 0 3820 0 900102 0 0 0 Stanley Konopko CFO (through 5/11/2018) 455736 0 40829 0 343200 0 0 0 9722 0 849487 0 0 0 Michael Kamali MD Board Member 0 609237 0 18450 0 2204 0 38703 0 25802 0 694396 0 0 Aileen Shinaman Board Member 0 264644 0 20000 0 18750 0 28502 0 49680 0 381576 0 0 Schedule J, Part I, Line 4 Jennifer Sullivan - Bonus $44,612, Severance $375,000; Stanley Konopko Bonus $40,829, Severance $343,200; Dr. Kamali - Bonus $18,450, SERP Plan - receipt of employer paid deferred compensation $12,300; Aileen Shinaman - Bonus $20,000. Schedule J, Part I, Line 7 Bonuses for Jennifer Sullivan $44,612.50; Stanley Konopko $40,829.36; Kevin Briceland $20,000. Form 990, Part I, Line 1 DESCRIPTION OF ORGANIZATION MISSION: ST. JAMES HOSPITAL, GOVERNED BY A SELF-PERPETUATING COMMUNITY BASED BOARD, IS A COMMUNITY OF PERSONS COMMITTED TO BEING A TRANSFORMING, HEALING PRESENCE WITHIN THE RURAL COMMUNITIES WE SERVE, PARTICULARLY ADDRESSING THE NEEDS OF THE POOR, UNDERSERVED AND DISADVANTAGED. Form 990, Part III, Line 1 See the Mission Description above for Part 1, Line 1. Form 990, Part VI, Section A, Line 4 Effective March 1, 2018, the Hospital, the University of Rochester Medical Center (URMC),a division of the University of Rochester (UR), entered into an affiliation agreement, which resulted in the UR becoming the sole corporate member of the Hospital. As a result, St. James Hospital amended its Bylaws to reserve certain powers to UR as its member and to change the composition, authority, quorum and voting approval requirements of its board of directors. Form 990, Part VI, Section A, Line 6 THE SOLE MEMBER OF ST. JAMES HOSPITAL IS THE UNIVERSITY OF ROCHESTER (UR). AS SUCH, UR HAS THE AUTHORITY TO ELECT THE GOVERNING BODY OF ST. JAMES HOSPITAL, AND CERTAIN DECISIONS OF ST. JAMES HOSPITAL ARE SUBJECT TO THE APPROVAL OF UR. SUCH DECISIONS INCLUDE AMENDMENT OF THE CERTIFICATE OF INCORPORATION AND BYLAWS AND APPROVAL OF EXTRAORDINARY CORPORATE ACTIONS SUCH AS MERGER OR DISOLUTION. Form 990, Part VI, Section A, Line 7a REFER TO SCHEDULE O, MEMBERSHIP INFORMATION, FORM 990, PART VI, SECTION A,LINE 6 Form 990, Part VI, Section A, Line 7b REFER TO SCHEDULE O, MEMBERSHIP INFORMATION, FORM 990, PART VI, SECTION A,LINE 6. Form 990, Part VI, Section B, Line 11b A COPY OF THE FORM 990 WAS MADE AVAILABLE TO EACH BOARD MEMBER BEFORE IT WAS FILED. ST. JAMES HOSPITAL HAS DESIGNED THE AUDIT AND COMPLIANCE COMMITTEE AS THE GROUP TO BE EDUCATED AND TO REVIEW THE RETURN. Form 990, Part VI, Section B, Line 12c Board members, officers, and key employees (determined by the President & CEO) complete conflict of interest forms annually to identify actual and potential conflicts of interest that may exist relative to their duties with the organization and the organization's COI policy. The CEO shall disclose to the Board or appropriate committee thereof any employee disclosure made relevant to the matter and the evaluation thereof. Copies are provided to the Corporate Compliance Office and maintained by the executive assistant to the Board of Directors and CEO. If a conflict is disclosed, that person shall leave the Board or committee meeting while the determination of a conflict of interest is discussed and voted upon. The Chairperson of the Board or committee will determine if a conflict of interest exist. To help ensure compliance with the COI policy, among the provisions the person with an actual or potential conflict of interest will not be allowed to participate in any discussion or decision in any area of conflict identified, and leave the room during discussion and vote. The Corporate Responsibility and Compliance Committee review these procedures every two (2) years to assess their effectiveness and recommend (or make) appropriate changes as needed to ensure the conflict of interest policy is consistently and effectively enforced. This was done with Board members on December 4, 2018. Form 990, Part VI, Section B, Line 15 THE BOARD HAS AN INDEPENDENT COMMITTEE REVIEW AND APPROVE ALL ELEMENTS OF REMUNERATION FOR ALL DISQUALIFIED PARTIES, AS WELL AS OTHER KEY MANAGEMENT. THE BOARD/COMMITTEE HAS AN ESTABLISHED COMPENSATION PHILOSOPHY WHICH DETAILS THE OBJECTIVES OF MARKET POSITIONING AND PAY ELEMENTS. THE COMMITTEE REVIEWS MARKET DATA, COMPARATIVE MARKET COMPENSATION DATA, APPROVES ANY SALARY ADJUSTMENTS FOR THE EXECUTIVE POPULATION, CONSIDERS BOTH REASONABLENESS AND EFFECTIVENESS OF ALL REMUNERATIVE PROGRAMS AND ESTABLISHES THE DETAILED PERFORMANCE EXPECTATIONS. ALL OF THESE DISCUSSIONS AND DECISIONS ARE DOCUMENTED THROUGH THE PROVISION OF MEETING MINUTES. THIS APPLIES TO THE PRESIDENT/CEO'S COMPENSATION AND WAS LAST DONE IN JULY 2018. Form 990, Part VI, Section C, Line 19 St. James Hospital's Form 1023 and Form 990 are available on request. St. James Hospital's governing documents, conflict of interest policy and audited financial statements are not routinely made available to the public. Form 990, Part XI, Line 9 Net Asset reconciliation also includes $19,903,990 grant for capital acquisitions, $13,636 release from temporary restricted to operating for capital, and ($1,039) misc changes. Form 990, Part XII, Line 2c THE AUDIT AND COMPLIANCE COMMITTEE IS RESPONSIBLE FOR THE SELECTION OF THE INDEPENDENT AUDITOR AND OVERSIGHT OF THE AUDIT. THERE HAS BEEN A CHANGE FROM THE PRIOR YEAR. University of Rochester 910 Genesee St Suite 200 Rochester NY 14611 160743209 School NY 501(c)(3) 2 N/A 0 Highland Hospital of Rochester 1000 South Avenue Rochester NY 14620 160743037 Hospital NY 501(c)(3) 3 Strong Partners Health System Inc 0 The Highland Foundation Inc 1000 South Avenue Rochester NY 14620 237310662 Fundraising NY 501(c)(3) 12 A 1 The Highland Hospital of Rochester 0 Highland Facilities Development Corp 1000 South Avenue Rochester NY 14620 223039077 Medical Building NY 501(c)(3) 10 The Highland Hospital of Rochester 0 Strong Partners Health System Inc 601 Elmwood Ave Box 706 Rochester NY 14642 161499099 Support Organization NY 501(c)(3) 12a1 University of Rochester 0 Highland Community Development Corp 100 Hahnemann Trail Pittsford NY 14534 223154715 Elder Care NY 501(c)(3) 10 Strong Partners Health System 0 The Highlands Living Center 500 Hahnemann Trail Pittsford NY 14534 223240227 Healthcare NY 501(c)(3) 10 Strong Partners Health System Inc 0 The Meadows at Westfall Inc 5901 Lac De Ville Blvd Rochester NY 14618 161502303 Healthcare NY 501(c)(3) 10 Strong Partners Health System Inc 0 FF Thompson Health System Inc 350 Parrish St Canandaigua NY 14424 222959987 Support Organization NY 501(c)(3) 12a1 University of Rochester 0 Frederick Ferris Thompson Memorial Hospital 350 Parrish St Canandaigua NY 14424 160743024 Hospital NY 501(c)(3) 3 Thompson Health System 0 M M Ewing Continuing Care Center 350 Parrish St Canandaigua NY 14424 237046583 Healthcare NY 501(c)(3) 3 FF Thompson Health System 0 F F Thompson Senior Communities Inc 1 Ferris Hills Canandaigua NY 14424 161557494 Elder Care NY 501(c)(3) 10 FF Thompson Health System 0 F F Thompson Foundation Inc 350 Parrish St Canandaigua NY 14424 222959984 Fundraising NY 501(c)(3) 7 FF Thompson Health System 0 The Memorial Hospital of William F and Gertrude F Jones Inc 191 North Main St Wellsville NY 14895 222807681 Hospital NY 501(c)(3) 3 University of Rochester 0 Jones Memorial Hospital Foundation 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501(C)(3) 7 ST JAMES HOSPITAL 1 Strong Home Care Group 2180 Empire Boulevard Webster NY 14580 222577664 Fundraising NY 501(c)(3) 7 University of Rochester 0 UR Medicine Home Care Certified Services Inc 2180 Empire Boulevard Webster NY 14580 160743215 Healthcare NY 501(c)(3) 10 Strong Home Care Group 0 Community Care of Rochester 2180 Empire Boulevard Webster NY 14580 161561691 Healthcare NY 501(c)(3) 10 Strong Home Care Group 0 Finger Lakes Visiting Nurse Service Inc 756 PreEmption Rd Geneva NY 14456 223067627 Healthcare NY 501(c)(3) 10 Visiting Nurse Service of Rochester and Monroe County 0 Finger Lakes Home Care Inc 756 PreEmption Rd Geneva NY 14456 161489133 Healthcare NY 501(c)(3) 10 Visiting Nurse Service of Rochester and Monroe County 0 UR Medicine Home Care Community Services Inc 2180 Empire Boulevard Webster NY 14580 825091873 Healthcare NY 501(c)(3) 10 Strong Home Care Group 0 UR Medicine Home Care Foundation Inc 2180 Empire Boulevard Webster NY 14580 831912967 Support Org NY 501(c)(3) 12a1 Strong Home Care Group 0 University of Rochester Employee Benefit Trust 910 Genesee St Suite 200 Rochester NY 14611 161600112 Employee Benefit Trust NY 501(c)(9) NA University of Rochester 0 Excell Partners Inc 343 State St Kodak Tower 2nd fl Rochester NY 14650 201862628 Economic Development NY 501(c)(4) NA University of Rochester 0 Rochester BioVenture Center Inc 601 Elmwood Ave Box 706 Rochester NY 14642 202485999 Biotech Incubator NY 501(c)(3) 12a1 University of Rochester 0 NextCorps Inc 260 East Main St Suite 6000 Rochester NY 14604 161195028 Business Incubator NY 501(c)(3) 7 University of Rochester 0 U of R Broadcasting Corporation 201 Wilson Commons Rochester NY 14627 160743209 Broadcast License NY 501(c)(4) NA University of Rochester 0 UR Real Estate Corporation 263 Wallis Hall Rochester NY 14627 271140014 Support Organization NY 501(c)(3) 12a1 University of Rochester 0 Meliora Real Estate Corporation 263 Wallis Hall Rochester NY 14627 452464788 Support Organization NY 501(c)(3) 12a1 University of Rochester 0 Excell Innovate NY Fund LP 343 State St Kodak Tower 2nd Fl Rochester NY 14650 462405519 Investment Fund NY ETV Inc Minority and Women Owned Investment Fund LP 343 State St Kodak Tower 2nd Fl Rochester NY 14650 810723223 Investment Fund NY ETV Inc Excell Partners Innovative TC Fund LP 343 State St Kodak Tower 2nd Fl Rochester NY 14650 810711015 Investment Fund NY ETV Inc Medical Administrative Associates Inc 777 South Clinton Avenue Rochester NY 14620 161354319 Retail Pharmacy NY Highland Hospital C 0 FFTH Properties and Services Inc 350 Parrish St Canandaigua NY 14424 161286518 Holding Company NY FF Thompson Health System C 0 Finger Lakes Community Care Network Inc 350 Parrish St Canandaigua NY 14424 161423442 Inactive NY FF Thompson Health System C 0 Excell Technology Ventures Inc 343 State St Kodak Tower 2nd Fl Rochester NY 14650 800909149 Biotech Incubator NY Rochester Bioventure C 0 Luminate Venture Challenge Corp 260 East 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